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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
PSC is associated with which gender and which condition
male | Ulcerative Colitis
26
what are the symptoms of PSC
fatigue/lethargy | jaundice - late symptom
27
what investigations are carried out for PSC
``` LFTs showing cholestatic picture pANCA +ve test liver imaging (US and ERCP) ```
28
what is the treatment for PSC
liver transplant most effective | also prevention of cirrhosis
29
what is the main complication of PSC especially with UC
cancer of the liver, gallbladder, bile duct and colon | annual colonoscopy required
30
what is haemochromatosis
autosomal recessive condition causing iron overload in the joints and skin (high iron levels can cause hepatic toxicity)
31
what are the signs and symptoms of haemochromatosis
slate grey appearance 'bronzed diabetic' typical signs of cirrhosis ascites, encephalopathy etc
32
what investigations are carried out for haemochromatosis
raised ferritin levels | LFTs
33
what is the treatment for haemochromatosis
regular venesection to remove excess iron | also good diet and no alcohol
34
what is Wilsons disease
autosomal recessive condition causing loss of ceruloplasmin causing excess copper in liver and ganglia
35
what are the symptoms of Wilsons disease
child presenting with liver disease CNS problems Kaiser Fleischer rings around eyes
36
what is the treatment of Wilsons disease
copper chelation drugs to help bind to copper
37
alpha 1 antitrypsin deficiency causes symptoms in what body systems
lungs - emphysema | liver - cirrhosis and cholestatic jaundice
38
what tests are carried out for alpha 1 antitrypsin deficiency and what do they show
low serum anti-trypsin reduced FEV1 liver biopsy
39
what is Budd-Chiari and who typically develops it
thrombosis of hepatic veins causing tender hepatomegaly, jaundice and ascites young women on oral contraceptive
40
what investigations and treatment are used for Budd-Chiari
ultrasound of hepatic veins | remove trigger, anti-coagulation, thrombolysis and TIPS
41
name the benign liver tumours
haemangioma focal nodular hyperplasia hepatic adenoma cystic lesions
42
who typically develops haemangioma and what is the severity of it
more common in females | hypervascular tumour, incidental finding with no treatment required
43
describe hepatic adenoma and the treatment
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
what is the main treatment for cystic lesions
removal and drainage | if an abscess also requires antibiotics
45
what is the most common type of malignant liver tumour
hepatocellular carcinoma (hepatoma)
46
what are the risk factors for developing hepatocellular carcinoma
NAFLD, cirrhosis, chronic HCV HBV, haemochromatosis, | more common in men
47
primary liver tumours are more common than secondary ones true/false
false - 90% are metastases
48
what are common sites of cancer that metastasise to the liver
breast, lung, colon, stomach and pancreas
49
what are the signs and symptoms of liver cancer
jaundice, ascites, weight loss, fatigue, RUQ pain, hepatomegaly
50
what investigations are required for diagnosing liver cancer
US/CT biopsy alpha feto protein
51
what is the main treatment for liver cancer
liver transplant best chance | resection has high recurrence rate
52
what causes gallstones to occur
abnormal ratio of cholesterol and lipids in bile
53
what two types of gallstones can occur
cholesterol pigment (dark) or mixture of both
54
what are the causes of gallstones
abnormal bile composition bile stasis infection excess cholesterol
55
what are the risk factors for gallstones
fat female fertile forty and fair
56
describe acute cholecystitis
blockage of the cystic duct causing inflammation of the gallbladder
57
gallbladder pain is typically referred to
the right shoulder
58
what are the symptoms of gallstones
biliary colic in RUQ radiating to shoulder typically after eating fatty meal nausea, flatulence, jaundice, PALE STOOLS DARK URINE
59
what is murphys sign and when is it positive
pain when breathing in and palpating the RUQ | positive during acute cholecystitis
60
what investigations are required for gallstones
US of biliary tree | further investigations using CT and ERCP
61
what is the treatment for symptomatic gallstones
nil by mouth antibiotics urgent laparoscopic cholecystectomy
62
what are the main complications of gallstones
migration of the stone to another site - gallstone ileus, pancreatitis and acute cholecystitis
63
what is the second most common hepatobiliary cancer
cholangiocarcinoma - cancer of the bile duct
64
cholangiocarcinoma risk is increased with what conditions
UC and PSC
65
what are the symptoms of cholangiocarcinoma and investigations
vague abdominal pain jaundice weight loss, lethargy, anorexia investigations - US, MRCP/ERCP
66
what is the treatment for cholangiocarcinoma
surgical resection of bile duct and liver - often too late | palliation through biliary stenting
67
which part of the colon is most likely to develop colorectal cancer
sigmoid colon
68
what are the risk factors for developing colorectal cancer
age, smoking, obesity/low fibre diet, polyps, genetic predisposition, PSC, UC
69
what is lynch syndrome
also known as hereditary non-polyposis colorectal cancer | increases risk of developing colorectal and endometrial cancer. genetic condition
70
what is FAP and what does it produce
familial adenomatous polyposis - causes mutation in APC causing carpet of polyps with malignant potential
71
the majority of colorectal cancers are left/right sided
left sided 75% - sigmoid colon
72
what are the symptoms of colorectal cancer (left and right sided)
left - rectal bleeding, tenesmus, constipation, altered bowel habit right - weight loss, anorexia and anaemia, fatigue
73
what are the common sites colorectal cancer can spread to
lung, liver through blood lymph nodes - IMA or superficial inguinal nodes ovaries/prostate through direct invasion
74
what is the main treatment options for colorectal cancer
surgical resection of affected area eg hemicolectomy or proctectomy neo-adjuvant radiotherapy palliative radiotherapy
75
what are oesophageal varices and how do the occur
submucosal venous dilatation secondary to portal hypertension
76
what are the symptoms of oesophageal varices
haematemasis ground coffee vomit symptoms of liver disease eg jaundice, cirrhosis and encephalopathy
77
name some pre, hepatic and post causes of portal hypertension
pre - thrombolysis hepatic - cirrhosis post - budd-chiari or heart failure
78
what is the management for oesophageal varices
IV fluids take bloods and insert catheter urgent endoscopy and either oesophageal banding or sclerotherapy to close off the vein from the inside
79
name some causes of pancreatitis
gallstones, alcohol, iatrogenic, trauma, drugs, autoimmune
80
what are the symptoms of pancreatitis
epigastric pain radiating to the back fever, nausea, vomiting - acute relapsing remitting symptoms and steatorrhoea - chronic
81
what are grey turners sign and cullens sign
grey tuners - flank bruising cullens - periumbilical bruising both signs of pancreatitis
82
what are the investigations and treatment done for pancreatitis
inv - CT, US | treatment - analgesia, fluids and stop alcohol
83
what are the complications of pancreatitis that require surgery
pseudocysts shock abscess necrosis/chronic pancreatitis
84
what are the risk factors for developing pancreatic carcinoma
smoking, alcohol, poor diet high in red meat, chronic pancreatitis, age and male gender
85
what are the symptoms of pancreatic cancer - think about parts of the pancreas
head - painless jaundice body and tail - epigastric pain radiating to the back both, weight loss and fatigue
86
which types of viral hepatitis can be treated with vaccination
Hep A and B
87
name some antivirals that can be used and when are they used in hepatitis
entecavir adefovir | only used in chronic infection
88
which strains of viral hepatitis can produce chronic infection
hep B, C, D
89
describe the spread of each type of viral hepatitis
``` 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
what lab tests are carried out for hep A
Hep A IgM and serology for clotted blood
91
positive anti-HBe Ab indicates
low infectivity of hep B
92
chronic hep B infection is defined as a positive HbsAg for how long?
>6 months
93
Hep B DNA positive indicates
highly infectious individual
94
Hep B IgM positive indicates
recently infected
95
what are the complications of developing chronic hepatitis
cirrhosis and increased risk of hepatocellular carcinoma
96
if an individual has suspected hep C what test is carried out
hep C Ab
97
if someone has positive hep C Ab what test is carried out next and what does it show
PCR for Hep C RNA - positive indicates active infection and negative indicates past infection
98
hep A is more common than Hep E true/false
false Hep E is more common

Gastrointestinal (7 decks)

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