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GRACE Phase 2a Medicine > Liver > Flashcards

Liver Flashcards

1
Q

95% of paracetamol at a therapeutic concentration is excreted how? What happens to the other 5%?

A

Conjugated (sulfation or glucuronidation) to form a non-toxic metabolite which is readily excreted

Other 5% is oxidised by CYP450 to form NAPQI which is a toxic metabolite. This then undergoes conjugation to make it into a readily excretable substance

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2
Q

What happens in paracetamol overdose?

A

Build up of toxic metabolite NAPQI, leading to hepatic necrosis

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3
Q

Symptoms of paracetamol overdose?

A

Nausea, vomiting, RUQ pain

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4
Q

Mx of paracetamol overdose?

A 
Activated charcoal (gastric decontamination)
IV NAC (N-acetylcysteine)
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5
Q

6 types of hernia?

A

Inguinal, femoral, hiatus, epigastric, incisional, umbilical

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6
Q

Inguinal hernia - direct and indirect

A

Indirect (80%) - protruded through the opening of the inguinal canal (deep ring)
Direct (20%) - protrudes through a weak spot

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7
Q

Risk factors for inguinal hernia?

A

Male, chronic cough, heavy lifting, past abdo surgery

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8
Q

Px of inguinal hernia

A

Swelling of groin, painful, inducible

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9
Q

Ix for hernias?

A

Clinical, MRI, USS, CT

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10
Q

Femoral hernia Px

A

mass in medial upper thigh, irreducible and likely to strangulate

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11
Q

Hiatus hernia

A

Stomach protrudes through the oesophageal hiatus in the diaphragm - sliding (80%), rolling (20%)

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12
Q

Sliding hiatus hernia (80%)

A

Gastrooesophageal junction (GOJ) slides up through the hiatus, LOS is less competent

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13
Q

Rolling hiatus hernia (20%)

A

GOJ remains in the abdomen, part of the fundus rolls UP through the hiatus, therefore the LOS is intact, reflux is UNCOMMON

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14
Q

Px of rolling hiatus hernia?

A

Heartburn, GORD, dysphagia

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15
Q

Ix for hiatus hernia?

A

Barium swallow, endoscopy

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16
Q

MX for hiatus hernia?

A

Lose weight, PPI, surgery

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17
Q

What is acute pancreatitis?

A

Disease due to acute inflammation in the pancreas characterised by self-perpetuating pancreatic enzyme mediated auto-digestion

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18
Q

Epidemiology of acute pancreatitis?

A

80% mild cases, 20% –> life-threatening disease, 12% mortality

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19
Q

Causes of acute pancreatitis? (I GET SMASHED)

A 
Idiopathic
Gallstones (40%)
Ethanol (25%)
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidaemia
ERCP
Drugs e.g. NSAIDs
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20
Q

Pathophysiology of acute pancreatitis?

A

Release of precursor digestive enzymes which are activated within the pancreas and cause autodigestion of pancreatic tissue, triggering recruitment of inflammatory cells and release of inflammatory mediators. This increases vascular permeability –> oedema

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21
Q

Px of acute pancreatitis?

A

Nausea/vomiting, sudden epigastric pain (may radiate to back), diarrhoea, tachycardia

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22
Q

Ix for acute pancreatitis

A

Raised serum amylase/lipase, ABG, USS

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23
Q

Glasgow criteria

A

Predicts severity of pancreatitis - 3 or more factors –> transfer to ITU

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24
Q

Nutritional management for pancreatitis?

A

Nil by mouth, NJ feeding, urinary catheter

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25
Mx for acute pancreatitis
Assess severity using Glasgow score, nil by mouth, urinary catheter, analgesia, monitor, ERCP if gallstone pancreatitis
26
Complications of acute pancreatitis?
Shock, ARDS, renal failure, hyperglycaemia
27
Px of chronic pancreatitis?
Epigastric pain radiates through to the back and is relieved by sitting forward/hot water bottles, severe weight loss, bloating, steatorrhoea, brittle diabetes
28
Ix for chronic pancreatitis?
US and CT scan - pancreatic calcifications
29
Mx of chronic pancreatitis?
analgesia, pancreatic enzyme supplements, no alcohol, surgical resection
30
What is hereditary haemochromatosis?
Autosomal recessive inherited disorder characterised by excessive iron storage in tissues --> organ failure, caused by mutation of human haemochromatosis gene
31
Px of hereditary haemochromatosis?
Hyperpigmentation (bronzed skin), painful joints, hair loss, sexual dysfunction, chronic fatigue, memory/mood disturbances
32
Dx of hereditary haemochromatosis?
Serum ferritin and transferrin saturation, genetic testing, liver biopsy
33
Mx of hereditary haemochromatosis?
Venesection, genetic screening
34
What is Wilson's disease?
Autosomal recessive disorder characterised by abnormal copper deposition, presenting with liver and neuropsychiatric symptoms
35
Cause of Wilson's disease?
Mutation in the ATP7B gene which encodes for the copper-transporting P-type ATPase found in hepatocytes
36
copper-transporting P-type ATPase
key protein in maintaining copper homeostasis, coded for on the ATP7B gene
37
Px of Wilson's disease
Hepatic problems - hepatitis, cirrhosis Cognitive problems - memory loss, decreased IQ, depression, decreased libido CNS problems - Parkinsonism (tremor, bradykinesia, dysarthria, rigidity - BUT symmetrical) Kayser-Fleischer ring in eye
38
Kayser-Fleischer ring
copper deposit in the cornea, ring around eye, sign of Wilsons disease
39
Ix for Wilson's disease
Serum caeruloplasmin (main carrier of Cu) serum copper, 24hr urinary copper excretion, liver biopsy
40
Mx of Wilson's disease
Copper chelation - penicillamine, liver transplants, genetic testing
41
Alpha-1 antitrypsin
Enzyme released by hepatocytes that inhibits neutrophil elastase, breaking down bacteria, lines the alveoli
42
Alpha-1 antitrypsin deficiency
autosomal recessive disorder causing liver/lung damage due to a mutation in the A1AT gene
43
Mutation causing abnormal A1AT
Polymerises and forms deposits within hepatocytes --> cellular destruction --> cirrhosis
44
Mutation causing lack of/no A1AT
Does not affect liver, lungs are are risk of elastase mediated damage since not inhibited by A1AT, breaks down elastin in alveoli --> emphysema --> COPD
45
Ix for A1AT?
Low serum A1AT levels
46
Mx for A1AT deficiency?
supportive, treat underlying disease, stop smoking
47
What % of liver tumours are secondary? where do they commonly metastasise from?
90%, lungs, breast, stomach, colon
48
two common primary malignant liver tumours?
HCC, cholangiocarcinoma
49
two common primary benign liver tumours?
haemangioma, hepatic adenoma
50
PX of liver tumours?
RUQ pain, fever, malaise, weight loss, late jaundice (except cholangiocarcinoma), hepatomegaly, abdominal mass
51
Rapid development of liver tumour symptoms is indicative of which type of cancer?
HCC
52
Ix for liver tumours?
Bloods - FBC, clotting, LFTs, alpha-fetoprotein CT and biopsy US
53
When is alpha-fetoprotein raised?
In liver cancer due to high hepatocyte turnover
54
What underlying disease is almost always present in HCC?
Cirrhosis
55
Risk factors for HCC?
Cirrhosis, Hep B, C, Aflatoxin, Betel nut chewing, alcohol, smoking
56
Mx of HCC?
Surgical resection, liver transplant
57
Cholangiocarcinoma
Biliary tree cancer
58
What is raised in cholangiocarcinoma?
Bilirubin --> jaundice, ALP
59
haemangiomas
Commonest benign tumour, usually found incidentally, no treatment is required
60
hepatic adenomas
associated with anabolic steroids, COCP, surgical resection only required if symptomatic or >5cm
61
Pancreatic adenocarcinomas
Often inoperable by time of presentation, metastasise early, present late, asymptomatic through development, most common pancreatic cancer
62
Pancreatic adenocarcinomas arise from what type of epithelium?
Ductal
63
Where are pancreatic adenocarcinomas located within the pancreas?
70% head, 20% body/tail
64
PX of pancreatic adenocarcinoma?
Head - obstructive jaundice, pale stools, dark urine | Body/tail - epigastric pain that radiates to the back
65
Mx of pancreatic adenocarcinoma
analgesia, nutrition, emotional support, resectable if caught early
66
Increased serum bilirubin is associated with
liver abnormalities
67
Pale stools + dark urine =
cholestatic jaundice
68
What is Budd-Chiari syndrome?
Vascular liver disorder due to obstruction of hepatic venous outflow, characterised by the classic triad of: Ascites Hepatomegaly Abdominal pain Syndrome due to a variety of underlying causes that cause obstruction anywhere from the small hepatic venules --> IVC at the R atrium
69
Triad of symptoms in Budd-Chiari syndrome?
Ascites, hepatomegaly, abdominal pain
70
Dx of Budd-Chiari syndrome?
Imaging - 1st line = doppler US, then CT/MRI
71
Acute cholangitis - px (charcots triad)
1. RUQ pain 2. Fever 3. Jaundice
72
How would you treat alcohol withdrawal?
Diazepam
73
What is primary sclerosing cholangitis?
Immune mediated disease causing progressive inflammation of the intra- and extra-hepatic bile ducts, --> cholestasis (poor flow), hepatic fibrosis (scarring) and bile duct strictures (narrowing)
74
What disease is primary sclerosing cholangitis strongly associated with?
IBS
75
Symptoms of primary sclerosing cholangitis?
Fatigue, itching, jaundice
76
Why do you get itching with liver disease?
Increase in bile salts under your skin --> causes itching
77
Pruritus?
itching
78
mx of primary sclerosing cholangitis?
Liver transplant is the only effective tx
79
What causes median arcuate ligament syndrome?
Compression of the coeliac artery by the MAL, causing abdominal pain, may be related to meals

GRACE Phase 2a Medicine (20 decks)

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