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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
Q

Pt presents with dark urine, jaundice and pale stools. Their ALP is markedly raised.

Likely diagnosis

A

Gallstones - obstructive cause of jaundice

ALP is upregulated in response to cholestasis

26
Q

Isolated raised ALP indicates…

Where is ALP concentrated?

A

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
Q

Where is ALT concentrated?

A

ALT is concentrated in HEPATOCYTES :. is a good marker for hepatocellular injury:
- hepatitis

28
Q

A marked raise in ALT and mild raise in ALP indicates…

A

Hepatocellular injury, eg Hepatitis

= Hepatic jaundice

29
Q

A marked raise in ALP and mild raise in ALT indicates…

A

Cholelithiasis

= Post-hepatic jaundice

30
Q

Pt is jaundiced, however their ALT and ALP levels are normal.

Likely cause? What will their urine and stools look like?

A

= 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
Q

What is Prothrombin Time?

Primary causes of raised PTT?

Secondary causes of raised PTT?

A

PTT = measure of blood’s coagulation tendency

Primary causes = Liver disease/ dysfunction

Secondary causes = anticoagulants + Vitamin K deficiency

32
Q

Low AST/ALT ratio indicates…

ie ALT >AST

A

Chronic liver disease

33
Q

High AST/ALT ratio indicates…

ie AST > ALT

A

Cirrhosis, acute alcoholic hepatitis, alcohol abuse

34
Q

Most common cause of hepatitis in travellers

Presentations?

A

Hepatitis A Virus

  • faecal-oral route
  • Abrupt onset
  • fever, n/v
  • JAUNDICE 2wks post-infection
35
Q

Acute vs Chronic Hepatitis

A

Acute <6 months

Chronic >6 months

36
Q

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?

A

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
Q

HBsAg indicates…

A

Surface antigen - Acute HBV

38
Q

HBeAg indicates…

A

E antigen - HBV Viral replication, implies high infectivity

39
Q

HBcAb indicates,,,

A

Core antibody - Past/ current HBV Infection

40
Q

HBsAb indicates…

A

Surface antibody - HBV vaccination/ past/ current infection

Vaccines inject surface antigens :. surface Ab develop

41
Q

Pt has malaise, joint pain and jaundice for 2 months. Hepatitis screen shows: HBsAg, HBeAg, HBcAb.

Likely diagnosis?

A

ACUTE (<6 months)

surface Ag - high infectivity
core Ab - current/ past
e antigen - current

= Acute HBV Infection

42
Q

Abdominal distension, shifting dullness, fluid thrill

A

Ascites

43
Q

Causes of ascites

A 
Liver cirrhosis 
Acute pancreatitis 
Heart failure 
Hypoalbuminemia 
Malignancy 
Meig's syndrome
44
Q

Weight loss, anaemia, ascites, elevated CA 19-9

A

Pancreatic cancer

45
Q

Meig’s syndrome classic triad

A
  • Benign ovarian tumour
  • ascites
  • pleural effusion
46
Q

Spontaneous Bacterial Peritonitis presentations

Common causes

A
  • severe abdominal pain
  • worsening ascites
  • fever
  • vomiting, rigors

Causes: E coli, Klebsiella, Strep pneumoniae

47
Q

Intermittent RUQ pain radiating to back.

Investigations, likely diagnosis, management

A

Biliary Colic

1L: US Gallbladder + LFT

Mx: further inv MRCP if no bile stones, but bile duct is dilated/ abnormal LFT

48
Q

Amylase is a marker for…

A

Pancreatic damage

49
Q

LFT results for a long history of alcohol abuse

A
  • Very high AST
  • High ALT
    (Low AST/ALT ratio)
  • High GGT
50
Q

Flue like symptoms + jaundice + IV drug use

A

Hepatitis C

(C)rack

51
Q

Features of Hepatitis D

A

Requires HBV
Blood borne
Eastern Europe + North Africa

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

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