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Phase 2a - conditions > Liver and friends > Flashcards

Liver and friends Flashcards

1
Q

What are the risk factors for gallstones?

A

Fat
Female
Forty
Fertile

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2
Q

What are the constituents of gall stones?

A

Cholesterol stones - 85%
Pigment stones
Mixed

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3
Q

What are the possible complications of gallstones?

A

Biliary colic
Acute choleecystitis
Ascending cholangitis
Gallstone ileus

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4
Q

What is biliary colic?

A

Pain associated with temporary obstruction of the cystic or common bile duct.

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5
Q

What are the symptoms of biliary colic?

A 
RUQ pain 
Radiates to the back/shoulder (phrenic nerve)
Nausea 
Vomiting 
Worse after fatty meals
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6
Q

What investigations should be carried out to identify gallstones?

A

Ultrasound of abdomen
LFTs - to check for liver/bile pathology
Blood tests - often show raised ESR/CRP

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7
Q

What is acute cholecystitis?

A

Gallstone becomes lodged in the neck of the gallbladder, outflow is obstructed and inflammation occurs.

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8
Q

What are the symptoms of acute cholecystitis?

A

Biliary colic
Vomiting
Fever
Local peritonism

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9
Q

What is the difference between biliary colic and acute cholecystitis?

A

Acute cholecystitis has an inflammatory component - fever, peritonism, raised WCC.

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10
Q

What is a specific sign for gallbladder inflammation?

A

Murphy’s sign - laying two finger over RUQ, pain is experienced when the patient breathes in. (only positive is same does not occur in the LUQ).

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11
Q

What is the treatment for biliary colic?

A

Analgesia
Fluids
Laprascropic cholecystectomy (if gallstone cannot be passed)

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12
Q

What is the treatment for acute cholecystitis?

A

Analgesia
Antibiotics
Laparoscopic cholecystectomy

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13
Q

What is ascending cholangitis?

A

Gallstone blocking the common bile duct and causing infection and inflammation.

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14
Q

What are the symptoms of cholangitis?

A

Charcot’s triad - fever, RUQ pain, jaundice

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15
Q

What is a specific sign for ascending cholangitis?

A

Rigors

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16
Q

What does an FBC show in cholangitis?

A

raised ESR and CRP

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17
Q

What do LFTs show in cholangitis?

A

raised AST and ALT

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18
Q

What enzymes can be used as markers of liver injury?

A

Alanine transaminase

Aspartate transaminase

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19
Q

How to treat cholangitis?

A

IV antibiotics

Stone removal

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20
Q

What is gallstone ileus?

A

When a gallstone erodes through the gallbadder into the duodenum - can then cause obstruction in the terminal ileum.

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21
Q

What are two autoimmune conditions of the biliary tract?

A

Primary biliary cholangitis

Primary sclerosing cholangitis

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22
Q

What is the nature of primary biliary cholangitis?

A

Autoimmune mediated inflammation of the interlobar bile ducts - non continuously.

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23
Q

What is the nature of primary sclerosing cholangitis?

A

Autoimmune mediated inflammation of the interlobar and extrahepatic bile ducts.

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24
Q

What autoantibody is present in primary biliary cholangitis?

A

AMA - diagnostic feature

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25
Q

What are the associations of primary sclerosing cholangitis?

A

other autoimmune conditions - IBD.

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26
Q

What are the S+S of the autoimmune cholangitis conditions?

A

Lethargy
Pruritus
Jaundice
If late - liver failure

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27
Q

What are the symptoms of acute hepatitis?

A

Asymptomatic
Malaise
Myalgia
RUQ pain

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28
Q

What are the signs of acute hepatitis?

A

Jaundice
Tender hepatomegaly
Raised AST and ALT and bilirubin

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29
Q

What are the causes of acute hepatitis?

A

Hepatitis A, B (+/- D), C and E

Alcohol, drugs, toxins

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30
Q

What are the symptoms of chronic hepatitis?

A

Asymptomatic
Malaise
Myalgia
Swollen RUQ

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31
Q

What are the signs of chronic hepatitis?

A

Clubbing
Jaundice
Ascites
Coagulopathy

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32
Q

What are the causes of chronic hepatitis?

A 
Hepatitis B (+/- D), C and E
Alcohol, drugs, toxins.
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33
Q

What is the genetic material in hepatitis A?

A

RNA

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34
Q

How is hepatitis A spread?

A

Faeco-orally

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35
Q

What are the risk factors for hepatitis A?

A

Travel, household contact, IVDU

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36
Q

What are the clinical features of hep A?

A

Acute only

100% immunity post infection

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37
Q

How do you diagnose infection by hepatitis?

A

Initial rise in anti-hepatitis ‘A’ virus IgM

Then anti-hepatitis ‘A’ virus IgG remains post infection as a marker of previous infection.

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38
Q

What is the management for hepatitis A?

A

vaccination available

Supportive treatment - self limiting condition.

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39
Q

What is the genetic material in hepatitis B?

A

DNA

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40
Q

How is hepatitis B spread?

A

Blood-borne

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41
Q

What are the risk factors for contracting hepatitis B?

A

mother-child, iatrogenic, IVDU

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42
Q

What are the clinical features of hepatitis B?

A

Acute and chronic (1-5%) forms

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43
Q

What can be used to treat chronic hepatitis B?

A

pegylated interferon - alpha 2a.

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44
Q

What is the genetic material of Hepatitis C?

A

RNA

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45
Q

How is hepatitis C transmitted?

A

Blood-bourne

46
Q

What are the risk factors for hepatitis C?

A

90% history of IVDU

47
Q

What are the clinical features of hepatitis C?

A

Acute (30%) or chronic (70%)
50% of cases are undiagnosed
Previous infection does not give immunity

48
Q

What is the consequence of chronic hepatitis C?

A

cirrhosis and liver failure

49
Q

How is chronic hepatitis C treated?

A

Anti-virals

50
Q

What is the genetic material of hepatitis D?

A

RNA

51
Q

What is the clinical features of hepatitis D?

A

It cannot arise on its own. Will only present in combination with Hepatitis B.

52
Q

What is Hep D spread?

A

Blood bourne

53
Q

What is the genetic material of Hepatitis E?

A

RNA

54
Q

How is hepatitis E transmitted?

A

faeco-oral spread

55
Q

What are the clinical features of hepatitis E?

A

95% asymptomatic

Usually acute, can be chronic in immunosuppressed.

56
Q

What are risk factors for hepatitis E?

A

Contaminated food and water - UK undercooked pork.

57
Q

What is the progression of liver damage from alcohol?

A

Inflammation - steatosis - fibrosis - cirrhosis

58
Q

How does alcohol damage the liver?

A

Conversion of ethanol - acetaldehyde uses NAD+ which leads to less fat oxidation.
Acetaldehyde directly damages the hepatocytes.

59
Q

What is the consequence of alcohol damage to the liver?

A

Liver failure

60
Q

What are the causes of liver cirrhosis?

A

Alcohol abuse
Hepatitis B or C
Genetic disorders
Non-alcoholic steatohepatitis

61
Q

What are the signs of chronic liver disease?

A 
Oedema 
Ascites
Spider naevi 
Easy bruising 
Jaundice 
Prirutus 
Encephalopathy (CNS changes due to toxins)
Infections
Hypoglycaemia
62
Q

What are the symptoms fo chronic liver disease?

A

Malaise
Fever
Anorexia

63
Q

What is the cause of oedema and ascites in liver failure?

A

Failure of production of albumin - hypoalbuminaemia - low oncotic pressure of blood - fluid not drawn back in.

64
Q

What is the cause of spider naevi?

A

Change in oestrogen metabolism causes dilation of blood vessels.

65
Q

Why is there easy bruising in liver failure?

A

Clotting factors not produced

66
Q

What are the results of blood tests in chronic liver failure?

A

LFTs - raised bilirubin, AST, ALT, GGT

Low albumin

67
Q

What other investigations should be carried out in liver failure?

A

Ultrasound

Biopsy

68
Q

How to treat chronic liver failure?

A

If alcohol induced - stop alcohol!
Avoid NSAIDs, sedatives, opiates
Treat cause
Liver transplant

69
Q

Is cirrhosis reversible?

A

NO

70
Q

What are the causes of portal hypertension?

A

pre-hepatic - thrombosis
hepatic - cirrhosis, fibrosis
post hepatic - RHF, constrictive pericarditis

71
Q

What is the effect of portal hypertension?

A

Results in varices (swollen veins) in teh oesophagus/stomach/rectum.
Can also cause ascites.

72
Q

What is the risk with varices?

A

Variceal bleeding - presents as a GI bleed.

73
Q

What is the pathogenesis of oesophagel varices?

A

Progressive liver fibrosis/cirrhosis - portal hypertension - splanchnic vasodilation - increased CO - formation of collaterals between portal and systemic (ie. lower oesophagus) - pressure increases - eventual bleed.

74
Q

What is non-alcoholic fatty liver disease?

A

An accumulation of fat in the liver that can lead to fibrosis and cirrhosis.

75
Q

What are the risk factors of NAFLD?

A

Obesity
Hypertension
Diabetes
Hyperlipidaemia

76
Q

What lifestyle advice should be offered in NAFLD?

A

Weight loss
Exercise
Healthier diet - Mediterranean

77
Q

What is no-alcoholic steatohepatitis?

A

Liver inflammation caused by fat deposition.

78
Q

What is a possible complication of NASH?

A

Increases the risk of hepatocellular carcinoma.

79
Q

What are three inherited metabolic causes of liver disease?

A

Wilson’s disease
Hereditory haemochromatosis
Alpha-1-antitrypsin deficiency

80
Q

What is Wilson’s disease?

A

Excess copper in the liver and CNS

81
Q

What is the presentation of Wilson’s disease?

A

Liver - heaptitis

CNS - tremor, dysartria, involuntary movements

82
Q

What is a sign of Wilson’s disease?

A

Kayser-Fleischer ring (copper deposition in the cornea)

83
Q

What is hereditory haemochromatosis?

A

Excess iron in various organs.

84
Q

What is the presentation of hereditory haemochromatosis?

A

Bronze pigmentation
Hepatomegaly
Diabetes
Pseudogout

85
Q

What is alpha-1-antitrypsin deficiency?

A

Accumulation of alpha-1-antitrypsin in hepatocytes and a lack of it in the serum. Causing a lack of protease inhibition in alveoli - alveolar damage.

86
Q

What is the physiology of bilirubin metabolism?

A

RBC breakdown releases unconjugated bilirubin - this is conjugated by the liver - released into the small intestine in bile - stercobilinogen excreted in faeces (brown) - urobilinogen reabsorped and excreted by kidneys (yellow).

87
Q

What are the causes of pre-hepatic jaundice?

A

Haemolytic anaemia

88
Q

What are the results of tests for pre-hepatic jaundice?

A

High unconjugated bilirubin

Normal otherwise.

89
Q

What are the causes of hepatic jaundice?

A

ALD
Hepatitis
Drugs
Autoimmune conditions

90
Q

What are the results of tests for hepatic jaundice?

A

High unconjugated and low conjugated

Dark urine and pale stools

91
Q

What are the causes of post-hepatic jaundice?

A

Gallstones

Stricture

92
Q

What are the results of tests for post hepatic jaundice?

A

High unconjugated and high conjugated

Dark urine and pale stools

93
Q

What is ascites?

A

Abnormal accumulation of fluid in the peritoneal cavity.

94
Q

What are the three mechanisms of ascites formation?

A

Reduced blood outflow (ie. portal hypertension)
Leaky membrane
Decreased oncotic pressure (ie. hypoalbuminaemia)

95
Q

What is the presentation of ascites?

A 
Swollen stomach 
Tense 
Prominent veins 
Pain/discomfort 
Sign - shifting dullness due to fluid movement within.
96
Q

What is an exudate fluid?

A

High protein fluid. low serum to ascites albumin gradient.

97
Q

What is the cause of an exudate fluid ascites?

A

Membrane problem.

Malignancy, sepsis, TB

98
Q

What is a transudate fluid?

A

Low protein fluid. High serum to ascites albumin gradient.

99
Q

What is the cause of a transudate fluid ascites?

A

Reduced outflow or decreased oncotic pressure. Cirrhosis, cardiac failure.

100
Q

How do you treat ascites?

A

Low sodium diet
Diuretics
FLuid restriction
If that does not work - drain

101
Q

What is the risk with ascites?

A

Spontaneous bacterial peritonitis (cloudy from the drain)

102
Q

What is the toxic intermediate in paracetamol overdose?

A

NAPQI

103
Q

What is the antidote for paracetamol overdose?

A

N-acetyl-cysteine (activated charcoal)

104
Q

What is the most common tumour of the liver?

A

Secondary metastatic tumours.

105
Q

Where may the secondary tumours of the liver originate from?

A

Stomach
Breast
Colon

106
Q

What is the most common primary liver tumour?

A

Hepatocellular carcinoma

107
Q

What are the symptoms of liver tumours?

A 
Fever
Malaise
Anorexia 
Weight loss 
RUQ pain 
Jaundice/ascites - late presentations
108
Q

Risk factors for hepatocellular carcinoma?

A

Hepatitis B virus
Hepatitis C virus
Cirrhosis
NAFLD

109
Q

What is a cancer of the biliary tree called?

A

Cholangiocarcinoma

110
Q

What is the most common benign tumour of the liver?

A

Hemangioma

Phase 2a - conditions (11 decks)

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