liver and friends Flashcards
list the 11 causes of pancreatitis
IGETSMASHED is the mnemonic to learn for this.
* Idiopathic
* Gallstones
* Ethanol (alcohol)
* Trauma
* Steroids
* Mumps / Malignancy
* Autoimmune
* Scorpion venom/spider bite
* Hyperlipidaemia, hypothermia, hypercalcaemia
* ERCP
* Drugs
pathophysiology of hepatitis?
- liver injury ->
- activation of inflammatory response ->
- infiltration of inflammatory cells and liver cell necrosis ->
- chronic inflammation can lead to progressive fibrosis and cirrhosis ->
- chronic liver disease
treatment for ruptured appendix?
appendectomy then IV antibiotics
what are 2 signs of Wilson’s disease?
- Kayser-Fleischer rings: Build-up of copper in the iris
- Neurological signs: build-up of copper in the CNS
5 clinical features of primary biliary cholangitis?
- MOST COMMON: Pruritus +- jaundice
- Hepatosplenomegaly
- Xanthelasma
- Raised serum ALP or autoantibodies
- Steatorrhea / Malabsorption of fat-soluble vitamins
treatment for paracetamol overdose?
if within 1hr of consumption: activated charcoal, if not: N-acetyl-cysteine
blood test results for ruptured oesophageal varices?
- Anaemia, (Low ferritin, Low Hb).
- Raised bilirubin.
- Low albumin.
- Raised ALT, AST and ALP.
- High creatinine.
- Increased prothrombin time.
- (Possibly viral serology shows hepatitis infection)
2 conditions that can cause bronze skin pigmentation?
Haemochromatosis
Addison’s disease
5 risk factors for acute cholecystitis?
female, fat, fertility, forty, flatulent
what is Murphy’s sign?
pain occurring on inspiration while palpating right subcostal area, occurs in acute cholecystitis
give 2 signs that appear on the abdomen as colour changes during acute pancreatitis
Cullen’s sign, grey turner sign
what is the first line investigation of acute pancreatitis?
serum amylase test
what is the first line treatment for autoimmune hepatitis?
prednisolone
gram-positive bacterium that is coag pos?
staphylococcus aureus
pathophysiology of primary sclerosing cholangitis?
inherited abnormality of immunoregulation leading to T lymphocyte mediated attack on bile duct epithelial cells
presentations of primary sclerosing cholangitis?
insidious onset, jaundice, pruritus, fatigue, +- IBS
what condition is associated with primary sclerosing cholangitis?
cholangiocarcinoma
first line drug given for alcohol withdrawal?
chlordiazepoxide
most common cause of liver cirrhosis?
hepatitis C
what causes median arcuate ligament syndrome?
compression of the coeliac artery
give 4 signs of chronic liver disease
- Palmar erythema
- Clubbing
- Dupuytren’s contracture
- Spider naevi
what test is diagnostic of primary biliary sclerosis?
blood test for anti-mitochondrial antibodies
what does obstructive dyspnoea and liver disease presenting with cholestatic jaundice suggest?
alpha antitrypsin deficiency
What’s the mechanism of action of N-acetyl cysteine?
Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds
what can cause chronic pancreatitis?
alcohol misuse, ERCP
What’s the first investigation you would perform when diagnosing haemochromatosis?
blood test for ferritin levels
Which form of viral hepatitis is a notifiable disease and to whom should it be reported?
hep A, Consultant in Communicable Disease Control OR Public Health England OR local Health Protection Team
Upon a blood test it is found that a patient has Hepatitis B. What was present in the blood to diagnose this?
HBsAg OR AntiHB antibody
Why is Hepatitis D only able to cause disease in those with Hepatitis B?
Incomplete RNA virus – needs Hep B to be able to assemble
Name 3 management protocols for acute Hepatitis B
avoid alcohol, vaccinate contacts, monitor liver function
what is the function of the gallbladder?
store and concentrates bile needed for food digestion
what are most gallstones made from?
cholesterol
how can gallstones cause vit K deficiency?
An obstruction of the bile duct would cause reduced secretion of bile into the small intestine. This would cause reduced absorption of fat and thus the fat soluble vitamins
A possible complication of gallstones is a gallstone ileus, what is this?
impaction of a gallstone within the small intestine
what are the possible treatments for gallstones?
surgery to remove gallbladder and medication to dissolve gallstones
Name the three stages in alcoholic liver disease
Alcoholic fatty liver, Alcoholic hepatitis, Alcoholic cirrhosis
Give 3 complications of liver cirrhosis
Hepatocellular carcinoma, Oesophageal varices, Portal hypertension
Explain why liver failure leads to ascites
- Low albumin produced - Oncotic pressure lower than hydrostatic pressure, fluid leaks into abdominal cavity
- Portal hypertension - Hydrostatic pressure greater than oncotic, fluid leaks into abdominal cavity
Name 2 first line drugs a patient might be prescribed to treat chronic hepatitis.
- SC pegylated interferon-alpha 2A/B
- oral ribavirin
Why can a vaccine for hepatitis C not be developed?
rapid mutations so envelope proteins change rapidly
Name 2 ways the spread of hepatitis C can be prevented.
screen blood products, protection when handling body fluids
give 4 main functions of the liver
- Glucose metabolism
- Fat metabolism
- Detoxification + excretion of: bilirubin/ ammonia/ drugs/ hormones/ pollutants
- Protein synthesis: albumin/ clotting factors
- Defence against infection
Give 3 differential diagnoses of a Biliary Colic
- IBS
- carcinoma on right side of colon
- renal colic
- pancreatitis
What are the 2 types of Biliary Colic?
cholesterol, bile pigment
antimicrobial antibodies are found in which condition typically?
primary biliary cholangitis
what kind of jaundice would present in malaria?
pre-hepatic
give 3 causes of chronic pancreatitis
chronic alcohol use, smoking, autoimmune, haemochromatosis
name 2 tests can be done to confirm chronic pancreatitis
faecal elactase, abdo US/CT to show pancreatic calcifications
state 3 medical treatments used for chronic pancreatitis
insulin therapy if DM has developed, analgesia (e.g. tramadol), pancreatic enzyme replacement therapy
state 3 potential complications of chronic pancreatitis
DM, biliary obstruction, splenic vein thrombosis, steatorrhoea, pancreatic carcinoma
when are ALT and AST be raised?
liver damage e.g. alcoholic hepatitis, cirrhosis
what does HBsAg indicate?
surface antigen - active infection / just been vaccinated
what does HBeAg indicate?
E antigen - marker of viral replication, implies high infectivity
what does HBcAb indicate?
core antibody - past or current infection
what does HBsAb indicate?
surface antibody - vaccination or past / current infection
what is secreted by a hepatocellular carcinoma?
alpha-fetoprotein
Which of the following is the gold standard investigation for portal hypertension?
hepatic venous pressure gradient
Where is an adenocarcinoma of the pancreas most likely to originate from?
head of the pancreas
chromosome for Haemochromatosis?
6
chromosome for Wilson’s disease?
13
chromosome for A1AT?
14
