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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
Q

what is acute cholecystitis

A

Obstruction (95%=gall stone) stuck in gallbladder neck
causes inflammation
secondary to retained bile in the gall bladder

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26
Q

why does inflam occur in acute cholecystitis

A

impaction in neck of GB/cystic duct causes static bile.

mucose secretes mucus and inflam enzymes = inflammation

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27
Q

how does acute cholecystitis lead to peritonitis

A

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)

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28
Q

how does acute cholecystitis lead to sepsis

A

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
Q

Cfs of acute cholecystitis

A 
RUQ pain radiates to R shoulder 
(epigastric if peritonitis)
fever
N+V
Murpheys sign 
guarding
REBOUND TENDERNESS
30
Q

what is Murpheys sign

A

pressure to r side of abdo so abdo contents dont move = deep breathe = diahragm down onto gallbladder = pain

31
Q

Mx of acute cholecystitis

A

cholecystectomy

analgesia

32
Q

what is ascending cholangitis

A

bacterial infection due to gallstone blocking the cystic bile duct resulting in inflammation

33
Q

what occurs in ascending cholangitis that is normally prevented by bile flow

A

bacterial migration up the biliary tree

34
Q

Cx of ascending cholangitis

A

E.coli
Enterococcus (D strep)
Klebsiella

35
Q

why does bacterial migration occur in ascending cholangitis

A

gall stone blocks bile flow and pancreatic juices

36
Q

what is a complication of asc cholangitis

A

SEPTIC SHOCK

37
Q

how does septic shock occur in asc cholangitis

A

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
Q

why do patients get confused as a result of ascending cholangitis

A

septic shock - hypotension due to leaky blood vessels - less blood to the brain - confusion (RAYNAUDS PENTAD)

39
Q

what is reynauds pentad in asc cholangitis

A

charcots + (fever+jaundice+RUQ pain)
hypOtension
confusion

40
Q

when does reynauds pentad occur in asc cholangitis

A

as a result of septic shock due to bacteria from increased p. in GB entering the blood stream
HYPOTENSION
CONFUSION

41
Q

what is charcots triad assos with

A

asc cholangitis

42
Q

what is charcots triad

A

fever
RUQ pain
jaundice

43
Q

what causes jaundice in asc cholangitis

A

bile in the blood stream ( GB increased pressure, spaces between cell lining widen = leaks out)

44
Q

what are syptoms of asc cholangitis

A 
fever 
RUQ pain
Rigors
Pruritus (jaundice)
dark urine pale stools
45
Q

signs of asc cholangitis

A 
jaundice
RUQ tenderness
confusion
hypotension
guarding and tenderness
46
Q

Dx of asc cholangitis

A

bloods - jaundice signs (increase serum bilirubin), shock, infection (increased neutrophils)
US - dilated common bile duct
CT - exl carcinoma of pancreas

47
Q

Mx of asc cholangitis

A

IV fluid and ABX (cefotaxime + metronidazole)
analgesia
relieve obstruction (ERCP/stenting)
cholecystectomy

48
Q

what does ERCP stand for and what is it used for

A

endoscopic retrograde cholangio pancreatography

49
Q

what causes RUQ pain in biliary disorders

A

biliary colic
acute cholecystitis
cholangitis

50
Q

what causes fever/increased WCC out of the biliary disorders

A

acute cholecystitis
asc cholangitis
NOT billiary colic

51
Q

which biliary tract diseases cause jaundice

A

asc cholangitis ONLY

52
Q

what is primary biliary cholangitis (PBC)

A

autoimmune destruction of interlobular bile ducts- leakage of bile and toxins into liver parenchyma and blood.
cholestasis - fibrosis - cirrhosis

53
Q

3 As of Primary biliary cholangitis

A

AI (autoimmune)
AMA positive
ALP increased

54
Q

Cfs of PBC

A 
asympt
fatigue
hepatosplenomegaly
pruritis
xanthomas 
xanthelasma
55
Q

Dx buzz word in blood of PBC

A

AMA postive

= antimitochondrial antibodies

56
Q

Dx of PBC

A 
bloods - Anitmitochondrial antibodies
LFTs - increased GGT and ALP
increased PTT as decreased albumin
Biopsy = granulomas
lymphocytes and plasma cells in the portal tracts
57
Q

complications of PBC

A

autoimmune (Sjogrens, Rheumatoid arthritis)
osteoporosis
ascites

58
Q

epidem of PBC

A

female x9

59
Q

Mx of PBC

A 
early = ursodeoxycholic acid (UDCA) to decrease cholestasis (Weight gain = SE)
supportive - itch = colestyramine 
cirrhosis complications
vit suppl (as fat malabsorb) ADEK
liver transpl
60
Q

what is primary sclerosing cholangitis

A

immune mediated chronic cholestatic liver disease characterised by the fibrosing infam destruction of both intra and extra hepatic bile ducts

61
Q

what is PSC assoc with

A 
Ulcerative collitis (75%)
or crohns
62
Q

Cfs of PSC

A

jaundice - itching, fatigue, yellow skin,
hepatosplenomegaly
abdo pain

63
Q

what often precedes primary sclerosing cholangitis

A

Ulcerative colitis

64
Q

epidem of primary sclerosing cholangitis

A

M more than F (70%)

65
Q

pathology of primary sclerosing cholangitis

A

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
Q

complications of primary sclerosing cholangitis

A

firosis builds up round bile ducts near portal veins - portal HTN - fluid backs up -
hepatosplenomegaly
cirrhosis
(BILE DUCT DAMAGE INCREASES RISK OF CHOLANGIOCARCINOMA)

67
Q

CFs of primary sclerosing cholangitis

A 
fluctuating pruritis
jaundice
cholangitis
fatigue 
yellow skin
abdo pain 
hepatosplenomegaly
68
Q

Dx of primary sclerosing cholangitis bloods

A 
increased conj bilirubin in serum 
increased ALP and gamma GGT enzymes
AMA -ve
ANCA +ve
bilirubinuria - no urobilinogen as bile flow obstructed
69
Q

Dx of primary sclerosing cholangitis (not bloods)

A

ERCP - endoscopy into bile ducts
cholioangiogram for irregular ducts - strictures
BEADED appearance due to fibrosis

2a RRS (26 decks)

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