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Phase 2a > Liver and Friends > Flashcards

Liver and Friends Flashcards

1
Q

What is biliary colic?

A

A SYMPTOM!

  • Pain due to obstruction of the cystic duct or the common bile duct with a gallstone
  • Epigastric/RUQ pain, may radiate to R shoulder
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2
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder as a result of obstruction of the cystic duct with a stone

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3
Q

What are the symptoms and signs of acute cholecystitis?

A

Symptoms:

  • Biliary colic
  • N+V
  • Fever

Signs:

  • Murphy’s sign (pain on inspiration when gallbladder is palpated)
  • Local peritonism (tenderness, guarding)
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4
Q

Describe the investigation of acute cholecystitis

A

Bloods:
- LFTs: raised bilirubin, raised alkaline phosphatase (ALP) and rasied gamma-glutamyltransferase (GGT)

Abdominal US:
- Gallstones

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5
Q

Describe the management of acute cholecystitis

A

1st line = cholecystectomy

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6
Q

What is ascending cholangitis?

A

Inflammation/infection of the biliary tree, most commonly due to obstruction of the common bile duct by a gallstone

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7
Q

What are the symptoms and signs of ascending cholangitis?

A

Symptoms:

  • Biliary colic
  • N+V
  • Fever

Signs:

  • Jaundice
  • Local peritonism (tenderness and guarding)
  • Hypotension
  • Confusion

Charcot’s triad = jaundice, biliary colic (RUQ pain), fever

Raynaud’s pentad = Charcot’s triad + hypotension and confusion

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8
Q

Describe the investigations of ascending cholangitis

A

Bloods:
- LFTs: raised bilirubin, alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT)

Abdominal US:
- Gallstones

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9
Q

Describe the pharmacological and interventional management of ascending cholangitis

A

Pharmacological:

  • Analgesia
  • IV Abx: Cefotaxime and Metronidazole

Interventional:

  • ERCP (stone removal/stenting)
  • Cholecystectomy
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10
Q

Briefly describe the pathophysiology of liver cirrhosis

A
  • Hepatocyte necrosis
  • Fibrosis
  • Nodule formation
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11
Q

Give some signs of liver cirrhosis

A
  • Hepatomegaly
  • Ascites
  • Jaundice
  • Clubbing
  • Leuconychia
  • Spider naevi
  • Dupuytren’s contracture
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12
Q

What are the causes of liver cirrhosis?

A
  • Alcoholic liver disease
  • Viral hepatitis
  • Autoimmune, e.g. primary biliary cholangitis
  • Metabolic, e.g. hereditary haemochromatosis, Wilson’s disease, alpha 1 antitrypsin deficiency
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13
Q

What is hereditary haemochromatosis?

A

An inherited condition in which iron levels in the body slowly build up over many years (iron overload) - this damages organs, e.g. heart, pancreas, liver

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14
Q

Describe the investigation of hereditary haemochromatosis

A

Bloods:

  • Serum ferritin levels raised
  • Transferrin saturation >45%

Liver biopsy:
- Perl’s stain = blue (iron present)

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15
Q

Describe the management of hereditary haemochromatosis

A

Conservative:
- Low iron diet

Interventional:
- Venesection (taking blood so that the body uses up its iron stored to make new RBCs)

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16
Q

Which organs does alpha 1 antitrypsin deficiency affect? How does it affect them?

A
  • Lungs, causes emphysema

- Liver, causes cirrhosis and increased risk of hepatocellular carcinoma

17
Q

Describe the investigation of alpha 1 antitrypsin deficiency

A

Bloods:
- Serum alpha 1 antitrypsin levels reduced

Liver biopsy:

  • Put tissue samples through diastase treatment which should break down glycogen, however A1AD provides resistance to diastase treatment, so glycogen still present
  • Use Periodic Acid Shiff (PAS) stain to show glycogen present (stains purple)
18
Q

Describe the conservative management of A1AD

A

Smoking cessation

19
Q

What is Wilson’s disease?

A

A genetic condition in which the levels of copper in the body are too high, so copper accumulates in organs (e.g. liver, brain) leading to organ damage

20
Q

Describe a characteristic sign of Wilson’s disease

A

Kayser-Fleischer rings (dark rings that encircle the iris as a result of excess copper deposition)

21
Q

Describe the investigation of Wilson’s disease

A

Urine:
- 24 hr copper excretion raised

Liver biopsy:
- Hepatic copper concentration raised

22
Q

Describe the management of Wilson’s disease

A

Conservative:
- Low copper diet

Pharmacological:

  • Penicillamine
  • Zinc
23
Q

What is primary biliary cholangitis?

A

Autoimmune destruction of the interlobar bile ducts, which leads to liver cirrhosis

24
Q

Describe the investigation of primary biliary cholangitis

A

Blood tests:

  • LFTs: raised bilirubin, raised ALP, low albumin
  • Prolonged PT
  • Autoantibody screen = anti-mitochondrial antibody (AMA)
25
Q

Describe the management of primary biliary cholangitis

A

Pharmacological:

  • Ursodeoxycholic acid (UDCA)
  • Colestyramine
  • Vitamin supplementation (fat soluble vitamins)

Interventional
- Consider liver transplant

26
Q

Describe the investigation of alcoholic liver disease

A

Bloods:

  • LFTS: raised bilirubin, low albumin, aspartate transaminase (AST) : alanine trasnaminase (ALT) >2, significantly raised GGT
  • Prolonged PT

Other Ix = imaging, biopsy

27
Q

Describe the management of alcoholic liver disease

A

Conservative:
- Abstinence from alcohol

Pharmacological:
- Drugs to help with alcohol withdrawal, e.g. naltrexone

Interventional:
- Liver transplant

28
Q

Describe the symptoms of alcoholic liver disease

A
  • N+V

- Anorexia

29
Q

Describe the symptoms of viral hepatitis

A
  • N+V
  • Fatigue
  • Weakness
  • Lymphadenopathy
30
Q

Describe the investigation of viral hepatitis

A

Viral serology and PCR to distinguish between different types

31
Q

Distinguishing which hepatit virus…

a) Which hepatitis viruses are RNA/DNA?
b) How are they spread?

A

a) ALL RNA except hepatitis B (which is DNA)

b) Hep A and E = faeco-oral, hep B, C and D = bloodborne

32
Q

What are the complications of liver cirrhosis?

A
  • Portal hypertension (gastro-oesophageal varices, ascites/spontaneous bacterial peritonitis)
  • Hepatocellular carcinoma
33
Q

Describe the pathophysiology of portal hypertension and its complications

A
  • Blood pressure in portal vein increases due to blockage/increased resistance to blood flow as a result of scarring (fibrosis)
  • This causes a porto-systemic shunt: blood is shunted from portal vein to distal oesophageal veins
  • This leads to dilatation of veins at the gastro-oesophageal junction (gastro-oesophageal varices) which can rupture

Portal hypertension also leads to ascites (collection of fluid in the peritoneal cavity)

34
Q

Patients with ascites are at risk of…

A

Spontaneous bacterial peritonitis - infection of fluid in peritoneal cavity (ascitic patient)

Treatment:
- IV Cefotaxime and Metronidazole

35
Q

What is the most common histological type of liver tumour?

A

Hepatocellular carcinoma

36
Q

Describe the investigation of liver cancer

A

CT abdomen and biopsy

37
Q

Describe the management of liver cancer

A

Resection

Phase 2a (16 decks)

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