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Gastrointestinal > Liver and Biliary Tree > Flashcards

Liver and Biliary Tree Flashcards

1
Q

what is the underlying pathology to liver disease

A

insult to hepatocytes initially causing reversible inflammation but if persistent causes irreversible fibrosis

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2
Q

what time frame is acute and chronic liver disease

A

acute <6 months

chronic >6 months

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3
Q

what are some of the main causes of liver disease

A 
alcohol 
NAFLD
paracetamol poisoning 
hep C
PBC
autoimmune hepatitis
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4
Q

describe compensated and decompensated cirrhosis

A

compensated - may not present with symptoms as still some normal liver function
decompensated - will present with symptoms, running out of functioning liver

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5
Q

what is portal hypertension classed as

A

> 5-8mmHg

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6
Q

what causes portal hypertension

A

liver doesnt function correctly, causes increased resistance to flow and increased portal venous outflow. causes increased back pressure in the artery which has systemic effects

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7
Q

what are the main causes of cirrhosis

A 
alcoholism 
NALFD
chronic HCV HBV 
genetic and autoimmune disorders 
drugs eg methotrexate
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8
Q

what are some signs of cirrhosis

A

leukonychia, xanthelasma, ascites, palmar erythema, gynaecomastia, spider naevi, encephalopathy, caput medusae, heptaosplenomegaly

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9
Q

what causes encephalopathy

A

ammonia that is usually metabolised in the liver goes directly to systemic circulation because of liver not functioning correctly. causes neurotransmitter problems and liver flap

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10
Q

what causes ascites

A

increase in interstital fluid due to increased back pressure

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11
Q

what are the main complications of cirrhosis

A

portal hypertension
oesophageal varices
rectal varices

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12
Q

what is the overall treatment for cirrhosis

A

good nutrition - high calorie diet
avoid alcohol completely
spirnolactone for ascites
prophylactic lactulose for encephalopathy

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13
Q

what is TIPS and when is it used

A

creates a new connection between portal and hepatic vein, used in portal hypertension to relieve pressure

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14
Q

what is a complication of NAFLD

A

can develop onto NASH - non-alcoholic steatosis hepatitis leading to end stage liver failure requiring transplant

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15
Q

what are 3 autoimmune conditions affecting liver/gallbladder

A

primary biliary cholangitis
autoimmune hepatitis
primary sclerosing cholangitis

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16
Q

what causes PBC and who typically gets it

A

bile ducts are damaged by chronic autoimmune granulomatous - causes build up of bile and cirrhosis
typically middle aged women present

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17
Q

what are the symptoms of primary biliary cholangitis

A 
fatigue 
painless jaundice 
itch without rash 
xanthelasma 
hepatosplenomegaly
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18
Q

what investigations are carried out to diagnose PBC

A

anti-mitochondrial antibodies
LFTs showing cholestatic picture
liver biopsy

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19
Q

what is the treatment for PBC and complications

A

treat itch with urseodeoxycholic acid

cirrhosis can develop which may require liver transplant

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20
Q

what causes autoimmune hepatitis

A

abnormal T cell function targets hepatocytes causing inflammation

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21
Q

who typically presents with autoimmune hepatitis and with what symptoms

A

young or middle ages women
fatigue and lethargy - general autoimmune symptoms
also hepatomegaly and possible jaundice

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22
Q

what investigations are carried out for autoimmune hepatitis

A

anti-smooth muscle antibodies
LFTs showing hepatocellular picture
(raised ALT/AST and PT)
liver biopsy

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23
Q

what is the treatment for autoimmune hepatitis (think reduce inflammation)

A

prednisolone or budesonide
immune suppression - azathioprine
urseodeoxycholic acid

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24
Q

what causes primary sclerosing cholangitis

A

progressive cholecystatis with bile duct inflammation affecting medium and large sized ducts

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25
Q

PSC is associated with which gender and which condition

A

male

Ulcerative Colitis

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26
Q

what are the symptoms of PSC

A

fatigue/lethargy

jaundice - late symptom

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27
Q

what investigations are carried out for PSC

A 
LFTs showing cholestatic picture 
pANCA +ve test 
liver imaging (US and ERCP)
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28
Q

what is the treatment for PSC

A

liver transplant most effective

also prevention of cirrhosis

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29
Q

what is the main complication of PSC especially with UC

A

cancer of the liver, gallbladder, bile duct and colon

annual colonoscopy required

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30
Q

what is haemochromatosis

A

autosomal recessive condition causing iron overload in the joints and skin
(high iron levels can cause hepatic toxicity)

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31
Q

what are the signs and symptoms of haemochromatosis

A

slate grey appearance
‘bronzed diabetic’
typical signs of cirrhosis ascites, encephalopathy etc

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32
Q

what investigations are carried out for haemochromatosis

A

raised ferritin levels

LFTs

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33
Q

what is the treatment for haemochromatosis

A

regular venesection to remove excess iron

also good diet and no alcohol

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34
Q

what is Wilsons disease

A

autosomal recessive condition causing loss of ceruloplasmin causing excess copper in liver and ganglia

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35
Q

what are the symptoms of Wilsons disease

A

child presenting with liver disease
CNS problems
Kaiser Fleischer rings around eyes

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36
Q

what is the treatment of Wilsons disease

A

copper chelation drugs to help bind to copper

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37
Q

alpha 1 antitrypsin deficiency causes symptoms in what body systems

A

lungs - emphysema

liver - cirrhosis and cholestatic jaundice

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38
Q

what tests are carried out for alpha 1 antitrypsin deficiency and what do they show

A

low serum anti-trypsin
reduced FEV1
liver biopsy

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39
Q

what is Budd-Chiari and who typically develops it

A

thrombosis of hepatic veins causing tender hepatomegaly, jaundice and ascites
young women on oral contraceptive

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40
Q

what investigations and treatment are used for Budd-Chiari

A

ultrasound of hepatic veins

remove trigger, anti-coagulation, thrombolysis and TIPS

41
Q

name the benign liver tumours

A

haemangioma
focal nodular hyperplasia
hepatic adenoma
cystic lesions

42
Q

who typically develops haemangioma and what is the severity of it

A

more common in females

hypervascular tumour, incidental finding with no treatment required

43
Q

describe hepatic adenoma and the treatment

A

benign neoplasm which has malignant potential
more common in females, oral contraceptive pill and steroid use
if present in males, requires resection and if >5cm in females requires resection due to risk of becoming malignant

44
Q

what is the main treatment for cystic lesions

A

removal and drainage

if an abscess also requires antibiotics

45
Q

what is the most common type of malignant liver tumour

A

hepatocellular carcinoma (hepatoma)

46
Q

what are the risk factors for developing hepatocellular carcinoma

A

NAFLD, cirrhosis, chronic HCV HBV, haemochromatosis,

more common in men

47
Q

primary liver tumours are more common than secondary ones true/false

A

false - 90% are metastases

48
Q

what are common sites of cancer that metastasise to the liver

A

breast, lung, colon, stomach and pancreas

49
Q

what are the signs and symptoms of liver cancer

A

jaundice, ascites, weight loss, fatigue, RUQ pain, hepatomegaly

50
Q

what investigations are required for diagnosing liver cancer

A

US/CT
biopsy
alpha feto protein

51
Q

what is the main treatment for liver cancer

A

liver transplant best chance

resection has high recurrence rate

52
Q

what causes gallstones to occur

A

abnormal ratio of cholesterol and lipids in bile

53
Q

what two types of gallstones can occur

A

cholesterol
pigment (dark)
or mixture of both

54
Q

what are the causes of gallstones

A

abnormal bile composition
bile stasis
infection
excess cholesterol

55
Q

what are the risk factors for gallstones

A

fat female fertile forty and fair

56
Q

describe acute cholecystitis

A

blockage of the cystic duct causing inflammation of the gallbladder

57
Q

gallbladder pain is typically referred to

A

the right shoulder

58
Q

what are the symptoms of gallstones

A

biliary colic in RUQ radiating to shoulder typically after eating fatty meal
nausea, flatulence, jaundice, PALE STOOLS DARK URINE

59
Q

what is murphys sign and when is it positive

A

pain when breathing in and palpating the RUQ

positive during acute cholecystitis

60
Q

what investigations are required for gallstones

A

US of biliary tree

further investigations using CT and ERCP

61
Q

what is the treatment for symptomatic gallstones

A

nil by mouth
antibiotics
urgent laparoscopic cholecystectomy

62
Q

what are the main complications of gallstones

A

migration of the stone to another site - gallstone ileus, pancreatitis and acute cholecystitis

63
Q

what is the second most common hepatobiliary cancer

A

cholangiocarcinoma - cancer of the bile duct

64
Q

cholangiocarcinoma risk is increased with what conditions

A

UC and PSC

65
Q

what are the symptoms of cholangiocarcinoma and investigations

A

vague abdominal pain
jaundice
weight loss, lethargy, anorexia
investigations - US, MRCP/ERCP

66
Q

what is the treatment for cholangiocarcinoma

A

surgical resection of bile duct and liver - often too late

palliation through biliary stenting

67
Q

which part of the colon is most likely to develop colorectal cancer

A

sigmoid colon

68
Q

what are the risk factors for developing colorectal cancer

A

age, smoking, obesity/low fibre diet, polyps, genetic predisposition, PSC, UC

69
Q

what is lynch syndrome

A

also known as hereditary non-polyposis colorectal cancer

increases risk of developing colorectal and endometrial cancer. genetic condition

70
Q

what is FAP and what does it produce

A

familial adenomatous polyposis - causes mutation in APC causing carpet of polyps with malignant potential

71
Q

the majority of colorectal cancers are left/right sided

A

left sided 75% - sigmoid colon

72
Q

what are the symptoms of colorectal cancer (left and right sided)

A

left - rectal bleeding, tenesmus, constipation, altered bowel habit
right - weight loss, anorexia and anaemia, fatigue

73
Q

what are the common sites colorectal cancer can spread to

A

lung, liver through blood
lymph nodes - IMA or superficial inguinal nodes
ovaries/prostate through direct invasion

74
Q

what is the main treatment options for colorectal cancer

A

surgical resection of affected area eg hemicolectomy or proctectomy
neo-adjuvant radiotherapy
palliative radiotherapy

75
Q

what are oesophageal varices and how do the occur

A

submucosal venous dilatation secondary to portal hypertension

76
Q

what are the symptoms of oesophageal varices

A

haematemasis
ground coffee vomit
symptoms of liver disease eg jaundice, cirrhosis and encephalopathy

77
Q

name some pre, hepatic and post causes of portal hypertension

A

pre - thrombolysis
hepatic - cirrhosis
post - budd-chiari or heart failure

78
Q

what is the management for oesophageal varices

A

IV fluids
take bloods and insert catheter
urgent endoscopy and either oesophageal banding or sclerotherapy to close off the vein from the inside

79
Q

name some causes of pancreatitis

A

gallstones, alcohol, iatrogenic, trauma, drugs, autoimmune

80
Q

what are the symptoms of pancreatitis

A

epigastric pain radiating to the back
fever, nausea, vomiting - acute
relapsing remitting symptoms and steatorrhoea - chronic

81
Q

what are grey turners sign and cullens sign

A

grey tuners - flank bruising
cullens - periumbilical bruising
both signs of pancreatitis

82
Q

what are the investigations and treatment done for pancreatitis

A

inv - CT, US

treatment - analgesia, fluids and stop alcohol

83
Q

what are the complications of pancreatitis that require surgery

A

pseudocysts
shock
abscess
necrosis/chronic pancreatitis

84
Q

what are the risk factors for developing pancreatic carcinoma

A

smoking, alcohol, poor diet high in red meat, chronic pancreatitis, age and male gender

85
Q

what are the symptoms of pancreatic cancer - think about parts of the pancreas

A

head - painless jaundice
body and tail - epigastric pain radiating to the back
both, weight loss and fatigue

86
Q

which types of viral hepatitis can be treated with vaccination

A

Hep A and B

87
Q

name some antivirals that can be used and when are they used in hepatitis

A

entecavir adefovir

only used in chronic infection

88
Q

which strains of viral hepatitis can produce chronic infection

A

hep B, C, D

89
Q

describe the spread of each type of viral hepatitis

A 
A - faecal oral 
B - blood/sex
C - blood/sex but less common 
D - only developed with hep B
E - faecal oral and animal spread
90
Q

what lab tests are carried out for hep A

A

Hep A IgM and serology for clotted blood

91
Q

positive anti-HBe Ab indicates

A

low infectivity of hep B

92
Q

chronic hep B infection is defined as a positive HbsAg for how long?

A

> 6 months

93
Q

Hep B DNA positive indicates

A

highly infectious individual

94
Q

Hep B IgM positive indicates

A

recently infected

95
Q

what are the complications of developing chronic hepatitis

A

cirrhosis and increased risk of hepatocellular carcinoma

96
Q

if an individual has suspected hep C what test is carried out

A

hep C Ab

97
Q

if someone has positive hep C Ab what test is carried out next and what does it show

A

PCR for Hep C RNA - positive indicates active infection and negative indicates past infection

98
Q

hep A is more common than Hep E true/false

A

false Hep E is more common

Gastrointestinal (7 decks)

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