Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NMF: General Surgery > Liver > Flashcards

Liver Flashcards

1
Q

Which antibiotic commonly causes jaundice and deranged LFTs?

A

co-amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the only sexually transmitted disease that has a safe and effective vaccine to protect against infection?

A

hep b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give vascular causes of jaundice

A

budd chiari syndrome

haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is budd-chiari?

A

causes hepatic vein obstruction leading to abdominal pain, ascites, and liver enlargement.

seen in patients on COCP, pregnancy or thrombophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give infectious causes of jaundice

A

viral hepatitis
ascending cholangitis
weil’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give neoplastic causes of jaundice

A

hepatocellular carcinoma
pancreatic cancer
cholangiocarcinoma
liver mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give drugs that cause jaundice

A

co-amoxiclav
COCP
sodium valproate
paracetamol OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give autoimmune causes of jaundice

A

autoimmune hepatitis
primary sclerosing cholangitis
primary biliary cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give traumatic causes of jaundice

A

gallstones

previous surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give endocrine causes of jaundice

A

haemochromatosis

willson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is cholangiocarcinoma?

A

cancer of the bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What questions are important when taking a jaundice history?

A 
pain? 
fever?
pruritus?
weight loss? fatigue? night sweats
symptoms of diabetes: polyuria? weight loss?
colour of urine and stools
travel hx
sexual hx
family hx of liver problems, diabetes, haemolysis...
alcohol and drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should you look for in a jaundice exam?

A

jaundice
tanned bronze skin
needle marks
tattoos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should you examine for in a jaundice exam?

A 
signs of chronic liver disease/ liver failure
RUQ tenderness
hepato-splenomegaly
masses suggestive of malignancy
ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name some signs of chronic liver disease/ liver failure

A

bruising
palmar erythema
spider naevi
caput medusae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What initial investigations should be carried out in someone with jaundice? why?

A

FBC to exclude haemolysis
LFTs to work out if hepatitic or cholestatic
PT and albumin as markers of liver function
urinalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is urinalysis carried out in someone with jaundice?

A

bilirubin in urine suggests post-hepatic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do raised ALT and AST in a jaundices patient suggest?

A

hepatic picture eg.viral hepatitis, autoimmune hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do raised ALP and GGT in a jaundiced patient suggest?

A

cholestatic picture eg. gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What other investigations should be considered in a jaundiced patient depending on their clinical picture?

A

ferritin and iron

viral screen

autoimmune screen

copper and ceruloplasmin

US of liver and abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why would ferritin and iron studies be carried out in a jaundiced patient?

A

to exclude haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What viruses would be screened for in a jaundiced patient?

A

Hepatitis A,B,C,D,E
Cytomegalovirus
Ebstein-Barr virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What auto antibodies would be screened for in a jaundiced patient?

A

ANA
anti-smooth muscle
anti-mitochondrial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why would copper and ceruloplasmin be screened for in a jaundiced patient?

A

to exclude wilson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Why would an US of liver and abdomen be carried out in a jaundiced patient?
look for malignancy
26
Which examination finding may be seen in acute viral hepatitis but not in chronic hepatitis?
Hepatomegaly
27
What would FBC show if haemolysis is the cause of jaundice?
Reduced haemoglobin
28
Which disease is often concurrent with haemachromatosis?
Diabetes
29
Do IgM or IgG antibodies indicate a chronic infection?
IgG Old is gold
30
Do IgM or IgG antibodies indicate an acute infection?
IgM
31
In a person with an active hepatitis B infection, which serology findings would be positive?
``` DNA Surface antigen (HbsAg) ```
32
Which type of hepatitis have immunisations?
Hep A and B
33
How would an acute hepatitis B infection be treated?
Supportive management with fluids | Avoid hepatotoxic agents eg. Paracetamol & alcohol
34
What proportion of adults with acute hep B infection self resolve?
95%
35
What indicates a severe hepatitis B infection?
Coagulopathy Prolonged jaundice (>4 weeks) Acute liver failure
36
How can severe hepatitis B infection be managed?
Tenofovir | Liver transplant
37
Which class of drug is tenofovir?
Nucleotide reverse transcriptase inhibitors (NRTIs)
38
Which step out with patient treatment must be taken for a hep B infection?
Contact tracing of sexual partners
39
How do children respond to acute hep B infection?
Likely to progress to chronic infection if they are under 1
40
How do children get hep B?
Mother to child transmission
41
What proportion of chronic hep B patients develop complications?
20-30%
42
What are the complications of chronic hep B?
Cirrhosis | Hepatocellular carcinoma
43
When are the complications of chronic Hep B worse?
If concurrent hep D virus
44
What serology would be positive for someone with a hep B immunisation?
Anti-Hbs IgG
45
What serology differentiates between a past hep B infection and a hep B immunisation?
Anti-HBc IgG Positive in past infection Negative in serology
46
What is anti Hbc?
The antibody to hep B core antigen Means you have hep B or have had it some time in the past
47
What is anti Hbs?
The antibody to hepatitis B surface antigen Means you are immune to Hep B through immunisation or past infection
48
Can someone with anti Hbs pass hep b to others?
No
49
What is HbsAg?
Hep b surface antigen Indicates current infection and that hep B is transmittable
50
How are babies born to Hep B positive mothers protected?
Give hep B vaccine and immunoglobulin within 12 hours from birth
51
What is pre-hepatic jaundice?
When excessive red cell destruction overwhelms the liver’s ability to conjugate bilirubin so there is increased unconjugated bilirubin in the blood
52
Give an example of a cause of pre-hepatic jaundice
Haemolytic anaemia
53
What is intrahepatic jaundice ?
Liver dysfunction disrupts bilirubin conjugation so there is increased unconjugated and conjugated bilirubin
54
What is post hepatic jaundice?
When biliary drainage is obstructed leading to increased conjugated bilirubin
55
``` What is the urine colour of a) prehepatic b) intrahepatic c) posthepatic jaundice patient? ```
a) normal b) dark c) dark
56
``` What is the stool colour of a) prehepatic b) intrahepatic c) posthepatic jaundice patient? ```
a) normal b) normal c) pale
57
What makes urine dark in jaundiced patient?
increased conjugated bilirubin
58
What makes stool pale in jaundiced patient?
bile salts cause fat to be excreted in poo
59
Which type of jaundice has the most to least bilirubin?
post hepatic intrahepatic prehepatic
60
How is unconjugated bilirubin made?
macrophage breaks down red blood cell into globin and heme heme becomes protoporphyrin and then unconjugated bilirubin
61
is UCB water or lipid soluble?
lipid soluble
62
How does UCB get to the liver?
carried by albumin
63
Which molecule conjugates bilirubin?
uridine glucuronyl transferase (UGT)
64
Where is conjugated bilirubin stored?
in the gall bladder as bile
65
Where is conjugated bilirubin released to when eating?
along common bile duct to duodenum of small intestine
66
What happens to conjugated bilirubin in the small intestine?
microbes convert it to urobilinogen some urobilinogen oxidises to urobilin which is excreted in faeces, 20% urobilinogen is recycled mostly to liver and 10% to kidneys where it is excreted in urine
67
Give causes of increased unconjugated bilirubin
extravascular haemolytic anaemia ineffective haemopoiesis physiological jaundice of the newborn gilbert's syndrome
68
Give causes of increased conjugated bilirubin
obstructive eg. gallstones, pancreatic cancer, cholangiocarcinoma, liver flukes dubin-johnson syndrome
69
Why does Gilbert's syndrome cause jaundice?
low UGT activity so if there is increased haemolysis then unconjugated bilirubin can build up
70
What is dubin-johnson syndrome?
low transporter protein for moving conjugated bilirubin to bile duct so it is instead moved into the blood
71
How does obstructive jaundice present? why?
pruritus, cholesterolaemia and xanthomas bile salts, bile acids and cholesterol are pushed into the blood due to increased pressure
72
Does viral hepatitis cause an increase in conjugated or unconjugated bilirubin?
both infected hepatocytes lose ability to conjugate and also let bile leak into blood
73
How does PBC present?
severe itching and mild jaundice | female > male
74
What autoantibodies are +ve in PBC?
anti-mitochondrial | high ALP
75
How does PSC present?
cholestasis (jaundice and itch) and biliary colic | young men with IBD
76
What autoantibodies are present in PSC?
pANCA | anti-nuclear antibodies
77
What autoantibodies are present in autoimmune hepatitis?
ANA anti-smooth muscle antibody anti-mitochondrial antibody normal ALP
78
What is PSC?
biliary disease of unknown cause that is characterised by inflammatrion and fibrosis of the large bile ducts
79
How is PSC treated?
urseodeoxycholic acid
80
Where is ALP found?
liver bile duct bone
81
Which marker indicates alcoholic liver damage?
GGT
82
What are the 3 signs of ascending cholangitis?
Charcot's triad - RUQ pain - fever - jaundice
83
What is cholecystitis?
an inflamed gall bladder due to cholestasis
84
Does cholecystitis cause jaundice?
no
85
What is ascending cholangitis?
bacterial infection of the biliary tree often due to gallstones
86
Does PBC or PSC have an increased risk of cholangiocarcinoma?
PSC
87
What is a hepatitis superinfection?
Hep B and hep D
88
which types of hepatitis can be sexually transmitted
B, C, D, B is easily transmittable but the others are less so
89
which types of hepatitis have faecal-oral spread?
A and E
90
What type of virus is Hep D?
RNA virus
91
What increases the transmission of Hep C?
concurrent HIV infection
92
In developed countries, what is the most common way to get Hep C?
IVDU
93
Is Hep A or C more likely to become chronic?
C
94
What marker is raised in hepatocellular carcinoma?
AFP
95
How is an acute variceal bleed managed?
ABCDE correct clotting with FFP and vitamin K terlipressin (vasoactive)
96
How can hepatic encephalopathy be managed?
lactulose | rifaximin
97
What blood test findings would someone with liver cirrhosis have?
low platelets anaemia >2.5 rise in AST to ALT
98
What is the AST:ALT in alcoholic hepatitis?
2:1
99
What blood findings suggest haemochromatosis?
raised ferritin and transferrin
100
What is Gilbert's syndrome?
hereditary unconjugated hyperbilirubin
101
How does Gilbert's syndrome?
asymptomatically jaundiced with normal LFTs in times of stress

NMF: General Surgery (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions