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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
Haemochromatosis - Investigations
Serum ferritin
26
Haemochromatosis - Management
Reduce dietary iron intake | Desferrioxamine (Remove excess iron)
27
Alpha-1-antitrypsin deficiency - Pathophysiology
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
28
Alpha-1-antitrypsin deficiency - Symptoms
COPD symptoms
29
Alpha-1-antitrypsin deficiency - Investigation
Serum alpha-1-antitrypsin
30
Alpha-1-antitrypsin - Management
``` Manage COPD Liver transplant (curative) ```
31
Liver cirrhosis - Pathophysiology
Normal smooth liver structure becomes distorted, with nodules surrounded by fibrosis, affecting the liver's synthetic, metabolic and excretory actions
32
Liver cirrhosis - Risk factors
Alcohol misuse Hep B/C Obesity T2DM
33
Liver cirrhosis - 2 Types
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
34
Decompensated liver cirrhosis - Causes
Infection Portal vein thrombosis Surgery
35
Liver cirrhosis - Investigation
Liver biopsy Transient elastography Screen for HCC every 6 months Upper GI endoscopy (oesophageal varices)
36
Liver cirrhosis - Treatment
Liver transplant
37
What is decompensated liver cirrhosis another name for?
Chronic liver failure
38
Decompensated liver failure - Symtoms
Jaundice Ascites Variceal haemorrhage due to portal hypertension
39
Portal hypertension - Pathophysiology
1) Endothelin-1 production increased in cirrhosis 2) Increased vasoconstriction/reduced vasodilation 3) Reduced radius, increased resistance 4) Higher pressure in portal system
40
Portal hypertension - Causes
Portal vein thrombosis Cirrhosis Right heart failure IVC obstruction
41
Oesophageal varices - Pathophysiology
These vessels are thin and not meant to transport high pressure blood, so can easily rupture
42
Oesophageal varices - Investigations
Upper GI endoscopy
43
Oesophageal varices - Treatment
B-blocker (reduce portal pressure) Nitrate (reduce portal pressure) TIPSS (surgical portosystemic shunt)
44
Ascites - Pathophysiology
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
Ascites - Causes
``` Cirrhosis IVC/portal vein thrmbosis Heart failure Inflammation (infection) Pancreatitis Malignancy ```
46
Ascites - Signs
``` Distended abdomen (swollen) - shifting dullness Ascitic tap (drain) - culture ```
47
Ascites - Management
Spironolactone (diuretic)
48
Spontaneous bacterial peritonitis - Causes
Ascites with cirrhosis
49
Spontaneous bacterial peritonitis - Investigation
Ascitic tap - bugs (e.coli, enterococcus), raised neutrophils
50
Spontaneous bacterial peritonitis - Management
Cefotaxime (initial antibiotic) | Ciprofloxacin (prophylaxis antibiotic)
51
Hepatocellular carcinoma - Investigation
``` CT/MRI Biopsy Raised AFP Bloods - Clotting abnormalities LFTs - deranged ```
52
Hepatocellular carcinoma - Treatment
``` Surgical resection (remove part of liver) Chemo Radiofrequency ablation (RFA) ```
53
Secondary liver tumours - 3 Origins (GBB)
GI tract Breast Bronchus
54
Acute liver conditions - 3
Hep A/E Liver abscess Drug-induced liver injury (paracetamol overdose)
55
Acute liver conditions - Presentation
Jaundice | Anorexia
56
Paracetamol overdose - Management
N-acetyl-cysteine
57
Amoebic liver abscess - Symptoms
``` Fever Right upper quadrant abdo pain Weight loss/anorexia Hepatomegaly Night sweats Bloody diarrhoea ```
58
Amoebic liver abscess - Microbiology
Entamoeba histolytica via faeco-oral route
59
Amoebic liver abscess - Investigations
Ultrasound (Abdo) | Serology of entamoeba histolytica
60
Amoebic liver abscess - Treatment
Abscess drainage | Metronidazole (antibiotic)
61
Fulminant liver failure - Pathophysiology
Massive necrosis of liver cells leading to liver failure within 8 weeks (fastest type of liver failure)
62
Fulminant liver failure - Treatment
Liver transplant | ICU
63
Gallstones - Risk factors
Obesity Age Female>male
64
Biliary colic - Pathophysiology
Gallstone impacted in gallbladder neck temporarily and then dislodged back into gallbladder
65
Acute cholecystitis - Pathophysiology
Gallstone stuck in gallblader neck and causes inflammation
66
Acute cholecystitis - Signs and symptoms
Symptoms - Right upper quadrant pain, fever, nausea/vomiting | Sign - Murphy's sign
67
Acute cholecystitis - Investigations
Ultrasound (abdo)
68
Acute cholecystitis - Treatment
Laparoscopic cholecystectomy (gallbladder removal) Analgesia Fluids
69
Ascending cholangitis - Pathophysiology
1) Gallstone stuck in common bile duct | 2) Halted flow of bile allows intestinal bacteria (E.coli, enterococcus) to migrate up biliary tree
70
Ascending cholangitis - Symptoms
``` Fever RUQ pain Jaundice Hypotension Confusion ```
71
Ascending cholangitis - Investigations
Ultrasound (abdo) | MRCP to locate stone
72
Ascending cholangitis - Treatment
ERCP
73
Acute pancreatitis - Causes
Gall stones Alcohol Trauma Autoimmune
74
Acute pancreatitis - Signs and symptoms
Signs - Hypercalcaemia, hyperlipidaemia, hypothermia, abdo distension/tenderness, bruising around umbilicus and flanks Symptoms - Abdo pain radiating to back, nausea/vom, fever
75
Acute pancreatitis - Investigations
CT (abdo) | Enzyme levels raised due to inflamed pancreas releasing enzymes
76
Acute pancreatitis - Treatment
Supportive (fluids, analgesia, nutrition) ERCP Furosemide Metronidazole
77
Acute pancreatitis - Complications
``` Sepsis DIC (disemminated intravascular coagulation) ```
78
Primary sclerosing cholangitis (PSC) - Pathophysiology
Cholestatic liver disease due to fibrosing inflammatory destruction of both intra and extrahepatic bile ducts
79
Primary sclerosing cholangitis (PSC) - Causes
Cholangiocarcinoma | Liver cirrhosis
80
Primary sclerosing cholangitis (PSC) - Investigation
Liver biopsy | MRCP/ERCP
81
Primary sclerosing cholangitis (PSC) - Treatment
Liver transplant | Ursodeoxycholic acid
82
Differences between primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) - Site and cause of destruction
PBC - Intrahepatic, inflammation | PSC - Intra/extrahepatic, fibrosis
83
What is painless jaundice with weight loss indicative of?
Cancer of pancreas head
84
ERCP - Sites of use
Pancreas | Bile ducts

Phase 2A Med Concise (18 decks)

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