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2A - Stuff i just cannot remember > Liver and Friends > Flashcards

Liver and Friends Flashcards

1
Q

Which Hepatitis virus is a DNA virus, rather than RNA?

A

Hepatitis B Virus (HBV)

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2
Q

Which Hepatitis viruses transmit via faeco-oral transmission?

A

HAV, HEV

fAEcal

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3
Q

Which Hepatitis viruses transmit via blood-blood transmission?

A

HBV, HCV, HDV

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4
Q

Who is at risk of contracting HDV? What is the management of HDV?

A

Person with HBV.

Can only get HDV WITH HBV.

Management: Pegasys: pegylated interferon-a 48wks

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5
Q

Acute HBV will show which antibody?

Past-exposure/ current HBV will show which Antibody?

A

Acute <6months - Anti-HBV IgM

Past-exposure - Anti-HBV IgG

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6
Q

Which Hepatitis Virus has no vaccine?

A

Hepatitis C - can be re-infected

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7
Q

Which Hepatitis Virus are you more likely to get if young?

A

Hepatitis A

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8
Q

Which Hepatitis Viruses give you a greater risk of developing Chronic Liver Disease/ Hepatocellular carcinoma?

A

Blood-Blood transmission viruses

HBV, HCV, HDV

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9
Q

Pt presents with Jaundice, fever and RUQ abdominal pain. They describe pale stools and you notice pruritus.

Likely diagnosis? Investigations?
Management

A

Acute Cholangitis

1L Transabdominal US

GOLD: ERCP + Biopsy
(Endoscopic retrograde cholangiopancreatography)

Mx: ABx, ERCRP Drainage + Decompression

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10
Q

Pt presents with RUQ Pain which started 9 hours ago, and a positive Murphy’s sign.

Investigation, Management?

A

Acute Cholecystitis

GOLD: Abdominal US

Mx: Early Laparascopic Cholecystectomy (w/in 1 wk)

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11
Q

Define Biliary Colic

A

Steady severe abdominal pain (intensity >5) in the right upper quadrant, lasting 15-30 minutes

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12
Q

Management of gallstones

A

Asymptomatic: conservative

Asymptomatic but stone in common bile duct: clearance + laparoscopic cholecystectomy

Symptomatic: Cholecystectomy

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13
Q

A 50yr old F comes in with RUQ pain, fatigue, pruritus. She complains of a dry mouth and teary eyes. Palpation reveals hepatomegaly.

Investigations, likely diagnosis, management?

A

PBC-specific Autoantibody - AMA (Antimitochondrial Antibodies)

Primary Biliary Cholangitis

Mx: Ursodeoxycholic Acid - bile acid analogue + Prednisolone

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14
Q

What drug is used to treat cholestatic pruritus?

A

Cholestyramine

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15
Q

Pt presents with epigastric stabbing pain radiating to their back. Pain is relieved when moving forward. Theyre feverish and vomiting.

Likely diagnosis? Investigations
Causes? Mx?

A

Acute Pancreatitis

Causes: GET SMASHED

  • gallstones
  • Alcohol binge
  • scorpion venom

Investigations: Elevated serum lipase/ amylase

IV Fluid Resus w/ crytalloids

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16
Q

Signs of severe haemorrhagic pancreatitis?

A

Cullen’s sign: blue colour around umbilicus

Grey-Turner’s sign: blue colour around flank

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17
Q

Pt presents with dull epigastric pain radiating to their back and steatorrhoea. Pain is worse after a fatty meal, and is relieved when sitting forward.

They are jaundice and you notice skin nodules.

Likely diagnosis? Investigations?

A

Chronic pancreatitis

Inv: Elevated BG

GOLD: CT abdomen - calcifications, enlargements, duct dilation

Mx: Alcohol abstinence, diet. Analgesia, insulin, pancreatic enzyme replacement.

Coeliac plexus block, pancreatectomy

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18
Q

Most common complication of acute liver failure

A

Infection

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19
Q

Management of Liver Failure

A

Underlying

Encephalopathy - IV Lactulose + Mannitol

Coagulopathy - VitK, fresh frozen plasma

Peritonitis - broad Abx

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20
Q

How do we determine if someone should have a liver transplant in the context of paracetamol overdose?

A

King’s College Hospital Criteria for Liver Transplant

  • arterial pH OR

prothrombin time
+ creatinine
+ Grade III/ IV encephalopathy

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21
Q

Pt presents with hepatic encephalopathy, bleeds readily and is jaundiced. They’re nauseous and tired. You notice ascites.

Likely diagnosis? Tx?

A

Liver Failure
(Acute <26wks. Chronic if Hx cirrhosis)

Lactulose + Mannitol

VitK + Plasma

22
Q

Management of Alcoholic Liver Disease.

Management of withdrawals

A

Abstinence + Oxazepam

Withdrawals: Chlordiazepoxide, Acamprostate, Naltrexone

23
Q

Management of Non-Alcoholic Liver Disease

A

VitE + Orlistat + Insulin-sensitizer

Lifestyle

24
Q

How do we assess the severity of someone’s alcoholism?

A

AUDIT + SADQ Questionnaire

25
Pt presents with dark urine, jaundice and pale stools. Their ALP is markedly raised. Likely diagnosis
Gallstones - obstructive cause of jaundice ALP is upregulated in response to cholestasis
26
Isolated raised ALP indicates... Where is ALP concentrated?
Isolated raised ALP indicates Bone pathology: tumour, vitD deficiency, fracture ALP is concentrated in: - liver - BILE DUCT - Bone tissue ALP is upregulated in response to cholestasis :, is a good marker
27
Where is ALT concentrated?
ALT is concentrated in HEPATOCYTES :. is a good marker for hepatocellular injury: - hepatitis
28
A marked raise in ALT and mild raise in ALP indicates...
Hepatocellular injury, eg Hepatitis = Hepatic jaundice
29
A marked raise in ALP and mild raise in ALT indicates...
Cholelithiasis = Post-hepatic jaundice
30
Pt is jaundiced, however their ALT and ALP levels are normal. Likely cause? What will their urine and stools look like?
= Pre-hepatic cause of jaundice - GILBERT's SYNDROME (impaired conjugation of bilirubin) - HAEMOLYTIC ANAEMIA (haemolysis = more bilirubin) Unconjugated Bilirubin is water insoluble, so: - Normal urine colour Pre-hepatic pathology, so fat absorption unaffected: - Normal stool colour
31
What is Prothrombin Time? Primary causes of raised PTT? Secondary causes of raised PTT?
PTT = measure of blood's coagulation tendency Primary causes = Liver disease/ dysfunction Secondary causes = anticoagulants + Vitamin K deficiency
32
Low AST/ALT ratio indicates... | ie ALT >AST
Chronic liver disease
33
High AST/ALT ratio indicates... | ie AST > ALT
Cirrhosis, acute alcoholic hepatitis, alcohol abuse
34
Most common cause of hepatitis in travellers Presentations?
Hepatitis A Virus - faecal-oral route - Abrupt onset - fever, n/v - JAUNDICE 2wks post-infection
35
Acute vs Chronic Hepatitis
Acute <6 months Chronic >6 months
36
48-M presents to GP with a swollen groin; he has noticed increasing pain the last few days. examination reveals a lump superior and medial to the pubic tubercle on the left. The lump is partially irreducible. There is no erythema; cough impulse is present. Likely diagnosis? RF? Management?
Inguinal hernia (cannot get above it - irreducible/ partially irreducible) RF: - Old M - connective tissue disease - AAA - prematurity Management: Symptomatic + irreducible: urgent referral to secondary care (because increased risk of strangulation)
37
HBsAg indicates...
Surface antigen - Acute HBV
38
HBeAg indicates...
E antigen - HBV Viral replication, implies high infectivity
39
HBcAb indicates,,,
Core antibody - Past/ current HBV Infection
40
HBsAb indicates...
Surface antibody - HBV vaccination/ past/ current infection Vaccines inject surface antigens :. surface Ab develop
41
Pt has malaise, joint pain and jaundice for 2 months. Hepatitis screen shows: HBsAg, HBeAg, HBcAb. Likely diagnosis?
ACUTE (<6 months) surface Ag - high infectivity core Ab - current/ past e antigen - current = Acute HBV Infection
42
Abdominal distension, shifting dullness, fluid thrill
Ascites
43
Causes of ascites
``` Liver cirrhosis Acute pancreatitis Heart failure Hypoalbuminemia Malignancy Meig's syndrome ```
44
Weight loss, anaemia, ascites, elevated CA 19-9
Pancreatic cancer
45
Meig's syndrome classic triad
- Benign ovarian tumour - ascites - pleural effusion
46
Spontaneous Bacterial Peritonitis presentations Common causes
- severe abdominal pain - worsening ascites - fever - vomiting, rigors Causes: E coli, Klebsiella, Strep pneumoniae
47
Intermittent RUQ pain radiating to back. Investigations, likely diagnosis, management
Biliary Colic 1L: US Gallbladder + LFT Mx: further inv MRCP if no bile stones, but bile duct is dilated/ abnormal LFT
48
Amylase is a marker for...
Pancreatic damage
49
LFT results for a long history of alcohol abuse
- Very high AST - High ALT (Low AST/ALT ratio) - High GGT
50
Flue like symptoms + jaundice + IV drug use
Hepatitis C (C)rack
51
Features of Hepatitis D
Requires HBV Blood borne Eastern Europe + North Africa

2A - Stuff i just cannot remember (19 decks)

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