Liver Flashcards
Indicators of liver function
- Prothrombin time - best indicator along with serum albumin
- Liver required to synthesise intrinsic factors and albumin
Cirrhosis diagnosis/treatment
- Definitive - liver biopsy
- LFTs
- Definite treatment - liver transplant
Ascites def/pres/diagnosis/treatment
- Fluid in peritoneal cavity
- Transudate - protein <25g/L - usually due to hypertension/low albuminaemia
- Exudate - protein >25g/L - usually due to inflammation as protein can leak out
- SHIFTING DULLNESS, gained weight, abdo distention
- Diagnostic aspiration - albumin, neutrophil count
- 1st line - salt restriction
- Diuretics - furosemide/spironolactome
Portal hypertension complications/diagnosis
- Ascites
- BLEEDING VARICES
- GI bleeds on background of chronic liver disease hints to bleeding varices
- Can lead to melaena (dark black faeces) or haematemesis (coffee ground vomit)
- 1stline/gold standard - upper GI endoscopy
Bleeding varices treatment
Active bleed
- Urgent gastroscopy/endoscopy
- Fluid resus as bleeding can be massive
- Terlipressin (ADH analogue)
- Gold standard ENDOSCOPY THERAPY - band ligation or sclerotherapy
- Prophylaxis - propanolol/isosorbide/TIPSS
Hepatitis B treatment
- Vaccine
- Antiviral treatment - TENOFEVIR
Hepatitis C treatment
- Ribavirin - expensive
Hereditary haemochromatosis def
Multi-system disorder of dysregulated dietary iron absorption and increased iron release from macrophages
- Iron accumulates in liver, joints, pancreas, heart, skin and gonads
Hereditary haemochromatosis pres/investigation/treatment
- SLATE GREY SKIN
- Hypogonadism
- Bloods - iron, LFTs
- Diagnostic is liver biopsy
- 1st line - VENESECTION phlebotomy
- 2nd line - iron chelation
- Definite liver transplant
Wilson’s disease def/pres
-Too much copper, BUILD-UP in liver and CNS
- Liver symptoms
- PARKINSON’S SYMPTOMS
- KAYSER FLEISCHER RINGS
Wilson’s disease investigation/treatment
- 1st line - 24 hour urine copper and blood caeruloplasmin
- Definite is liver biopsy
- PENICILLAMINE (copper chelation)
- Liver transplant
Liver cancer treatment
- Depends on staging
- Partial hepatectomy or transplant
- Chemo to downstage and possibly resect or palliative chemo to prolong life
Pancreatic cancer presentations
- EPIGASTRIC PAIN worse at night
- Weight loss and anorexia
- PALPABLE GALL BLADDER (Courvoisier’s sign)
- Recent diagnosis of DM
- Trousseau’s sign (hypocalcemia)
Pancreatic cancer investigations/treatment
- Bloods - CARBOHYDRATE ANTIGEN 19-9 + LFTs
- CT and endoscopic ultrasound
- Biopsy
- Surgery - Whipple’s procedure
- Chemo - neoadjuvant, adjuvant or palliative
Acute pancreatitis pres/causes
- Severe EPIGASTRIC PAIN radiating to back
- N+V
- Fever and chills
- IGETSMASHED for causes
- Idiopathic
- Gallstones
- EtOH
- Trauma etc.
Acute pancreatitis investigations/treatment
- AMYLASE/LIPASE, LFTs, CRP
- CT, USG gallbladder, MRCP
- Nil by mouth - bowel rest
- AGGRESSIVE FLUID RESUS
- Antibiotics if necrotising pancreatitis
Chronic pancreatitis investigations
- SECRETIN STIMULATION TEST
- CT, MRI, MRCP
Biliary colic def/pres/management
- Temporary blockade of CYSTIC DUCT by gallstones
- RUQ pain often following FATTY MEALS
- Referred shoulder pain
- N+V
- Analgesia, LAPOROSCOPIC CHOLECYSTECTOMY
Acute cholecystitis def/pres/treatment
- Blockade of CYSTIC DUCT leading to build-up of bile causing transmural inflammation of gallbladder
- Same pres as biliary colic
- Fever
- MURPHYS +VE - pain on inspiration whilst palpating gall bladder
- Early LAPOROSCOPIC CHOLECYSTECTOMY
Ascending cholangitis def/pres/treatment
- Medical emergency characterised by BACTERIA ascending BILIARY TREE leading to SEPTICAEMIA
- CHARCOT’S TRIAD - RUQ PAIN, JAUNDICE, FEVER + RIGORS
- Reynold’s pentad - Charcot’s triad + confusion + septic shock
- Aggressive fluid resus
- IV antibiotics - penicillins and aminoglycosides e.g. gentamycin
- Cholecystectomy when better
Primary biliary cholangitis/cirrhosis (PBC) def/pres/treatment
- Progressive AUTOIMMUNE destruction of LIVER AND BILIARY TREE leading to fibrosis and eventually CIRRHOSIS
- AMA +VE against PDC-E2
- F 9x>M
- Very non specific presentation
- URSODEOXYCHOLIC ACID to reduce cholestasis
Primary sclerosing cholangitis (PSC) def/diagnosis/treatment
- Progressive SCLEROSIS (hardening) of biliary tree leading to chronic cholestasis and ESLD
- 80% associated with IBD, most commonly UC
- ALP >1.5x normal for more than 6 months
- Cholangiography showing biliary strictures with beaded appearance
- Liver biopsy consistent with PSC
- Liver transplant
