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5th year countdown > Liver > Flashcards

Liver Flashcards

1
Q

Describe cirrhoses

A

Fibrosis (nodules), heretic vascular distortion → ↑intrahepatic resistance → Portal HTN

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2
Q

Portal HTN can open collateral between portal and systemic system - name 3

What does portal HTN cause → 3 systemic signs + 1 neuro

A

Opens collateral between portal and systemic system:
• Varices
• Caput medusa
• Haemorrhoids

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3
Q

Name a neuro sign for portal HTN

A

Encephalopathy

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4
Q

Name an abdo sign caused by portal HTN and why it happens

A

Ascites: RAAS activation and fluid retention

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5
Q

What does hepatocyte damage cause

A

↓ liver function
• Cant detoxify - increased metabolites/toxin → encephalopathy
• ↓ Synthesis- ↓ clotting factors, ↓
albumin

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6
Q

Causes of Cirrhosis

A 
Alcohol
Hepatitis B,C,autoimmune 
EBV CMC
Non-alcoholic fatty liver disease 
Drugs e.g. MTX, Amiodarone, isonazid
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7
Q

Signs for cirrhosis

A 
Bruising 
Asterixis
Caput M
Enlarged Spleen
Ascites
Duputens contracture
Clubbing 
S naevi
Gyneacomastia
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8
Q

Investigations

A 
Bloods: FBC, U+E, Clotting, G+S, Hepatitis serology, EBV/CMV serology, autoantibodies, copper 
US liver + biopsy 
Ascitic tap (risk SBP)
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9
Q

Hb↓ ↓ platelets - why

A

Bleeding, hypersplenism

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10
Q

AST↑ GGT↑ ↓ Albumin

A

Hepatocyte damage, active alcoholic, advanced cirrhosis

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11
Q

↑ PPT & INR

A

Advanced cirrhosis

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12
Q

Decompensated liver disease

  • Name the 4 factors which can indicate DLD
A

As liver worsens → portal HTN worsens → DLD

Variceal Bleed
Ascites
Encephalopathy
Jaundice

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13
Q

Score for DLD - Name it, what factors in it, when transplant

A 
Child-Pugh Score 
Score of > 7 = transplanted list 
BRAIN
Brilirubin
Refactory Ascites 
Albumin
INR
eNecephalopathy
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14
Q

MGMT

A 
Liver transplant 
Dellay progression - alcohol cessation 
Suppotyive - Calorie + protein 
Anihistamines for pruuriti 
Curvillance for varices + hepatocellular ca
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15
Q

Treating portal HTN

A

Conservative
• Salt restricted diet

Medical
• Diuretic: Spironolactone, Furosemide
• Propanolol
• Paracentesis for ascites

Surgical
Portal HTN shunt - TIPS procedure
Complication = encephalopathy

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16
Q

Treating Encephalopathy

A

High dose lactulose (gets rid of ammonium)

Avoid CNS depressants e.g. benzo (haloperidol is better)

5th year countdown (17 decks)

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