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2a RRS > Liver > Flashcards

Liver Flashcards

1
Q

what is biliary colic

A

pain assosicated with the obstruction of the cystic or common bile duct by a gall stone

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2
Q

what is collicky pain

A

pain due to gallbladder constriction and duct spasms

- assos with fatty foods

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3
Q

charactersitics of abo pain caused by biliary colic

A 
RUQ pain for less than 24hrs
severe
constant 
sudden onset
crescendo character
RADIATES to R shoulder/R subscapular
hours after meal/laying flat/at night
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4
Q

other Cfs of biliary colic other than abdo pain (sever attacks)

A

N+V

anorexia

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5
Q

Complications of biliary colic

A

acute cholecystitis

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6
Q

Dx of biliary colic

A

bloods - LFT - increase in bilirubin or ALP in attack

abdo US - gall stones, distended ducts

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7
Q

Mx of biliary colic

A 
alagesia (can pass on own)
elective cholecystectomy (gallbladder removal)
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8
Q

what is cholecystitis

A

GB inflammation

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9
Q

what is cholangitis

A

bile duct inflam

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10
Q

what are gall stones

A

Solid stones inside gallbladder composed of bile components due to an imbalance of chemical constitutes

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11
Q

what are gall stones most commonly made up of

A

cholesterol (75%)

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12
Q

Rfs for gall stones

A

Fat (high cholesterol)
Female (linked to oestrogen - oral contraceptive pill)
Forty
Fertile

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13
Q

why do gall stones form

A

supersaturation
gall bladder stasis
not enough bile salts/acids/phospholipids to keep cholesterol in solution

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14
Q

what causes the release of bile into the duodenum

A

enteroendocrine cells in duodenum secrete CKK into the blood. CKK relaxes the sphincter of Oddi
bile released into the duodenum

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15
Q

what causes bilirubin stones

A

too much unconj bilirubin in the bile.
combines with Ca2+ to form CALCIUM BILIRUBINATE =
precipitates out as stones
Cx= increase in RBC breakdown secondary to liver cirrhosis, bil tract infection of blood conditions

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16
Q

are bilirubin stones radioopaque?

A

yes

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17
Q

what do brown stones signify

A

infection

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18
Q

what colour are bilirubin stones

A

black

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19
Q

what is the difference between brown stones and bilirubin stones

A

brown stones are a sign of infection and are made up of hydrolysed phospholipid also
(calcium + uncoj bilirubin + hydrolysed phospholipids)
bilirubin stones just calcium and uncoj bilirubin

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20
Q

are cholestrol gall stones seen on xray

A

no

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21
Q

what are causes of brown gall stones

A

E.coli
ascaris lumbricoides (round worm)
(the bacteria bring in the hydrolytic enzyme)

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22
Q

what colour are cholesterol gall stone

bilirubin gall stones

A

cholesterol stones = yellow / green

bilirubin = dark

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23
Q

Rfs for gall stones

A 
female
obesity
high oestrogen - oral contraceptive
rapid weight loss (decrease lipids = imbalance in bile)
FAT FEMALE FORTY FERTILE
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24
Q

what makes up biliary tract diseases (in order)

A

biliary colic
cholecystitis
asc cholangitis

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25
what is acute cholecystitis
Obstruction (95%=gall stone) stuck in gallbladder neck causes inflammation secondary to retained bile in the gall bladder
26
why does inflam occur in acute cholecystitis
impaction in neck of GB/cystic duct causes static bile. | mucose secretes mucus and inflam enzymes = inflammation
27
how does acute cholecystitis lead to peritonitis
bile retained - inflammation and pressure build up causing distension. BV supply to GB compromised = ischaemia. bacterial growth in static bile (E.coli, klebsiella) - invades GB wall and causes inflam of peritoneum (PERITONITIS)
28
how does acute cholecystitis lead to sepsis
gall stone blockage -> inflam and pressure build up --> distension --> compromises blood supply to GB --> ischaemia --> gangerous cell death weakening wall --> ruptures and bacteria into blood = SEPSIS (bacteria build up due to static bile)
29
Cfs of acute cholecystitis
``` RUQ pain radiates to R shoulder (epigastric if peritonitis) fever N+V Murpheys sign guarding REBOUND TENDERNESS ```
30
what is Murpheys sign
pressure to r side of abdo so abdo contents dont move = deep breathe = diahragm down onto gallbladder = pain
31
Mx of acute cholecystitis
cholecystectomy | analgesia
32
what is ascending cholangitis
bacterial infection due to gallstone blocking the cystic bile duct resulting in inflammation
33
what occurs in ascending cholangitis that is normally prevented by bile flow
bacterial migration up the biliary tree
34
Cx of ascending cholangitis
E.coli Enterococcus (D strep) Klebsiella
35
why does bacterial migration occur in ascending cholangitis
gall stone blocks bile flow and pancreatic juices
36
what is a complication of asc cholangitis
SEPTIC SHOCK
37
how does septic shock occur in asc cholangitis
blcokage by gall stone of the cystic bile duct - increases pressure in GB and so spaces betweeen cells lining the bile duct increase and bacteria enters blood stream = SEPTIC SHOCK
38
why do patients get confused as a result of ascending cholangitis
septic shock - hypotension due to leaky blood vessels - less blood to the brain - confusion (RAYNAUDS PENTAD)
39
what is reynauds pentad in asc cholangitis
charcots + (fever+jaundice+RUQ pain) hypOtension confusion
40
when does reynauds pentad occur in asc cholangitis
as a result of septic shock due to bacteria from increased p. in GB entering the blood stream HYPOTENSION CONFUSION
41
what is charcots triad assos with
asc cholangitis
42
what is charcots triad
fever RUQ pain jaundice
43
what causes jaundice in asc cholangitis
bile in the blood stream ( GB increased pressure, spaces between cell lining widen = leaks out)
44
what are syptoms of asc cholangitis
``` fever RUQ pain Rigors Pruritus (jaundice) dark urine pale stools ```
45
signs of asc cholangitis
``` jaundice RUQ tenderness confusion hypotension guarding and tenderness ```
46
Dx of asc cholangitis
bloods - jaundice signs (increase serum bilirubin), shock, infection (increased neutrophils) US - dilated common bile duct CT - exl carcinoma of pancreas
47
Mx of asc cholangitis
IV fluid and ABX (cefotaxime + metronidazole) analgesia relieve obstruction (ERCP/stenting) cholecystectomy
48
what does ERCP stand for and what is it used for
endoscopic retrograde cholangio pancreatography
49
what causes RUQ pain in biliary disorders
biliary colic acute cholecystitis cholangitis
50
what causes fever/increased WCC out of the biliary disorders
acute cholecystitis asc cholangitis NOT billiary colic
51
which biliary tract diseases cause jaundice
asc cholangitis ONLY
52
what is primary biliary cholangitis (PBC)
autoimmune destruction of interlobular bile ducts- leakage of bile and toxins into liver parenchyma and blood. cholestasis - fibrosis - cirrhosis
53
3 As of Primary biliary cholangitis
AI (autoimmune) AMA positive ALP increased
54
Cfs of PBC
``` asympt fatigue hepatosplenomegaly pruritis xanthomas xanthelasma ```
55
Dx buzz word in blood of PBC
AMA postive | = antimitochondrial antibodies
56
Dx of PBC
``` bloods - Anitmitochondrial antibodies LFTs - increased GGT and ALP increased PTT as decreased albumin Biopsy = granulomas lymphocytes and plasma cells in the portal tracts ```
57
complications of PBC
autoimmune (Sjogrens, Rheumatoid arthritis) osteoporosis ascites
58
epidem of PBC
female x9
59
Mx of PBC
``` early = ursodeoxycholic acid (UDCA) to decrease cholestasis (Weight gain = SE) supportive - itch = colestyramine cirrhosis complications vit suppl (as fat malabsorb) ADEK liver transpl ```
60
what is primary sclerosing cholangitis
immune mediated chronic cholestatic liver disease characterised by the fibrosing infam destruction of both intra and extra hepatic bile ducts
61
what is PSC assoc with
``` Ulcerative collitis (75%) or crohns ```
62
Cfs of PSC
jaundice - itching, fatigue, yellow skin, hepatosplenomegaly abdo pain
63
what often precedes primary sclerosing cholangitis
Ulcerative colitis
64
epidem of primary sclerosing cholangitis
M more than F (70%)
65
pathology of primary sclerosing cholangitis
inflam of intrahepatic bile ducts and assos scar tissue = onion skin fibrosis (peri ductal oedema) minor inflam --> cirrhosis leads to strictures impeding bile flow to small intestines causes ductopenia pANCA increased
66
complications of primary sclerosing cholangitis
firosis builds up round bile ducts near portal veins - portal HTN - fluid backs up - hepatosplenomegaly cirrhosis (BILE DUCT DAMAGE INCREASES RISK OF CHOLANGIOCARCINOMA)
67
CFs of primary sclerosing cholangitis
``` fluctuating pruritis jaundice cholangitis fatigue yellow skin abdo pain hepatosplenomegaly ```
68
Dx of primary sclerosing cholangitis bloods
``` increased conj bilirubin in serum increased ALP and gamma GGT enzymes AMA -ve ANCA +ve bilirubinuria - no urobilinogen as bile flow obstructed ```
69
Dx of primary sclerosing cholangitis (not bloods)
ERCP - endoscopy into bile ducts cholioangiogram for irregular ducts - strictures BEADED appearance due to fibrosis

2a RRS (26 decks)

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