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Phase 2a Yellow Conditions > Liver and friends > Flashcards

Liver and friends Flashcards

1
Q

What is infective diarrhoea?

A
  • increased stool frequency and volume
  • decreased consistency
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2
Q

Causes of infective diarrhoea

A

viral

  • rotavirus → children
  • norovirus
  • adenovirus

bacterial

  • e.coli
  • norovirus
  • c difficile

parasites → giardia

Abs

other

  • anxiety
  • food allergy

chronic

  • IBS
  • IBD
  • coeliac
  • bowel cancer
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3
Q

Risk factors for infective diarrhoea

A
  • foreign travel
  • crowded area
  • poor hygiene
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4
Q

Causes of infective diarrhoea

A

viral

  • rotavirus → children
  • norovirus
  • adenovirus

bacterial

  • e.coli
  • norovirus
  • c difficile

parasites → giardia

Abs

other

  • anxiety
  • food allergy

chronic

  • IBS
  • IBD
  • coeliac
  • bowel cancer
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5
Q

Risk factors for infective diarrhoea

A
  • foreign travel
  • crowded area
  • poor hygiene
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6
Q

Pathophysiology of haemochromatosis

A
  • mutation in autosomal recessive HFE gene
  • increased intestinal iron absorption
  • iron accumulates in liver, joints, pancreas, heart, skin, gonads
  • organ damage
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7
Q

Presentation of haemochromatosis

A
  • slate grey skin → brownish/bronze
  • fatigue, arthralgia, weakness
  • hypogonadism eg ED
  • chronic liver disease, HF, arrythmia
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8
Q

Pathophysiology of haemochromatosis

A
  • mutation in autosomal recessive HFE gene
  • increased intestinal iron absorption
  • iron accumulates in liver, joints, pancreas, heart, skin, gonads
  • organ damage → liver fibrosis, cirrhosis, HCC
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9
Q

Presentation of haemochromatosis

A
  • slate grey skin → brownish/bronze
  • fatigue, arthralgia, weakness
  • hypogonadism eg ED
  • chronic liver disease, HF, arrythmia
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10
Q

Investigations for haemochromatosis

A
  • bloods → iron study, LFTs
  • genetic testing
  • MRI → detects iron overload

GOLD STANDARD = liver biopsy

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11
Q

Treatment for haemochromatosis

A
  1. venesection
  2. iron chelation

DEFINITIVE TREATMENT = liver transplant

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12
Q

Complications of haemochromatosis

A
  • cirrhosis
  • HCC
  • diabetes
  • heart disease
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13
Q

What is Wilson’s disease?

A
  • too much copper
  • builds up in liver and CNS
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14
Q

Aetiology of Wilson’s

A
  • autosomal recessive
  • defective enzyme involved in biliary excretion of excessive copper
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15
Q

Pathophysiology of Wilson’s

A

Cu2+ accumulates in

  • liver → liver symptoms
  • basal ganglia → Parkinson’s
  • cornea → kayser-Fleischer rings
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16
Q

Presentation of Wilson’s

A
  • depression
  • neurotic behavioural patterns
  • Parkinson’s symptoms
  • hepatitis, cirrhosis
  • Kayser-Fleischer ring → copper in cornea, green/brown pigment at outer edge
17
Q

Investigations for Wilson’s

A
  1. serum copper and caeruloplasmin reduced
    GOLD STANDARD = liver biopsy
18
Q

Pathophysiology of A1AT deficiency

A

A1AT gene

  • produced in liver
  • inhibits neutrophil elastase → produced with inflammation, infection, smoking
  • with A1AT deficiency, elastase breaks down elastic unchecked
  • affects lung (alveolar wall destruction) and lung
19
Q

What is A1AT deficiency?

A
  • autosomal recessive genetic disorder
  • results in lung and/or liver disease
20
Q

Pathophysiology of A1AT deficiency

A
  • A1AT defi
21
Q

Presentation of A1AT deficiency

A

lung

  • COPD like symptoms
  • SOB
  • emphysema

liver

  • cirrhosis
  • hepatitis
  • neonatal jaundice
22
Q

Investigations for A1AT deficiency

A
  • bloods → serum A1AT low
  • LFTs, PFTs
  • chest xray
  • liver biopsy
23
Q

What is peritonitis

A

inflammation of the peritoneum

24
Q

Pathophysiology of peritonitis

A
  • inflammation from infection of irritation
25
Q

Primary causes of peritonitis

A
  • SBP
  • ascites
26
Q

Treatment for peritonitis

A
  • ABCDE management
  • find and treat underlying cause
  • IV fluids
  • IV Abs → 1. broad spec 2. specific for pathogen
  • peritoneal lavage → clean cavity
27
Q

Investigations for peritonitis

A

bloods

  • FBC, CRP
  • amylase → pancreatitis
  • hCG → ruptured ectopic pregnancy
  • erect chest xray → air below diaphragm
  • abdo xray → bowel obstruction
  • abdo CT → ischaemia

ascitic tap and blood cultures

28
Q

Treatment for peritonitis

A
  • ABCDE
29
Q

Causes of portal HTN

A

prehepatic
- portal vein thrombosis

intrahepatic

  • cirrhosis
  • budd chiari

posthepatic

  • RHS HF
  • IVC obstruction
30
Q

Symptoms of portal HTN

A

asymptomatic or symptoms of complications

  • ascites
  • bleeding varices
31
Q

What are bleeding varices?

A
  • GI bleed with chronic liver disease
  • most patients with cirrhosis develop varices
  • only 1/3 bleed → often massive
32
Q

Investigations for varices

A
  1. GOLD STANDARD = upper GI endoscopy
33
Q

Progression of varices

A
  • rupture
  • haematemesis
  • blood digested
  • malaena
34
Q

Treatment for varices

A
  • beta blocker to reduce CO → reduces portal pressure
  • nitrate to reduce portal pressure
  • band ligation
  • trans jugular intrahepatic portosystemic shunt (TIPSS)
35
Q

Management of active bleeding varices

A
  • urgent endoscopy/gastroscopy
  • fluid resusictation
  • terlipressin or octreotide
  • balloon tamponade

GOLD STANDARD = endoscopic therapy → band ligation/scleropathy

36
Q

How do you prevent reoccurrence of varices?

A
  • 60-80% chance of recurrence within 2 years

secondary prophylaxis

  • propanolol/isosorbide
  • repeat variceal banding
  • TIPSS

Phase 2a Yellow Conditions (12 decks)

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