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Finals > Liver and GI > Flashcards

Liver and GI Flashcards

1
Q

signs of compensated liver disease

A

yellow sclera, spider naevi, gynacomastia, liver large or small, splenomegaly, clubbing, duputryens, scratch marks, pigmented ulcers

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2
Q

signs of decompensated liver disease

A

disorientated, drowsy, coma, hepatic flap, dilated abdo veins, oedema

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3
Q

What is jaundice?

A

skin/sclerae yellow discolouration due to raised bilirubin

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4
Q

which enzyme converts unconjugated bilirubin –> conjugated bilirubin?

A

glucuronyl transferase

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5
Q

Congenital cause of jaundice?

A

Gilbert’s syndrome

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6
Q

how does gilbert’s syndrome present? which gene is mutated?

A

asymptomatic incidental finding of raised unconjugated bilirubin.

Mutation in glucuronyl transferase (less of the bilirubin is conjugated.)

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7
Q

What clinical picture does cholestatic jaundice give?

A

pale stools, dark urine (bilirubin conjugated)

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8
Q

Intrahepatic causes of cholestatic jaundice?

A

hepatitis, drugs, alcohol, cirrhosis, neoplastic infiltrations

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9
Q

Extrahepatic causes of cholestatic jaundice?

A

duct stones, bile duct/pancreatic cancer, stricture, sclerosing cholangitis

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10
Q

How do you determine location of problem with LFTs?

A

Raised AST = intrahepatic

Raised ALP = extrahepatic

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11
Q

Ix of cholestatic jaundice?

A

LFTs, US of the biliary tree, hep A and B markers, prothrombin time

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12
Q

What is hepatitis?

A

liver cell necrosis and inflammatory cell infiltration

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13
Q

Causes of hepatitis?

A

viral - A,B, C, EBV, CMV, yellow fever
Drugs - paracetamol
Alcohol
Other - wilson’s disease, haemochromatosis

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14
Q

Features of Hep A?

A

spread faeco-orally via contaminated shellfish/water

- jaundice, N&V, anorexia, hepatomegaly

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15
Q

Ix for hepatitis viral infections?

A

LFTs, HEP antibodies, ESR, bilirubin levels

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16
Q

How are hep B and C spread?

A

blood/blood products/sex

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17
Q

Prophylaxis against hep B and C?

A

avoid needle sharing/prostitutes, counselling patients, immunisation

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18
Q

features of fulminant liver failure

A

reduced attention, liver flap, disorientated in time, confused and coma

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19
Q

Features of autoimmune hepatitis?

A

anorexia, malaise, nausea, fatigue, palma erythema, spider naevi, hepatosplenomegaly, jaundice

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20
Q

Mx of autoimmune hepatitis?

A

prednisolone, immunosuppressants

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21
Q

What is non-alcoholic fatty liver disease?

A

same liver biopsy findings as those drinking lots, but in absence of heavy drinking

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22
Q

what diseases are affected by NAFLD?

A

obesity, T2DM, hyperlipidaemia

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23
Q

What do you see on an US of NAFLD?

A

hyperchoic texture/bright liver and fatty infiltratione

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24
Q

What is cirrhosis?

A

necrosis of liver cells followed by fibrosis and nodule formation. Result = impaired liver cell function and distortion of liver architecture

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25
Q

Name the 2 histology types of cirrhosis? + their causes

A

MICRONODULAR - uniform small 3mm nodules in diameter. Cause = alcohol/biliary tract dis
MACRONODULAR - variable nodule size and normal acini inbetween. Follows viral hepatitis

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26
Q

Ix for cirrhosis?

A

LFTs/FBC/prothrombin time/albumin/UEs/aFP/US liver and portal veins, endoscopy for varices, DXA for osteoporosis

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27
Q

Mx of cirrhosis?

A

correct the underlying cause. Immunisations. Liver transplant.
screen HCC - aFP and US 6 monthly

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28
Q

Name 3 complications of cirrhosis?

A

portal HTN, variceal haemorrhage, ascites

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29
Q

which veins meet to form the portal vein?

A

splenic vein and superior mesenteric

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30
Q

Features of portal vein HTN?

A

GI oesophageal bleeding, ascites, hepatic encepalopathy

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31
Q

How do you manage an active variceal haemorrhage?

A
  1. resuscitate the patient
  2. urgent gastroscopy –> band ligation
  3. Terlipressin (reduces portal blood flow)
  4. Somatostatin infusion
  5. balloon tamponade
  6. surgical ligation of barices
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32
Q

Transudate causes of ascites?

A

portal HTN, cardiac failure, cirrhosis

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33
Q

Exudate causes of ascites?

A

pacreatitis, nephrotic syndrome, peritoneal TB

34
Q

Ascites features?

A

flank fullness, shifting dullness, pleural effusion, peripheral oedema, tense ascites

35
Q

Ascites Ix?

A

aspirate the ascitic fluid - albumin, neutrophil count, gram stain and culture, cytologym amylase

36
Q

Mx of ascites?

A

measure UEs and K levels

spironolactone/furosemide

37
Q

Common bacteria which causes spontaenous bacterial peritonitis?

A

E.Coli

38
Q

Which toxic substance causes portosystemic encepalopathy?

A

Ammonia

39
Q

Features of portosystemic encepalopathy?

A

drowsy and coma, increased tone and reflexes

patient irritable and slow/confused

40
Q

Mx of portosystemic encepalopathy?

A

lactulose, Abx, maintain Kcals

41
Q

What is primary biliary cirrhosis?

A

progressive destruction of intrahepatic bile ducts due to abnormal immunoregulation –> causes cholestasis and cirrhosis

42
Q

What antibodies are there in primary biliary cirrhosis? What does the biopsy show?

A

AMA ABs

loss of bile ducts/lymphocyte infiltration/granuloma formation

43
Q

Mx of primary biliary cirrhosis?

A

lifeling Ursodeoxycholic acid

44
Q

What is hereditary haemochromatosis?

A

excessive iron deposition in organs –> fibrosis –> organ failure. It is due to increased iron absorption from the upper small intestine

45
Q

Features of hereditary haemochromatosis?

A 
Liver - hepatomegaly/lethargy
Pancreas - DM
Heart - Cardiomegaly
Pituitary - reduced libido, impotence
Joints - arthralgia
Skin - increased pigment
46
Q

Ix findings in haemochromatosis?

A

LFTs often normal, increased serum iron, reduced TIBC, genotyping HFE

47
Q

What is wilsons disease?

A

mutation which causes reduced Cu secretion into bile. Cu accumulates in the liver = liver failure and cirrhosis. It also causes parkinson’s/dementia in the basal ganglia and kayser fleischer rings in the cornea.

48
Q

Ix findings for wilson’s disease?

A

low serum Cu, increased urinary Cu secretion

49
Q

Mx of wilson’s disease?

A

Penicillame

50
Q

What is the histology of alcohol hepatitis?

A

steatosis, ballooned hepatocytes, MALLORY BODIES (surrounded by neutrophils and fibrous/foamy degeneration of hepatocytes)

51
Q

what is primary sclerosing cholangitis?

A

progressive fibrosis of intra and extra hepatic ducts –> cirrhosis. 75% of patients have UC

52
Q

Mx of primary sclerosing cholangitis?

A

ursodeoxycholic acid

53
Q

What is Budd-Chiari syndrome?

A

occluded hepatic vein obstructing venous outflow from the liver and causes staiss –> hypoxic damage and necrosis of hepatocytes

54
Q

What organism commonly causes a liver abscess?

A

E.Coli

55
Q

Features of a liver abscess?

A

fever, lethargy, weight loss, abdo pain, enlarged and tender lvier, right chest effusion

56
Q

RF for HCC?

A

Hep B/C, androgenic steroids, aflatoxin, COCP? male

57
Q

Features of HCC

A

weight loss, anorexia, ascites, abdo pain

58
Q

name the 2 types of gallstones

A

cholesterol, pigment

59
Q

Describe biliary pain?

A

exam = normal
severe constant upper abdo pain (subsides after hours)
pain can radiate to the right shoulder
associated with vomiting

60
Q

Gallstone RF?

A

increasing age, female, family history, rapid weight loss, ileal disease, diet high in animal fat

61
Q

What do the LFTs show with gallstones?

A

raised ALP and raised bilirubin (conjugated)

62
Q

Mx for gallstones?

A

analgesia, elective cholecystectomy

63
Q

What is acute cholecystitis?

A

impaction of a stone in cystic duct/gall bladder neck

64
Q

Features of acute cholecystitis?

A

initial features similar to biliary colic

LEADS TO - severe localised pain, associated fever, muscle guarding, Murphy’s pain (pain worse on inspiration)

65
Q

Ix for acute cholecystitis?

A

WCC raised, serum LFTs mildly abnormal

abdo US - gallstone and distended gallbladder

66
Q

Mx of acute cholecystitis?

A

NBM, IV fluids, IV cefotaxime, cholecystectomy

67
Q

what is acute cholangitis?

A

infection of biliary tree, often due to obstructed CBD by gallstones

68
Q

features of acute cholangitis?

A

CHARCOT TRIAD - fever, jaundice, RUQ pain

69
Q

Pathogenesis of acute pancreatitis?

A

increased intracellular Ca, causing activation of intracellular proteases and release of pancreatic enzymes which results in acinar cell injury/necrosis –> inflammatory cells recruited

70
Q

Features of acute pancreatitis?

A

epigastric pain radiating to back, associated nausea and vomiting.
Abdo tenderness, guarding, rigidity
coma, multiorgan failure

71
Q

Signs of acute pancreatitis on the abdomen?

A

cullens - ecchymoses around umbilicus

grey turner sign - ecchymoses around the flank area

72
Q

Causes of acute pancreatitis?

A

gallstones, alcohol, post surgery/ERCP/pancreatic tumours/trauma

73
Q

Ix for acute pancreatitis?

A

Bloods - increased amylase/lipase (also do FBC/CRP/UE/LFT/Ca)
Radiology - CXR, Abdo US (shows inflamed pancreas and fluid collections)

74
Q

what is the scoring criteria for acute pancreatitis?

A

glasgow scoring criteria

75
Q

Mx for acute pancreatitis?

A 
HDU if necessary
IV fluids
correct metabolic abnormalities
LMWH
supplmentary O2
sliding scale insulin
76
Q

Complications of acute pancreatitis?

A

hyperglycaemia, hypocalcaemia, renal failure, shock

77
Q

What is chronic pancreatitis?

A

inappropriate activation of enzymes within pancreas leading to plugs within duct lumen –> forms nidus for calcification. Duct blockage causes ductal HTN and pancreatic damage

78
Q

name causes of chronic pancreatitis?

A

alcohol, autoimmune, CF

79
Q

Features of chronic pancreatitis?

A

epigastric abdo pain which radiates to back + weight loss

diabetes/steatorrhea - due to endocrine and exocrine insufficiency

80
Q

Ix of chronic pancreatitis?

A

XR - pancreatic calcification
US/CT - duct dilation/fluid collection
BG - increased if there is DM

81
Q

Features of pancreatic cancer?

A

painless jaundice and weight loss
scratch marks
distended gallbladder
central abdo mass

82
Q

Ix for pancreatic cancer?

A

US/CT, ERCP (palliative stent), CA19-9

Finals (21 decks)

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