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Phase 2A Med Concise > Liver > Flashcards

Liver Flashcards

1
Q

5 LFTs (Liver function tests) - GAABA

A 
GGT - Raised in alcoholic liver disease
ALP - Raised in biliary tree damage and also in bone resorption (metastases)
AST/ALT - Raised in hepatocyte damage
Bilirubin
Albumin
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2
Q

Progression of chronic liver disease - 5 phases

A

1) Chronic liver condition
2) Liver damage
3) Liver symptoms
4) Liver cirrhosis
5) Liver failure/risk of hepatocellular carcinoma

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3
Q

Viral hepatitis A/B/C/D/E - Modes of transmission

A

Hep A - Faeco-oral (contaminated food/water)
Hep B - Blood-borne
Hep C - Blood-borne
Hep D - Blood-borne
Hep E - Faeco-oral (contaminated food/water)

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4
Q

Viral hepatitis - Investigation

A

Serology - Detect antibodies/antigens

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5
Q

Viral hepatitis A/B - Vaccines

A

Hep A - Travellers

Hep B - Immunisation

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6
Q

Viral hepatitis A/B/C/E - Treatment

A

Hep A/E - Supportive
Hep B - Pegylated interferon-alpha 2a/pegasys (immune response)
Hep C - Sofosbuvir (antiviral)

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7
Q

What is the worst combination of viral hepatitis?

A

Hep B/D

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8
Q

Alcoholic liver disease - Pathophysiology 5 steps

A

1) Reduced NAD+
2) Reduced fat oxidation
3) Fat accumulation in hepatocytes
4) Liver cell membranes damaged
5) Inflammation and eventual cirrhosis

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9
Q

Alcoholic liver disease - Investigations

A

GGT raised
AST/ALT raised
FBC - Macrocytic anaemia

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10
Q

Alcoholic liver disease - Treatment

A

Quit alcohol

Thiamine (malnutrition from alcohol)

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11
Q

NAFLD (Non-alcoholic fatty liver disease) - Risk factors

A

T2DM

Metabolic syndrome

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12
Q

NAFLD (Non-alcoholic fatty liver disease) - Investigations

A

Liver fibrosis test

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13
Q

NAFLD (Non-alcoholic fatty liver disease) - Management

A

Lifestyle - exercise

Screening for obesity-related conditions

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14
Q

Autoimmune hepatitis - Investigations

A

Antibodies

Liver biopsy

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15
Q

Autoimmune hepatitis - Management

A

Prednisolone (immunosuppression)

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16
Q

Primary biliary cirrhosis (PBC) - Pathophysiology

A

Autoimmune destruction of intrahepatic biliary ducts, leading to cholestasis - excess bile and cholesterol in the blood

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17
Q

Primary biliary cirrhosis (PBC) - Signs and symptoms

A

Excess bile - Jaundice, pruritis (severe itching)

Excess cholesterol - Hyperpigmentation

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18
Q

Primary biliary cirrhosis (PBC) - Investigations

A 
Antibodies
LFT - Raised ALP
Serum cholesterol - Raised
Ultrasound (Abdo)
Liver biopsy
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19
Q

Primary biliary cirrhosis (PBC) - Management

A

Colestyramine (pruritus)
ADEK supplementation
Bisphosphonate (osteoporosis)

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20
Q

Wilson’s disease - Pathophysiology

A

Hereditary - Autosomal recessive chromosome 13

Excess copper in liver and CNS

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21
Q

Wilson’s disease - Sign

A

Kayser-fleischer rings (dark rings around iris)

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22
Q

Wilson’s disease - Management

A

Reduce copper intake

Penicillamine (excretes copper)

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23
Q

Haemochromatosis - Pathophysiology

A

Hereditary - Autosomal recessive chromosome 6

Excess iron everywhere

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24
Q

Haemochromatosis - Complications

A 
Restrictive cardiomyopathy due to iron deposition
Bronze diabetes (hyperglycaemia and skin darkening)
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25
Q

Haemochromatosis - Investigations

A

Serum ferritin

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26
Q

Haemochromatosis - Management

A

Reduce dietary iron intake

Desferrioxamine (Remove excess iron)

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27
Q

Alpha-1-antitrypsin deficiency - Pathophysiology

A

Autosomal recessive chromosome 14

1) Accumulation of alpha-1-antitrypsin in hepatocytes and lack of it in serum
2) Lack of protease inhibition in alveoli
3) Alveolar damage leads to emphysema

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28
Q

Alpha-1-antitrypsin deficiency - Symptoms

A

COPD symptoms

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29
Q

Alpha-1-antitrypsin deficiency - Investigation

A

Serum alpha-1-antitrypsin

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30
Q

Alpha-1-antitrypsin - Management

A 
Manage COPD
Liver transplant (curative)
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31
Q

Liver cirrhosis - Pathophysiology

A

Normal smooth liver structure becomes distorted, with nodules surrounded by fibrosis, affecting the liver’s synthetic, metabolic and excretory actions

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32
Q

Liver cirrhosis - Risk factors

A

Alcohol misuse
Hep B/C
Obesity
T2DM

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33
Q

Liver cirrhosis - 2 Types

A

Compensated - Liver can still function with no/few symptoms
Decompensated - Liver cannot function adequately and complications arise (jaundice, ascites, etc), at this point it is known as chronic decompensated hepatic failure

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34
Q

Decompensated liver cirrhosis - Causes

A

Infection
Portal vein thrombosis
Surgery

35
Q

Liver cirrhosis - Investigation

A

Liver biopsy
Transient elastography
Screen for HCC every 6 months
Upper GI endoscopy (oesophageal varices)

36
Q

Liver cirrhosis - Treatment

A

Liver transplant

37
Q

What is decompensated liver cirrhosis another name for?

A

Chronic liver failure

38
Q

Decompensated liver failure - Symtoms

A

Jaundice
Ascites
Variceal haemorrhage due to portal hypertension

39
Q

Portal hypertension - Pathophysiology

A

1) Endothelin-1 production increased in cirrhosis
2) Increased vasoconstriction/reduced vasodilation
3) Reduced radius, increased resistance
4) Higher pressure in portal system

40
Q

Portal hypertension - Causes

A

Portal vein thrombosis
Cirrhosis
Right heart failure
IVC obstruction

41
Q

Oesophageal varices - Pathophysiology

A

These vessels are thin and not meant to transport high pressure blood, so can easily rupture

42
Q

Oesophageal varices - Investigations

A

Upper GI endoscopy

43
Q

Oesophageal varices - Treatment

A

B-blocker (reduce portal pressure)
Nitrate (reduce portal pressure)
TIPSS (surgical portosystemic shunt)

44
Q

Ascites - Pathophysiology

A

1) Oedema = hydrostatic pressure>oncotic pressure
2) Oncotic pressure decreases in liver cirrhosis due to hypoalbuminaemia
3) Hydrostatic pressure increases due to portal hypertension and RAAS activation (fluid retention)

45
Q

Ascites - Causes

A 
Cirrhosis
IVC/portal vein thrmbosis
Heart failure
Inflammation (infection)
Pancreatitis 
Malignancy
46
Q

Ascites - Signs

A 
Distended abdomen 
(swollen) - shifting dullness
Ascitic tap (drain) - culture
47
Q

Ascites - Management

A

Spironolactone (diuretic)

48
Q

Spontaneous bacterial peritonitis - Causes

A

Ascites with cirrhosis

49
Q

Spontaneous bacterial peritonitis - Investigation

A

Ascitic tap - bugs (e.coli, enterococcus), raised neutrophils

50
Q

Spontaneous bacterial peritonitis - Management

A

Cefotaxime (initial antibiotic)

Ciprofloxacin (prophylaxis antibiotic)

51
Q

Hepatocellular carcinoma - Investigation

A 
CT/MRI
Biopsy
Raised AFP
Bloods - Clotting abnormalities
LFTs - deranged
52
Q

Hepatocellular carcinoma - Treatment

A 
Surgical resection (remove part of liver)
Chemo
Radiofrequency ablation (RFA)
53
Q

Secondary liver tumours - 3 Origins (GBB)

A

GI tract
Breast
Bronchus

54
Q

Acute liver conditions - 3

A

Hep A/E
Liver abscess
Drug-induced liver injury (paracetamol overdose)

55
Q

Acute liver conditions - Presentation

A

Jaundice

Anorexia

56
Q

Paracetamol overdose - Management

A

N-acetyl-cysteine

57
Q

Amoebic liver abscess - Symptoms

A 
Fever
Right upper quadrant abdo pain
Weight loss/anorexia
Hepatomegaly 
Night sweats
Bloody diarrhoea
58
Q

Amoebic liver abscess - Microbiology

A

Entamoeba histolytica via faeco-oral route

59
Q

Amoebic liver abscess - Investigations

A

Ultrasound (Abdo)

Serology of entamoeba histolytica

60
Q

Amoebic liver abscess - Treatment

A

Abscess drainage

Metronidazole (antibiotic)

61
Q

Fulminant liver failure - Pathophysiology

A

Massive necrosis of liver cells leading to liver failure within 8 weeks (fastest type of liver failure)

62
Q

Fulminant liver failure - Treatment

A

Liver transplant

ICU

63
Q

Gallstones - Risk factors

A

Obesity
Age
Female>male

64
Q

Biliary colic - Pathophysiology

A

Gallstone impacted in gallbladder neck temporarily and then dislodged back into gallbladder

65
Q

Acute cholecystitis - Pathophysiology

A

Gallstone stuck in gallblader neck and causes inflammation

66
Q

Acute cholecystitis - Signs and symptoms

A

Symptoms - Right upper quadrant pain, fever, nausea/vomiting

Sign - Murphy’s sign

67
Q

Acute cholecystitis - Investigations

A

Ultrasound (abdo)

68
Q

Acute cholecystitis - Treatment

A

Laparoscopic cholecystectomy (gallbladder removal)
Analgesia
Fluids

69
Q

Ascending cholangitis - Pathophysiology

A

1) Gallstone stuck in common bile duct

2) Halted flow of bile allows intestinal bacteria (E.coli, enterococcus) to migrate up biliary tree

70
Q

Ascending cholangitis - Symptoms

A 
Fever
RUQ pain
Jaundice
Hypotension 
Confusion
71
Q

Ascending cholangitis - Investigations

A

Ultrasound (abdo)

MRCP to locate stone

72
Q

Ascending cholangitis - Treatment

A

ERCP

73
Q

Acute pancreatitis - Causes

A

Gall stones
Alcohol
Trauma
Autoimmune

74
Q

Acute pancreatitis - Signs and symptoms

A

Signs - Hypercalcaemia, hyperlipidaemia, hypothermia, abdo distension/tenderness, bruising around umbilicus and flanks
Symptoms - Abdo pain radiating to back, nausea/vom, fever

75
Q

Acute pancreatitis - Investigations

A

CT (abdo)

Enzyme levels raised due to inflamed pancreas releasing enzymes

76
Q

Acute pancreatitis - Treatment

A

Supportive (fluids, analgesia, nutrition)
ERCP
Furosemide
Metronidazole

77
Q

Acute pancreatitis - Complications

A 
Sepsis 
DIC (disemminated intravascular coagulation)
78
Q

Primary sclerosing cholangitis (PSC) - Pathophysiology

A

Cholestatic liver disease due to fibrosing inflammatory destruction of both intra and extrahepatic bile ducts

79
Q

Primary sclerosing cholangitis (PSC) - Causes

A

Cholangiocarcinoma

Liver cirrhosis

80
Q

Primary sclerosing cholangitis (PSC) - Investigation

A

Liver biopsy

MRCP/ERCP

81
Q

Primary sclerosing cholangitis (PSC) - Treatment

A

Liver transplant

Ursodeoxycholic acid

82
Q

Differences between primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) - Site and cause of destruction

A

PBC - Intrahepatic, inflammation

PSC - Intra/extrahepatic, fibrosis

83
Q

What is painless jaundice with weight loss indicative of?

A

Cancer of pancreas head

84
Q

ERCP - Sites of use

A

Pancreas

Bile ducts

Phase 2A Med Concise (18 decks)

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