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JazGI > Liver, biliary and pancreatic pathology > Flashcards

Liver, biliary and pancreatic pathology Flashcards

1
Q

Chronic liver disease lasted ___

Must have +

A

> 6 months

stellate activation and cirrhosis

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2
Q

4 types of liver cells:

A

hepatocytes
Kupffer cells
endothelial cells of fenustrates
stellate cells

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3
Q

hepatic macrophages that breakdown RBCs

A

Kupffer cells

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4
Q 
function of hepatocytes
near artery = \_\_
near central vein = \_\_\_
A

artery = metabolic processes

central vein = toxin clearance

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5
Q

normally stellate cells are ___ and function =__

A

quiescent

store fat, vit. A and control sinusoid blood flow

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6
Q

Damage to the liver causes loss of ___ on hepatocytes, ___ activate, ___ are lost from epithelial cells and __ cells are activated

A

hepatic microvilli
Kupffer cells
fenustrates
Stellate

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7
Q

Liver damage=>
activated stellate cells: proliferate, become more ___, attract ___ and chemotaxis of __ => extracellular matrix degradation and ___ laid down = ___=>

A

contractile
leukocytes
stellate cells
collagen = fibrogenesis=> cirrhosis

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8
Q

Liver damage:

Causes stellate apoptosis which => ___

A

TIMP - tissue inhibitor of metalloproteases

resolution

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9
Q

What activates Kupffer cells?

A

product of damaged cells

activation factors eg. TGFB1, PDGF …

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10
Q

Can diagnose steatosis by

A

US

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11
Q

2 hit theory for NASH:

A 
1= too many tri.s to store = free FAs
2= ox. stress + lipid peroxidation due to MCD diets/pro-inflam cytokine release = reperfusion injury
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12
Q

Autoimmune disease characterised by +AMA antibodies, T cell CD4 mediated against intra-hepatic bile ducts, mostly in women

A

PBC (primary biliary cirrhosis)

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13
Q

Autoimmune hepatitis is more common in M/F?

A

females 4:1

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14
Q

Histology of autoimmune hepatitis shows:

A

piecemeal necrosis
interface hepatitis
numerous plasma cells

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15
Q

Type 2 AI hepatitis is more/less common than type one
Occurs usually in ___
+AI antibodies =

A

more
young adults / children
AMA, LKM-1

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16
Q

Type 1 AI hepatitis is associated with which +AI antibodies

A

ANA, ASMA, SLA(marks severity), IgG, AMA, pANCA

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17
Q

Diagnosis of AI hepatitis is based on which investigations?

A

increased AST and ALT in LFTs
Increased IgG, AI Igs
liver biopsy

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18
Q

treatment of AI hepatitis =

A

corticostreoids - prednisolone (start high dose then lower to maintenance dose)
azathioprine

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19
Q 
PSC is more common in M/F?
\+antibodies?
is AI destruction of \_\_\_
image of biliary tree shows \_\_\_
associated with \_\_\_
A 
M 4:1
ANCA mainly
large and medium intra and extrahepatic bile ducts
onion skinning/ beading of biliary tree
UC
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20
Q

PBC or PSC increases risk of cholangiocarcinoma

If also have UC it increases risk of ___ too

A

PSC

colorectal carcinoma

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21
Q

Haemochromatosis=

A

autosomal recessive disease of Fe overload

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22
Q

___ mutations in __ gene =>___

In haemochromatosis

A

C282Y/H63D
HFE gene
=> liver doesnt signal enterocyte to stop absorbing Fe

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23
Q

bronzed diabetic has…

A

haemochromatosis

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24
Q

treatment of haemochromatosis =

A

venesection

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25
Q

Wilson’s disease =

A

autosomal recessive condition where loss of function/protein in caeruloplasmin => copper deposits in tissues and basal ganglia

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26
Q

Kaiser fleischer rings =

A

Copper

Wilson’s

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27
Q

Wilson’s is associated with ____ and ___ problems

A

liver (cirrhosis, sub-fulminant liver failure)

neuro (Chorea)

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28
Q

If have chronic liver disease and emphysema you have …

A

α-1 anti-trypsin deficiency

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29
Q

Budd-Chiari syndrome =

A

thrombosis of the hepatic veins due to congenital webs + Protein C/S deficiency

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30
Q

__ used to diagnose Budd-Chiari

Treat with

A

US

recanalisation/TIPSS

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31
Q

Drug that causes liver fibrosis =

Drug is for:

A

methotrexate

psoriasis and rheumatoid arthritis

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32
Q

Cardiac cirrhosis of the liver is caused by :

A

increased R heart pressure

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33
Q

Cirrhosis =

1) liver ___ due to less ____
2) disruption of ___
3) generation of ____

A

dysfunction due to less hepatocytes
vasculature
abnormal signalling

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34
Q

Portal vein hypertension is defined as > ___mmHg OR a : ratio of more than __

A

5-8mmHg

Portal:hepatic vein P >5mmHg leading to an increase in hydrostatic P in portal vein

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35
Q

normal portal vein + hepatic vein bp are +

gradient =>

A

7mmHg portal
4mmHg hepatic
pushes blood through liver

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36
Q

4 anastamoses of portal venous to hepatic venous system:

A

oesophageal+gastric venous plexus
umbilical vein reopens from L portal vein -> epigastric venous system
retroperitoneal collaterals behind the spleen
anal venous plexus

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37
Q

caput medusae is engorged ____

A

umbilical and epigastric veins

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38
Q

portal hypertension causes + varices

A

oesophageal and anorectal

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39
Q

Prehepatic causes of portal hypertension are

A

thrombosis/occlusion of veins before liver

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40
Q

Intrahepatic causes of portal hypertension are

A

pre-sinusoidal: eg. schistosomiasis
post-sinusoidal eg. cirrhosis, alcoholic hepatitis
Budd-Chiari

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41
Q

Sinusoidal hypertension causes release of enogenous ___ eg.

=>

A

vasodilators eg. NO, CO, CGRP, glucagon

splanchnic and peripheral vascular resistance drops

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42
Q

Ascites occurs due blood pooling and systemic vasodilation =>
activates ___

A

hypodynamic circulation as decreased effective arterial blood volume
RAAS

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43
Q

End stage liver failure is due to ___ hepatocytes

A

insufficient

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44
Q

Signs of compensated liver failure:

A 
spider naevi (blanch on pressure)
gynaecomastia
spleno/hepatomegaly
palmar erythema
NONE possibly
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45
Q

Signs of decompensated liver failure:

A

ascites
jaundice
encephalopathy
easy bruising

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46
Q

Treatment of ascites =

A 
no NSAIDs
stop drinking alcohol
low salt
spironolactone and loop
paracentesis
TIPSS
transplant
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47
Q

Alcoholics get vitamin __ supplements to prevent __

A

B1 - thiamine

Wernicke-Korsakoff syndrome

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48
Q

In ascites you retain __ and ___

A

NaCl and H2O

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49
Q

treatment of spontaneous bacterial peritonitis due to ascites

A

antibiotics, terlipressin and maintain renal perfusion

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50
Q

encephalopathy occurs in liver disease due to :

A

NH3 is not removed from gut => brain and is deposited

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51
Q

treatment of liver related encephalopathy =

A

lactulose

rifaxamin

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52
Q

Prophylaxis for varices

A

variceal ligation

non-selective β-blockers (propranolol - best / carvidelol - best tolerated)

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53
Q

in acute variceal bleed treatment =

A

terlipressin (vasoconstrict)
sclerotherapy/balloon tamponade (bridge)
ligation
TIPSS

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54
Q

If have liver disease put on an ___ as clotting factor balance is off

A

anti-coagulant

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55
Q

UKELD score of >__ is needed to be listed as have a _% 1yr mortality risk
Unless have ___ in which go on list with score

A

49
9%
HCC/other syndrome
49

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56
Q

As the degree of liver dysfunction increases what happens to the markers (ascites, bilirubin, albumin, PT and encephalopathy)

A

increase: ascites, bilirubin, PT, encephalopathy
decease: albumin

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57
Q

3 major factors of portal hypertension: reduced_++

A

liver blood flow
metabolic function
plasma proteins

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58
Q

If oral dose is greater than IV dose this suggests

A

1st pass metabolism is important factor

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59
Q

endothelin and oestrogen levels in liver disease inc/decrease because ___

A

increase

not metabolised by liver

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60
Q

Activation of RAAS in liver disease => (3) electrolyte and fluid consequences

A

Na+ and H2O retention

K+ depleted

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61
Q

Hepatorenal syndrome =
is mainly caused by __
___ compensate for ____ vasoconstrition
therefore dont give ___ as make renal problems worse by decreasing ___

A

renal failure caused by hepatic disease
endothelin
renal prostaglandins compensate for endothelin
NSAIDs are a NO as decrease PGs

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62
Q

NSAIDs in liver disease cause

A

1) less renal PGE synthesis =>worsen renal impairment, Na retention, worsen CHF
2) more cirrhosis peptic ulcers

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63
Q

codeine doesnt work in liver disease patients because

A

it is a pro drug and liver no longer activates it

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64
Q

Don’t give __/__ in liver disease as worsens encephalopathy

A

sedatives/opioids

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65
Q

Highly reactive intermediate in paracetamol metabolism =

A

N-acetyl-p-benzoquinamine

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66
Q

highly reactive intermediate in paracetamol metabolism is removed by ___

A

glutathione

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67
Q

Running out of ___ in paracetamol overdose causes liver necrosis by ___

A

glutathione

N-acetyl-p-benzoquinamine

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68
Q

Pain relief in liver disease

A

give paracetamol 1mg bds - dont exceed 3g per day
codeine 30mg tds - watch for sedation
NO NSAIDs

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69
Q

Are thiazide diuretics used in ascites? Why/why not?

A

no

worsens hypokalaemia and hypomagnesaemia

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70
Q

Are loop diuretics used in ascites? Why/why not?

A

no
reduces intra-vascular volume
worsens hypokalaemia and hypomagnesaemia

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71
Q

Which diuretic is used for ascites? Why?

A

Spironolactone in big doses+ fluid restriction

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72
Q

How much water loss do you aim for per day when using diuretics for ascites?

A

1kg/day

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73
Q

Forms of sedation used in liver disease

A

Phase II metabolised benzodiazepines in low doses

eg. lorazepam, oxazepam, lormetazepam

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74
Q

Are antibiotics safe to give in liver disease?

A

Yes, mostly.
Aminoglycosides = nephrotoxic
quinolones = epileptogenic
metronidazole = reduced metabolism by liver disease

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75
Q

To measure drug levels in liver disease must measure

A

free drug level

not just plasma levels as lots are unbound

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76
Q

In liver disease use drugs with ___ excretion
avoid __-drugs
Drugs to be wary of:

A

renal
pro-drugs
CNS drugs, sedatives, anticoagulants, NSAIDs, theophyllines, aminoglycosides

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77
Q

Acute liver disease defintion

A

rapid development of liver dysfunction wo prior liver disease
less than 6 months in duration

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78
Q

LFTs that is raised shows liver damage

A

ALT and AST

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79
Q

LFT that is more specific for liver damage

A

ALT>AST

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80
Q

LFT found in liver bile duct and bone

A

ALP

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81
Q

Cholestatic LFTs =

A

GGT and ALP

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82
Q

LFT that monitors cirrhosis due to alcohol =

A

GGT

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83
Q

GGT is made in cells __+__

A

hepatocytes around intrahepatic bile ducts

bile duct cells extrahepatically

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84
Q

bilirubin is raised in __/__/__

A

bile obstruction
liver damage
increased RBC breakdown

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85
Q

albumin is decreased in (5)

A 
liver disease
Fe deficiency
infection
poor diet 
diarrhoea
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86
Q

PT increases in __+__

Is the best test to monitor for

A

vitamin K deficiency
liver disease
monitor liver function - do every 6 hrs

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87
Q

causes of acute liver disease =

A 
Hepatitis viruses
CMV
EBV
toxoplasmosis
drugs
shock
cholangitis
alcohol
cancer
Budd-Chiari
Pregnancy
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88
Q

Investigations for acute liver disease =

A

LFTs, PT, Hx (itch, jaundice, exposure)
examine
US
Virology

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89
Q

For itch in liver disease give (3)

A

Na bicarbonate bath, cholestyramine or ursodeoxycholic acid

90
Q

//_ (electrolytes) are usually low in liver disease so monitor and maybe supplement

A

Mg

K PO4

91
Q

Drugs that cause acute liver disease =

A 
paracetamol
co-amoxiclav
flucloxacillin
NSAIDs
"protein powder"
92
Q

Fulminant hepatic failure = __+__ in previously normal liver

A

jaundice and encephalopathy

93
Q

Causes of fulminant hepatic failure = (7)

A 
paracetamol + other drugs
Hep A+B
Budd Chiari
Pregnancy
Cancer
Wilson's
mushrooms
94
Q

treatment of fulminant hepatic failure =

A

supportive
inotropes and fluids
manage increased intracranial P
may need transplant

95
Q

Hep A is spread by ___
causes acute/chronic hepatitis
vaccine?
Investigations?

A

faeco-oral
acute - CANNOT cause chronic
vaccine given to travellers
serology and Hep A IgM

96
Q

Hep E is spread by ___
vaccine?
acute/chronic

A

faeco-oral/zoonosis - british pigs/abroad in tropics
no vaccine
acute unless IC

97
Q

Hep D is ony found with ___

= / infection

A

Hep B

co/superinfection

98
Q

Hep B is spread by //_
acute/chronic
vaccine?

A

sex, blood, mother to child
chronic usually
yes vaccine

99
Q 
HBsAg =
HBeAg =
HB DNA =
HB IgM =
HB IgG =
A

HBsAg = current infection - present in all infected
HBeAg = present in highly infectious
HB DNA = increased level =increased infectivity and worse prognosis - monitors therapy
HB IgM = recently infected
HB IgG = immunity

100
Q

Hep C is spread by //_
acute/chronic?
vaccine?
investigation

A

sex (less effectively than B), blood, mother and child
chronic in 75%
no vaccine
+ve antibody alwats present
PCR for RNA +ve = active, -ve = previous infection

101
Q

Treatment of acute viral hepatitis

A

monitor
notify public health
immunise contacts

102
Q

chronic viral hepatitis treatment =

A

antivirals (8 for HCV - if RNA +ve and genotype known, 6 for HBV - if HBsAg and DNA +ve)
vaccinate for other HVs, pneumococcal and influenza
less alcohol
screeen for HCC - serum AFP and US

103
Q

Interferon α =

A

human protein that’s part of immune response to viral infection
Injected as PEG-interferon α = antiviral

104
Q

Sustained virological response (SVR) after Hep C therapy is declared when _

A

no HCV RNA after 6 moths of stopping therapy

105
Q

Chronic HCV patients (even if cured) get __ screening every ___

A

HCC - US

6 months

106
Q

3 zones from portal triad&raquo_space; central vein =

___ most susceptible to injury as receives least O2

A

periportal>mid-acinar>pericentral

pericentral

107
Q

Cirrhosis induced by alcohol is ___nodular

A

micronodular

108
Q 
Intense drinking of alcohol
2-3days =
4-6wks =
months-yrs =
yrs =
A

fatty liver
hepatitis
fibrosis - irreversible
cirrhosis

109
Q

characteristics of alcoholic hepatitis:

A

hepatocyte necrosis, neutrophils, mallory bodies, pericellular fibrosis

110
Q

Mason’s triad seen in cirrhosis =

A

blue collagen, white fat, red hepatocytes

111
Q

Viral hepatitis causes =

A 
Hep ABCDE viruses
δ agent
EBV
yellow fever
HSV
CMV
112
Q

Hepatitis A is directly/indirectly cytopathic

A

directly

113
Q

Chronic viral hepatitis on histology =

A

interface hepatitis
piecemeal necrosis
councilman bodies - lobular inflam

114
Q

Chronic hepatitis causes =

A

Hep B and C
PBC
PSC
AI or drug induced hepatitis

115
Q

PBC main autoantibodies =

A

AMA

116
Q

PBC/PSC is predominant in females

A 
PBC = 90% females
PSC = 70% males
117
Q

AI hepatitis is more common in M/F

characteristic findings =

A 
Females
usually triggered
ass with other AIs
SM/nuclear/LKM autoantibodies
Increased IgG
numerous plasma cells
118
Q

PSC/PBC is associated with onion skinning of bile ducts

A

PSC

119
Q

PSC/PBC is associated with granuloma wreaths around bile ducts

A

PBC

120
Q

Autosomal recessive cause of iron overload
worse in M/F?
Fe confirmed in liver by ___

A

Primary Haemochromatosis
Males (and females post-menopause)
Perls stain

121
Q

Risk factors for gallstones

A 
Fat, fair, female, Forty, fertile (5Fs)
diabetic
Crohn's (bile salt loss)
dysmotility of GB
prolonged fasting
TPN
122
Q

Pigment gallstones =

A

excess bilirubin due to haemolysis = black stones

123
Q

soft white gallstones are caused by too much

A

cholesterol

124
Q

Mucocoele =

A

gallbladder gets blocked eg. by gallstone = fills with mucus

125
Q

inflammation of the gallbladder =

A

cholecystitis

126
Q

Acute cholecytitis is indicated by presence of ___ causes intense __ in 2-3 days

A

neutrophils (pus)

adhesions

127
Q

Chronic cholecystitis causes wall to be __ but not ___

have ___ sinuses

A

thickened but not distended

Rokitansky-Aschoff sinuses

128
Q

carcinomas of the gallbladder =

A

adenocarcinomas - poor prognosis

129
Q

adenocarcinoma of the bile ducts =

present with __

A

cholangiocarcinoma

obstructive jaundice - poor prognosis - rarely resectable

130
Q

tumour at confluence of R and L hepatic ducts =

A

klatskin tumour

131
Q

Increased serum __ indicates pancreatitis

A

AMYLASE

132
Q

Causes of acute pancreatitis =

A

(GET SMASHED)

alcohol and cholelithiasis (mainly), shock, mumps, hyperparathyroidism, hypothermia, trauma, iatrogenic

133
Q

In pancreatitis pancreas releases __+__ consequences =

A

proteases - tissue destruction and haemorrhage

lipases - intra+peripancreatic fat necrosis - may bind Ca2+

134
Q

Acute pancreatitis complications include hypo___ and hyper ___

A

hypocalcaemia

hyperglycaemia

135
Q

Treatment of acute pancreatitis

A

monitor and modify cause to prevent recurrence

136
Q

Causes of chronic pancreatitis

A 
GET SMASHED
alcohol
gallstones
CCF
familial, hyperparathyroidism
137
Q

Autodigestion of pancreatic acinar cells occurs in __

A

pancreatitis

138
Q

Carcinoma of the pancreas =

histologically looks like :

A

adenocarcinoma

irregular abortive glands in a dense stroma

139
Q

RBCs lifespan =

A

100-120 days

140
Q

In small intestine bacteria convert colourless __/___ to brown stercobilirubin

A

stercobilinogen/urobilinogen

141
Q

Yellow colour in urine =

A

urobilin

142
Q

Limiting factor in bilirubin conjugation that results in pre-hepatic jaundice due to unconjugated bilirubin

A

glucaronyl transferase

143
Q

There is no increase in ___ bilirubin in pre-hepatic jaundice

A

urinary

144
Q

In pre-hepatic jaundice LFTs are __

A

normal

145
Q

Jaundice is less marked in which cause of jaundice out of the 3?

A

Pre-hepatic

146
Q

In pre-hepatic jaundice urine and faeces are

A

normal colour

147
Q

In hepatic jaundice ___ hyperbilirubinaemia predominates

associated symptoms = stools are ___ ; + ___

A

conjugated
stools normal but may be pale if excretion is significantly impaired
tender hepatomegaly

148
Q

___ jaundice causes pale stools and dark orange urine

A

post-hepatic - conjugated bilirubin

149
Q

In abscence of liver disease ____ liver cancer is more common

A

metastatic

150
Q

Commonest liver tumour =

affects females or males more

A

haemangioma

females

151
Q

Appearance of liver haemangioma
symptoms
Diagnosis investigations
Treatment

A

single small wall demarcated capsule that is surrounded by hypervascularisation
asymptomatic
US - CT - MRI - no need for FNA
NO need for treatment

152
Q

Focal Nodular Hyperplasia (FNH) classic appearance

A

central scar with a large artery with branches radiating to the peripheries = hub+spokes

153
Q

FNH is due to a congenital ___ abnormality
associated with __+__
it is a ___ response to abnormal ____ flow

A

vascular
Osler-Weber-Rendu and liver haemangioma
hyperplastic response
arterial flow

154
Q

Benign liver lesion that is isointense on sulfur colloid scan and has sinusoids, bile ductules and Kupffer cells present on histology

A

FNH - focal nodular hyperplasia

155
Q

FNH is more common in ___ (demographic)

A

young and middle aged women

156
Q

FNH symptoms
malignancy risk?
Diagnosis investigations
treatment

A

asymptomatic - min. pain and bleeding risk
no malignancy risk
US - CT - MRI - may need FNA (normal hep.s and Kuppfer w. central core)
no treatment

157
Q

Appearance of hepatic adenoma

A

normal hepatocytes with no portal tract, central veins of bile ducts.
Usually are solitary fat containing lesions

158
Q

Benign liver lesion that is associated with contraceptive hormones and is more common in females

A

liver adenoma

159
Q

Hepatic adenoma is usually found in the __ lobe
symptoms =
malignancy risk?

A

R
usually asymptomatic - maybe haemorrhage/RUQ pain
malignancy development risk

160
Q

Multiple hepatic adenomas =

rare condition associated with ___

A

adenomatosis

Glycogen storage disease

161
Q

Investigations for hepatic adenoma

treatment

A

US (filling defect)
CT (diffuse arterial enhancement)
MRI - may need FNA
stop hormones - observe every 6mnths - if no regression then excise

162
Q

Benign liver lesions =

A

Cystic lesions
Hepatic adenoma
haemangioma
FNH - focal nodular hyperplasia

163
Q

4 cystic liver lesions =

A

simple
hydatid
polycystic liver disease
liver abscess

164
Q

Characteristics of simple cystic liver lesion =

A

liquid collection lined by an epithelium, no biliary tree communication, solitary and unloculated

165
Q

Symptoms of simple cystic liver lesion

treatment

A

asympt - but sympt.s if haemorrhages, ruptures, infection, compresses
none - if symptomatic then open drainage

166
Q

Hydatid cysts in the liver are caused by ___ from ___(geog)

A

Echinococcus granulosus

E. Europe, America and Africa

167
Q

Treatments for hydatid cysts in liver =

A 
conservative = open cystectomy
radical = lobectomy/pericystectomy
medical = albendazole
percutaneous drainage
PAIR
168
Q

Polycystic liver disease is due to __

A

embryonic ductal plate malformation of intrahepatic biliary tree

169
Q

3 types of polycystic liver disease

A

Von Meyenburg Complexes (microhamartomas)
Polycystic liver disease
ADPKD - auto dom polycystic kidney disease

170
Q

In Von Meyenburg Complexes are due to remnants of ___ causing small cysts
symptoms =
not ___ genetically linked

A

cystic bile duct malformations
asymptomatic
germline

171
Q

In Polycystic liver disease liver and renal function is ___

___+__ genes related

A

preserved
PRKC5H
SEC63

172
Q

In ADPKD ____+___ symptoms are common
potential ___
genes=

A

renal failure and extra-hepatic symptoms
massive hepatic enlargement
PKD1+2

173
Q

Presentation of polycystic liver diseases

A

abdominal pain and distension
compression symptoms
failure of affected organ

174
Q

treatment of polycystic liver diseases

A

conservative = somatostatin analogues - sympt relief and decrease liver volume
in advanced = aspiration/transplant

175
Q

Liver abscesses present with

Hx may include:

A

high fever, leukocytosis, abdominal pain, complex lesion

Hx = dental procedure, abdo/biliary infection

176
Q

Treatment of liver abscess =

A

broad sprectrum antibiotics 4wks with repeat imaging
aspiration
echocardiogram (check for endocarditis
no regression = open drainage

177
Q

Malignant primary liver lesions =

A

HCC - hepatocellular cancer
fibro-lamellar carcinoma
hepatoblastoma
intrahepatic cholangiocarcinoma

178
Q

Most common malignant primary liver cancer =

most common in M/F

A

HCC - hepatocellular caracinoma

Males

179
Q

Biggest risk factor for HCC and what causes it

A

cirrhosis

eg. NASH, alcohol, HBV, HCV, aflatoxin

180
Q

Marker for HCC

may not be raised in___

A

AFP - alphafetoprotein

small HCC

181
Q

Investigations to diagnose HCC

A 
blood = LFT, clotting tests, AFP
US
triphasic CT (v. early arterial perfusion)
MRI 
Biopsy
182
Q

Treatment of HCC

A

small, single and preserved liver function = curabel resection
3 or fewer nodes/less than 5cm = transplant
worse = chemo + palliative
local ablation - temporary measure
TACE
Sorafenib

183
Q

Fibro-lamellar carcinoma is commonest in which age range?

It is not ___ related and __ is normal

A

5-35yos
not cirrhosis related
AFP normal

184
Q

CT for fibro-lamellar carcinoma shows

A

stellate scar with radial septa

185
Q

Treatment for fibro-lamellar carcinoma=

A

resection/transplant

otherwise TACE

186
Q

TACE stands for
Indication =
Procedure =

A

Trans-arterial chemoembolism
for early cirrhosis
inject chemo and then embolic agent into hepatic artery

187
Q

Gold standard test for diagnosis of gallstones =

A

US

188
Q

Treatment for biliary colic =

A

analgesics and low fat diet/lose wt if obese for 3-6months

if recurrent = ursodeoxycholic acid (for 2yrs)/cholecystectomy

189
Q

Treatment of cholecystitis

A

IV antibiotics and fluids
nil by mouth
US to confirm diagnosis and if need be cholecystectomy

190
Q

Treatment of gallstones causing acute pancreatitis

A

cholecystectomy within 2wks if fit

if frail = ERCP sphincterotomy

191
Q

Gallstone ileus occurs when

A

GB is inflamed>sticks to duodenum>erodes = fistula>large gallstone through and obstructs small intestine

192
Q

Treatment of gallstone ileus =

A

urgent laparotomy to remove stone

cholecystecctomy in 3 months time

193
Q

Treatment for cholangiocarcinoma

A

resection is only cure

palliative = biliary stent = survive 1-6months

194
Q

1st line to assess cholangiocarcinoma =

A

duplex US

195
Q

Endocrine cells of the pancreas and their secreetions

A

α=glucagon
β = insulin
δ = somatostatin
PP = pancreatic polypeptide

196
Q

Function of pancreatic polypeptide

A

self-regulates pancreatic secretion+activities+hepatic glycogen levels

197
Q

Predominant feature in mild acute pancreatitis=

A

interstitial oedema

minimal organ dysfunction

198
Q

In sever acute pancreatitis its ass. with ___

___ may be present

A

organ failure+/local complication

pancreatic necrosis

199
Q

3 most common causes of acute pancreatitis

A

biliary disease
alcohol
post ERCP

200
Q

Painless jaundice =

A

pancreatic cancer

201
Q

Bloods for acute pancreatitis

A

AMYLASE
glucose
Ca2+
CRP - U+Es - clotting - FBC - LFTs

202
Q

acute pancreatitis signs on AXR =

A

sentinel loop / pleural effusion

203
Q

Imaging for acute pancreatitis

A

A/CXR
US - check for biliary cause)
CT - assess severity and can see complications

204
Q

Only use ERCP to treat acute pancreatitis due to obstruction if ___

A

patient is jaundiced

205
Q

If have necrosis associated with acute pancreatitis :
Do a ___ to culture
only operate if necrosis is ___

A

FNA

infective

206
Q

Chronic pancreatitis definition =

A

progressive and irreversible destruction of pancreatic tissue leading to permanent loss of exo+endocrine function

207
Q

Hereditory exocrine pancreatic insufficiency makes you 53x more likely to get a ___

A

pancreatic ductal adenocarcinoma

208
Q

hyper___ in hyperparathyroidism/renal failure can cause chronic pancreatitis

A

hypercalcaemia

209
Q

Imaging for chronic pancreatitis

A

C/AXR (pancreatic calcification and duct dilatation)
AUS
CT (dilated ducct, calcification, intrapanc fluid collection)
M/ERCP
MRI

210
Q

Most effective treatment for chronic pancreatitis

A

Analgesics

Pustow / Frey / Beger procedures - drain it into duodenum

211
Q

95% of pancreatic cancers are ___

A

exocrine - adenocarcinomas - occur anywhere in pancreas

212
Q

___crine tumours of the pancreas are more likely to be treatable

A

endocrine

213
Q

types of endocrine cancers of the pancreas

A

gastrinoma (=> ^HCl = ulcers)
insulinoma (=> store glucose = hypoglycaemia)
glucagonoma (hyperglycaemia)
somatosatinoma (diabetic steatorrhea)
vipoma (severe diarrhoea, hypoK+, achlorydria)

214
Q

Risk factors for pancreatic cancer=

A 
SMOKING
TI+IID
inactivity
obesity
charred meat
215
Q

Investigations for pancreatic cancer

A

Bloods > US > CT (goldstandard can deduce if operable)

> ERCP and stent

216
Q

cut off stage for surgery of pancreatic cancer

A

roughly T3 = more than 2cm and invaded surrounding tissue but not organs/vessels

217
Q

Treatment of pancreatic cancer =

A

surgery (20-30%) whipple resection/pancreatectomy - curative

palliative = surgery - biliary/gastric/double bypass OR chemo+/ radio

218
Q

Cullen’s sign =

indicates

A

periumbilical bruising

pancreatitis

219
Q

Grey Turner’s sign =

indicates

A

flank bruising

pancreatitis

220
Q

tenderness on percussion =

A

peritonism

221
Q

Clinical signs differences between biliary colic and cholecystitis

A 
colic = -ve Murphy's
cholycystitis = +ve Murphy's, leukocytosis, may have RUQ peritonitis

JazGI (26 decks)

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