Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2a > Liver and Friends > Flashcards

Liver and Friends Flashcards

1
Q

What is liver failure?

A

The inability of the liver to perform its normal functions, and repair or regenerate. Recognised by development of coagulopathy and encephalopathy, can be chronic or acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of liver failure

A 
•   Viral hepatitis, yellow fever
•   Paracetamol overdose
•   Poisonous mushrooms
•   Alcohol, fatty liver disease, autoimmune 
    hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathology of liver failure

A

Destruction of hepatocytes -> development of fibrosis in response to chronic inflammation -> destruction of architecture of the liver nodules -> liver can’t repair or regenerate or perform functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs of liver failure

A
  • Jaundice
  • Hepatic encephalopathy – confusion, drowsiness
  • Bad breath
  • Asterixis
  • Bleeding, bruising
  • Ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of liver failure

A 
o   Itchiness
o   Easy bruising 
o   Abdominal swelling 
o   URQ pain
o   Bad breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations for suspected liver failure

A

• Bloods – FBC, clotting (↑PT), hepatitis,
autoantibodies, low glucose, LFT
• Microbiology – blood culture, urine culture, ascitic
tap
• Radiology – CXR, abdominal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of liver failure

A
  • Treat underlying cause
  • Liver transplant
  • Treat complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of liver failure

A
  • Sepsis
  • Hypoglycaemia
  • GI bleeds/varices
  • Encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Epidemiology of gallstones

A

o Oestrogen link - women > men, pill
o Obesity increases risk
o Prevalence increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Admirand’s triangle?

A

Increased risk of gallstones if ↓lecithin, ↓bile salts, ↑cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the risk factors for cholesterol stones?

A

female, fat, forty, fertile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a cause of bilirubin/pigment stones?

A

Haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are brown/mixed stones usually a sign of?

A

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for gallstones becoming symptomatic?

A

Smoking and pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of gallstones?

A

o Most asymptomatic
o Biliary colic - RUQ pain
o Acute cholecystitis - RUQ pain and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for suspected gallstones

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is biliary colic?

A

Sudden abdominal pain due to a gallstone temporarily blocking the cystic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of biliary colic

A

RUQ pain, radiates to back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations for suspected biliary colic

A

Urinalysis, CXR and ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of biliary colic

A

o Analgesia, rehydrate, NBM

o Laparoscopic cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder, usually caused by gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of acute cholecystitis

A

o Continuous epigastric/RUQ pain
o Vomiting
o Fever, peritonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Signs of acute cholecystitis

A

o Murphy’s sign – lay 2 fingers over RUQ, ask patient
to breath in, pain on inspiration
o Palpable GB mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Investigations for suspected acute cholecystitis

A

o Bloods – high WBC

o US – thick-walled, shrunken GB, fluid, stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of acute cholecystitis

A

o NBM, pain relief, IVI and antibiotics
o Laparoscopic cholecystectomy
o Open surgery if perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is cholangitis?

A

Inflammation of the bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the main causes of cholangitis?

A

Gallstones, infection (E. coli, Klebsiella, enterococcus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pathology of cholangitis

A

o Flow of bile prevents intestinal bacteria from
migrating up biliary tree
o Obstruction of the CBD -> inflammation and
susceptibility to infection -> infection ‘ascends’ from
junction with the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the signs and symptoms of cholangitis?

A

o Fever
o RUQ pain
o Jaundice (dark urine, pale stool, itching)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Charcot’s triad?

A

Features of cholangitis: fever, RUQ pain, Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Investigations for suspected cholangitis

A

o Blood tests: LFTs + FBC (hgh WCC)
o US - detect stone/stent/stricture
o MRCP or ERCP - defintitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of cholangitis

A

o IV fluids and antibiotics
o Pain relief
o Clear obstruction with ERCP
o Stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is acute pancreatitis?

A

Sudden inflammation of the pancreas due to destruction by its own digestive enzymes – autodigestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pathology of acute pancreatitis

A

Acinar cells damaged or pancreatic ducts blocked -> zymogens prematurely converted to digestive enzymes -> digest the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

List 10 causes of acute pancreatitis

A 
o   Gallstones 
o   Ethanol abuse
o   Trauma
o   Steroids
o   Mumps
o   Autoimmune
o   Scorpion venom
o   Hyperlipidaemia, hyperthermia, hypercalcaemia 
o   ERCP
o   Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Symptoms of acute pancreatitis

A

Severe epigastric pain (radiates to back, relived by sitting forward), vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Signs of acute pancreatitis

A

o Tachycardia, fever, shock – hypocalcaemia
o Jaundice
o Ridged abdomen ± tenderness
o Periumbilical bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Investigations for suspected acute pancreatitis

A

o Bloods – raised serum amylase and lipase
o ABG – monitoring
o CT – inflammation, necrosis, pseudocysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of acute pancreatitis

A

o Glasgow criteria for predicting severity
o NBM -> IVI
o Analgesia
o Antibiotics if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is chronic pancreatitis?

A

A continuing, chronic, inflammatory process of the pancreas, characterized by irreversible morphologic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Signs and symptoms of chronic pancreatitis

A

o Epigastric pain ‘bores’ through to back – relieved by
sitting forward, hot water bottle
o Bloating, steatorrhoea, weight loss, brittle diabetes
o Symptoms relapse and worsen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Pathology of chronic pancreatitis

A

Repeated bouts of acute pancreatitis -> ductal dilatation and healthy tissue replaced by fibrosis, atrophy and calcification -> pancreatic insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Causes of chronic pancreatitis

A

o Alcohol
o Smoking
o Autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Investigations for suspected chronic pancreatitis

A

o US/CT – calcifications confirm diagnosis
o Bloods – sometimes high amylase and lipase
o ERCP/MRCP – image ducts
o AXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Management of chronic pancreatitis

A

o Pharmacological – analgesia, lipase, fat
soluble vitamins, insulin if DM
o Diet – no alcohol, less meat, reduce obesity
o Surgery – if unremitting pain, narcotic abuse, weight
loss – pancreatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Complications of chronic pancreatitis

A

DM, pancreatic pseudocysts, pancreatic carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is alcoholic liver disease?

A

Chronic liver disease caused by an excess of alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Epidemiology of alcohol liver disease

A

• Most common cause of chronic liver disease in
western world
• Usually presents in men 40-50yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Pathology of alcoholic fatty liver

A

o Acute/reversible
o Reduced NAD -> less oxidation of fat > so it
accumulates in hepatocytes
o Increased ROS damages hepatocytes, acetaldehyde
damages liver cell membranes -> inflammation and
eventually cirrhosis if drinking continues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pathology of alcoholic hepatitis

A

o Bloated hepatocytes contain eosinophilic material
called Mallory bodies, neutrophils surround them
o Fibrosis and foamy degeneration of hepatocytes
o Usually coexists with cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Pathology of alcoholic cirrhosis

A

o Final stage
o Destruction of liver architecture and fibrosis
o Mallory bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Sign and symptoms of alcoholic fatty liver

A

Asymptomatic

53
Q

Signs and symptoms of alcoholic hepatitis

A

Malaise, ↑TPR, anorexia, D&V, jaundice, tender hepatomegaly, ascites, encephalopathy

54
Q

Signs and symptoms of alcoholic cirrhosis

A

May be asymptomatic, usually present with complications of cirrhosis (varices, ascites, encephalopathy, hepatopulmonary hypertension, carcinoma), spider naevi

55
Q

Investigations for suspected alcoholic liver disease

A
  • LFTs: GGT very raised, AST and ALT mildly raised
  • Bloods: elevated MCV
  • Liver biopsy
56
Q

What are the diagnostic features of cirrhosis on a liver biopsy?

A

Mallory bodies, fibrosis, scarring

57
Q

Management of alcoholic liver disease

A

• Lifelong abstinence from alcohol:
o Chlordiazepoxide to help with withdrawal issues
o Counselling
o Acamprosate - relapse
o Disulfiram – unpleasant effects with alcohol
• Thiamine to treat malnutrition from alcohol
• Steroids – help inflammation
• Liver transplant if severe

58
Q

Give a complication of alcoholic liver disease

A

Liver failure

59
Q

Causes of cirrhosis

A

o Chronic alcohol abuse

o Chronic HBV or HCV infection

60
Q

What is cirrhosis?

A

Liver disease characterised by irreversible scarring

61
Q

Pathology of cirrhosis

A

Chronic inflammation and damage -> necrosis of liver cells -> fibrosis

62
Q

Histology of cirrhosis

A

Loss of normal hepatic architecture with bridging fibrosis and structurally abnormal nodular regeneration

63
Q

Symptoms of cirrhosis

A

o Jaundice
o Ascites
o Easy bruising
o Encephalopathy

64
Q

Signs of cirrhosis

A 
o   Splenomegaly 
o   Nail changes – clubbing 
o   Palmar erythema 
o   Loss of body hair
o   Spider naevi
65
Q

Investigations for suspected cirrhosis

A

o Liver biopsy – confirms diagnosis
o Lab tests – raised bilirubin, raised enzymes,
thrombocytopenia (low platelets)

66
Q

Management of cirrhosis

A

o Treat underlying cause – alcohol abstinence,
antiviral treatment
o Liver transplant if severe – definitive treatment
(cirrhosis not reversible)

67
Q

Complications of cirrhosis

A

o Hepatic failure
o Portal hypertension
o Hepatorenal syndrome

68
Q

What are gastro-oesophageal varices?

A

Submucosal venous dilation secondary to portal hypertension

69
Q

Causes of portal hypertension

A

Cirrhosis, schistosomiasis, portal vein thrombosis, right heart failure

70
Q

Consequences of portal HTN

A

Varices (oesophageal, gastric), splenomegaly

71
Q

Management of varices

A

o Oesophageal – endoscopic banding
o Gastric – sclerotherapy
o BB prophylaxis

72
Q

What is jaundice?

A

Yellow discolouraton of the skin caused by high serum bilirubin level

73
Q

Pathology of pre-hepatic jaundice

A

Increased RBC breakdown so increased levels of unconjugated bilirubin

74
Q

Features of pre-hepatic jaundice

A
  • No excess bilirubin in urine
  • Stools brown and urine normal
  • Enlarged spleen (due to excess breakdown)
75
Q

Causes of pre-hepatic jaundice

A

Malaria, sickle cell disease, jaundice of the newborn

76
Q

Pathology of hepatic jaundice

A

Hepatocellular swelling -> liver damaged -> build up in serum unconjugated bilirubin

77
Q

Features of hepatic jaundice

A
  • Raised serum unconjugated and conjugated bilirubin
  • Decreased urobiligen
  • Dark urine, pale stools
  • Enlargement of spleen
78
Q

Causes of hepatic jaundice

A

Hepatitis, drugs, cirrhosis, jaundice of the newborn

79
Q

Pathology of post-hepatic jaundice

A

Biliary system is damaged, inflamed or obstructed

80
Q

Features of post-hepatic jaundice

A
  • Raised serum conjugated bilirubin
  • Unconjugated bilirubin normal
  • Dark urine, pale stools
81
Q

What is hepatitis?

A

Inflammation of the liver

82
Q

Causes of hepatitis

A

• Infection – hepatitis virus (A, B±D, C, E), herpes, TB,
parasites
• Non-infection – alcohol, non-alcohol fatty liver, drugs,
autoimmune, genetic, pregnancy

83
Q

Symptoms of hepatitis

A
  • Malaise
  • Myalgia
  • GI upset
  • Jaundice
  • Tender hepatomegaly
  • Encephalopathy
  • Coagulopathy
84
Q

Signs of hepatitis

A

o Clubbing
o Palmar erythema
o Spider naevi
o Ascites

85
Q

Complications of hepatitis

A

Hepatocellular carcinoma, portal hypertension –> varices, bleeding

86
Q

Investigations for suspected hepatitis

A
  • Serology – detecting antibodies/antigens
  • Bloods – raised AST, ALT (GGT, ALP) +/- bilirubin
  • LFTs can be normal if compensated chronic
87
Q

Management of hepatitis

A
  • Vaccines available: A (travellers) & B (immunisation)
  • A&E: supportive as they are self-limiting
  • Chronic B: Pegylated interferon-α 2a = pegasys
  • Chronic C: antiviral: Velpatasvir/sofosbuvir
88
Q

How is Hep A transmitted?

A

Faeco-oral, normally with travel history, contaminated food or water, associated with shellfish

89
Q

Is Hep A acute or chronic?

A

Acute

90
Q

How is Hep B transmitted?

A

Blood-borne - usually intercourse

91
Q

Is Hep B acute or chronic?

A

Both

92
Q

How is Hep C transmitted?

A

Blood-borne - usually shared needles

93
Q

Is Hep C acute or chronic?

A

Both

94
Q

How is Hep D transmitted?

A

Blood-borne (IVDU) - combines with B

95
Q

Is Hep D acute or chronic?

A

Both

96
Q

How is Hep E transmitted?

A

Faeco-oral, contaminated food or water, endemic in UK, undercooked pork

97
Q

Is Hep E acute or chronic?

A

Acute - chronic risk if immuno-compromised

98
Q

What is Wilson’s disease?

A

Rare inherited disorder with excess copper deposition in liver and CNS

99
Q

Cause of Wilson’s disease

A

Autosomal reccessive disorder

100
Q

Pathophysiology of Wilson’s disease

A

Incorporation and excretion of iron into bile is impaired -> copper accumulates in liver, and later other organs

101
Q

Signs and symptoms of Wilson’s disease

A

o Children – hepatitis, cirrhosis, liver failure
o Young adults – tremor, dysphagia, Parkinsonism,
ataxia
o Mood changes
o Cognitive decline
o KF rings – copper in iris
o Haemolysis

102
Q

Investigations for suspected Wilson’s disease

A

o Bloods – low caeruloplasmin, high serum copper

o Urine – high 24hr copper excretion

103
Q

Management of Wilson’s disease

A

o Lifelong penicillamine

o Liver transplant

104
Q

What is haemochromatosis?

A

Inherited disorder of iron metabolism - increased intestinal iron absorption leads to iron deposition in liver, joints and other organs

105
Q

Epidemiology of haemochromatosis

A

Middle-aged men > women (menstruation protective), Northern European

106
Q

Cause of haemochromatosis

A

Mutation in HFE gene

107
Q

Signs and symptoms of haemochromatosis

A 
o   Slate-grey skin pigmentation 
o   Signs of chronic liver disease (cirrhosis)
o   Cardiomyopathy 
o   DM
o   Hypogonadism
108
Q

Investigations for suspected haemochromatosis

A

o Bloods – high ferritin, high transferrin
o HFE genotyping
o Liver biopsy – Perl’s stain

109
Q

Management of haemochromatosis

A

o Venesection for life (bloodletting)

o Screen first degree relatives

110
Q

What is alpha-1-antitrypsin deficiency?

A

Inherited disorder affecting the lungs (emphysema) and liver (cirrhosis)

111
Q

What is alpha-1-antitrysin?

A

A glycoprotein and a serine protease inhibitor made in the liver that controls inflammatory cascades

112
Q

Symptoms of A1AT deficiency

A

o Dyspnoea from emphysema
o Cirrhosis
o Cholestatic jaundice

113
Q

Investigations for suspected A1AT deficiency

A

o Low serum A1AT
o Lung function tests
o Liver biopsy
o Phenotyping

114
Q

Management of A1AT deficiency

A

o Smoking cessation
o Liver/lung transplantation
o Inhaled/IV A1AT

115
Q

Epidemiology of pancreatic cancer

A

Male >70yrs

116
Q

Risk factors for pancreatic cancer

A

Smoking, alcohol, DM, chronic pancreatitis, central obesity, KRA2 gene

117
Q

Symptoms of pancreatic cancer

A

o Epigastric pain
o Weight loss, anorexia
o Diabetes
o Acute pancreatitis

118
Q

Signs of pancreatic cancer

A

o Jaundice and palpable gallbladder
o Epigastric mass
o Hepato/splenomegaly
o Ascites

119
Q

Management of pancreatic cancer

A

o Most present with mets
o Surgical resection
o Opiates
o Stenting for jaundice in palliation

120
Q

Investigations for suspected pancreatic or hepatocellular cancer

A

o US/CT/MRI

o Biopsy

121
Q

Epidemiology of hepatocellular carcinoma

A

China and America, M:F 3:1

122
Q

Signs and symptoms of hepatocellular carcinoma

A 
o	Fatigue
o	Loss of appetite, weight loss
o	RUQ pain 
o	Jaundice 
o	Ascites 
o	Haemobilia
123
Q

Known causes of hepatocellular carcinoma

A

o HBV and HCV
o Cirrhosis
o Non-alcohol fatty liver

124
Q

Management of hepatocellular carcinoma

A

o Surgical resection of solitary tumours
o Liver transplant
o Prevention - HBV vaccine

125
Q

What is ascites?

A

Abnormal accumulation of fluid within the abdomen

126
Q

Causes of ascites

A
  • Chronic liver disease (most)
  • Neoplasia (ovary, uterus, pancreas)
  • Pancreatitis
  • Cardiac causes
127
Q

What is the characteristic LFT finding in alcoholic liver disease?

A

Severely raised GGT

128
Q

What is Reynold’s pentad?

A

Charcot’s triad + shock + altered mental state

Phase 2a (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions