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2a stuff > Liver > Flashcards

Liver Flashcards

1
Q

Indicators of liver function

A
  • Prothrombin time - best indicator along with serum albumin

- Liver required to synthesise intrinsic factors and albumin

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2
Q

Cirrhosis diagnosis/treatment

A
  • Definitive - liver biopsy
  • LFTs
  • Definite treatment - liver transplant
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3
Q

Ascites def/pres/diagnosis/treatment

A
  • 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
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4
Q

Portal hypertension complications/diagnosis

A
  • 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
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5
Q

Bleeding varices treatment

A

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
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6
Q

Hepatitis B treatment

A
  • Vaccine

- Antiviral treatment - TENOFEVIR

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7
Q

Hepatitis C treatment

A
  • Ribavirin - expensive
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8
Q

Hereditary haemochromatosis def

A

Multi-system disorder of dysregulated dietary iron absorption and increased iron release from macrophages
- Iron accumulates in liver, joints, pancreas, heart, skin and gonads

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9
Q

Hereditary haemochromatosis pres/investigation/treatment

A
  • SLATE GREY SKIN
  • Hypogonadism
  • Bloods - iron, LFTs
  • Diagnostic is liver biopsy
  • 1st line - VENESECTION phlebotomy
  • 2nd line - iron chelation
  • Definite liver transplant
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10
Q

Wilson’s disease def/pres

A

-Too much copper, BUILD-UP in liver and CNS

  • Liver symptoms
  • PARKINSON’S SYMPTOMS
  • KAYSER FLEISCHER RINGS
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11
Q

Wilson’s disease investigation/treatment

A
  • 1st line - 24 hour urine copper and blood caeruloplasmin
  • Definite is liver biopsy
  • PENICILLAMINE (copper chelation)
  • Liver transplant
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12
Q

Liver cancer treatment

A
  • Depends on staging
  • Partial hepatectomy or transplant
  • Chemo to downstage and possibly resect or palliative chemo to prolong life
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13
Q

Pancreatic cancer presentations

A
  • EPIGASTRIC PAIN worse at night
  • Weight loss and anorexia
  • PALPABLE GALL BLADDER (Courvoisier’s sign)
  • Recent diagnosis of DM
  • Trousseau’s sign (hypocalcemia)
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14
Q

Pancreatic cancer investigations/treatment

A
  • Bloods - CARBOHYDRATE ANTIGEN 19-9 + LFTs
  • CT and endoscopic ultrasound
  • Biopsy
  • Surgery - Whipple’s procedure
  • Chemo - neoadjuvant, adjuvant or palliative
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15
Q

Acute pancreatitis pres/causes

A
  • Severe EPIGASTRIC PAIN radiating to back
  • N+V
  • Fever and chills
  • IGETSMASHED for causes
  • Idiopathic
  • Gallstones
  • EtOH
  • Trauma etc.
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16
Q

Acute pancreatitis investigations/treatment

A
  • AMYLASE/LIPASE, LFTs, CRP
  • CT, USG gallbladder, MRCP
  • Nil by mouth - bowel rest
  • AGGRESSIVE FLUID RESUS
  • Antibiotics if necrotising pancreatitis
17
Q

Chronic pancreatitis investigations

A
  • SECRETIN STIMULATION TEST

- CT, MRI, MRCP

18
Q

Biliary colic def/pres/management

A
  • Temporary blockade of CYSTIC DUCT by gallstones
  • RUQ pain often following FATTY MEALS
  • Referred shoulder pain
  • N+V
  • Analgesia, LAPOROSCOPIC CHOLECYSTECTOMY
19
Q

Acute cholecystitis def/pres/treatment

A
  • 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
20
Q

Ascending cholangitis def/pres/treatment

A
  • 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
21
Q

Primary biliary cholangitis/cirrhosis (PBC) def/pres/treatment

A
  • 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
22
Q

Primary sclerosing cholangitis (PSC) def/diagnosis/treatment

A
  • 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

2a stuff (9 decks)

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