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med > Liver and friends > Flashcards

Liver and friends Flashcards

1
Q

Which liver enzymes is raised the most in alcoholic liver disease?

A

AST

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2
Q

What are the metabolic causes of liver disease?

A

Hereditary haemochromatosis
Wilsons disease
Alpha 1 antitrypsin deficiency

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3
Q

What are the symptoms of hereditary haemochromatosis?

A 
(Jack lost his point and shoot)
Joints - arthralgia
Liver - CLD
Heart - dilated cardiomyopathy
Pancreas - DM
& - loss of libido 
Skin - slate grey skin
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4
Q

What Ix are done for hereditary haemochromatosis?

A

Ferritin (low values would exclude)
Transferrin sat > 45%
HFE gene testing

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5
Q

What is the mainstay of treatment for hereditary haemochromatosis?

A

Venesection

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6
Q

What additional monitoring will a hereditary haemochromatosis pt need if liver is cirrhotic?

A

Yearly screen for hepatocellular carcinoma with USS +- AFP

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7
Q

Why is iron high in hereditary haemochromatosis?

A

Increased intestinal iron absorption

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8
Q

What are the presenting features of wilsons disease/

A

hepatic - ALF, cirrhosis, chronic hepatitis
Depression/personality change
Tremor, ataxia, clumbsiness
Kayser Fleischer rings

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9
Q

What Ix for wilsons disease?

A

Low serum caeruloplasmin
High free copper
High urine copper excretion

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10
Q

How is wilsons disease mx?

A

Diet control

Penicillamine

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11
Q

Ix should you do in young person with features of COPD and liver disease

A

serum alpha1- antitrypsin

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12
Q

Define hyperacute liver failure

A

Onset less than 7 days

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13
Q

Define acute liver failure

A

Onset 8-21 days

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14
Q

Which drug can be used to help tx encephalopathy due to liver failure?

A

Lactulose

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15
Q

How do you tx cerebral oedema?

A

Mannitol IV and hyperventilate on ITU

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16
Q

Aet of ascites

A

CIRRHOSIS
MALIGNANCY
heart failure
nephrotic syndrome

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17
Q

What should you suspect in a patient with a triad of cirrhosis, ascites and renal failure?

A

Hepatorenal failure

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18
Q

What are the comps of cirrhosis?

A

Hepatic failure
Portal htn
Hepatocellular carcinoma (HCC risk)

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19
Q

What are the most common causes of cirrhosis?

A

Chronic alcohol abuse
HBV
HCV
non-alcoholic steatohepatitis

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20
Q

What features on liver biopsy indicate cirrhosis?

A

Loss of hepatic architecture
Bridging fibrosis
Nodular regeneration

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21
Q

What scoring system can be used to assess the prognosis of CLD?

A

Child-pugh classification

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22
Q

What are the components of child-pugh classification?

A 
Encephalopathy
Ascites
Bilirubin
Albumin 
INR
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23
Q

What are the comps of portal htn?

A

Oesophageal varices
Caput medusae
Rectal haemorrhoids
Ascites

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24
Q

What drug can be used in the primary prevention of varices?

A

Beta blockers (e.g. propranolol)

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25
Q

What drug can be used to help manage an acute varices bleed?

A

Terlipressin

26
Q

What are the two most common types of primary liver Ca?

A

HCC

cholangiocarcinoma

27
Q

Causes of HCC?

A

Cirrhosis
Hep C
Hep B
Autoimmune hepatitis

28
Q

How do you screen for HCC?

A

12 monthly USS and AFP

29
Q

Which condition increases the risk of cholangiocarcinoma?

A

PSC

30
Q

Name a immunohistochemical sign of ALD?

A

Mallory bodies

31
Q

Which Abs are raised in autoimmune hepatitis?

A

Antismooth muscle Abs

32
Q

How is autoimmune hepatitis mx?

A

Steroids and azathioprine

33
Q

What amylase value is suggestive of acute pancreatitis?

A

3 fold of upper limit

34
Q

What Ix for acute pancreatitis?

A 
Amylase
Lipase
AXR
CXR
CT
ABG
35
Q

What score is used to calculate the probability of severe pancreatitis developing?

A

Modified Glasgow score

36
Q

What happens to glucose in acute pancreatitis?

A

Goes up

37
Q

What’s the leading cause of chronic pancreatitis?

A

Alcohol

38
Q

How does chronic pancreatitis present?

A

Abdo pain
N & V
Diarrhoea, steatorrhoea
DM

39
Q

What amylase level indicates chronic pancratitis?

A

Will be normal

40
Q

What should you suspect in a patient with painless obstructive jaundice?

A

Pancreatic Ca

41
Q

What is courvoisiers sign?

A

In a pt with painless jaundice and an enlarged gallbladder unlikely to be gallstones

Likely pancreatic or biliary neoplasm

42
Q

Which tumour marker can aid in diagnosis of pancreatic Ca?

A

CA19-9

43
Q

Which tests are used to visualise the pancreas and bile ducts?

A

ERCP/MRCP

44
Q

What are gallstones made of?

A

Cholesterol (80%)
Pigment (10%)
Mixed (10%)

45
Q

Whats the most sensitive Ix for biliary stones?

A

USS

46
Q

How does cholecystitis px?

A 
RUQ pain (continuous)
\+
Fever/raised WCC
47
Q

Whats the definitive tx for cholecystitis?

A

Laparoscopic cholecystectomy

48
Q

What’s charcots triad?

A

RUQ pain
Fever/ raised WCC
JAUNDICE

49
Q

What does charcots triad suggest?

A

Ascending cholangiitis

50
Q

What is Reynolds pentad?

A

Charcots (RUQ pain, fever and jaundice)
+
ALTERED MENTAL STATE and CONFUSION

51
Q

What can cause ascending cholangitis?

A

Stones
Tumours
ERCP

52
Q

What three conditions help dx ascending cholangitis?

A

1) systemic inflammation
2) evidence of cholestasis
3) Imaging (CT best)

53
Q

How do you manage ascending cholangitis?

A

same as sepsis

54
Q

Define primary sclerosing cholangitis

A

Progressive cholestasis with bile duct inflammation and strictures
Effects intra and extrahepatic ducts

55
Q

How does PSC px?

A

Pruritus
Fatigue

Can eventually get cirrhosis/liver failure

56
Q

What conditions is PSC associated with?

A

IBD (esp UC)

Cancer (bileduct, gallbladder, liver, colon)

57
Q

What monitoring do PSC pts need?

A

Yearly USS and colonoscopy due to Ca risk

58
Q

Which autoantibody is most commonly positive in PSC?

A

ANA

59
Q

Define primary biliary cirrhosis

A

INTERLOBULAR bile ducts damaged by chronic autoimmune granulomatous inflammation

60
Q

Which auto Ab is positive in primary biliary cirrhosis?

A

Antimitichondrial Ab

61
Q

Give three tests you would want to do in PBC?

A

LFTs
USS (rule out obstruction)
MRCP (rule out PSC)

62
Q

What drug can be used to tx pruritus due to biliary obstruction?

A

Colestyramine

med (25 decks)

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