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Year 3 > Liver, biliary tract and pancreatic disease > Flashcards

Liver, biliary tract and pancreatic disease Flashcards

1
Q

What is bilirubin formed from?

A

The breakdown of mature red blood cells

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2
Q

What tests measure liver synthetic function

A

Albumin and prothrombin time

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3
Q

How is prothrombin time prolonged in biliary obstruction?

A

It results in vitamin K deficiency as bile salts are needed for good absorption of K+

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4
Q

Where is AST found?

A

Liver, heart, muscle, kidney and brain.

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5
Q

What causes high AST?

A

Hepatic necrosis, myocardial infarction, muscle injury and congestive heart failure

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6
Q

Is serum bilirubin normally conjugated or unconguated?

A

Unconjugated

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7
Q

Viral hepatitis and liver enzymes

A

Without cirrhosis ALT higher than AST, if cirrhosis AST is higher

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8
Q

If someone has liver disease, but no cirrhosis and AST is higher than ALT what does this mean?

A

Alcohol or obesity more likely than viral, because in viral ALT is higher than AST without cirrhosis

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9
Q

What points towards ALP being high due to liver problems?

A

A high gamma GT. ALP is found in bones, intestines and placenta too.

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10
Q

When do the highest levels of ALP happen? (+1000)

A

Hepatic metastasis and primary biliary cirrhosis

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11
Q

What makes gamma GT increase?

A

Alcohol, Warfarin and phenytoin. It is useful for an alcohol guide. Also increases in fatty liver

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12
Q

Effect of a alcohol on red blood cells?

A

macrocytosis

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13
Q

What does a elevation of serum bilirubin and alkaline phosphatase in excess of aminotransferases indicate?

A

cholestatic disorder such as primary biliary cirrhosis or any biliary disease

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14
Q

An isolated rise in bilirubin is most likely due to

A

Gilbert’s disease

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15
Q

First imaging in liver diseases

A

Ultarsound

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16
Q

Is higher or lower stiffness worse?

A

Higher stiffness means more fibrosis

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17
Q

Which is better for diagnosis MRCP or ERCP

A

MRCP

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18
Q

What is ERCP used for therapeutically?

A

Bile blockage, e.g stones

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19
Q

Contraindications for liver biopsy

A

prolonged PT by 3-5s, platelet count less than 50, extrahepatic cholestasis and suspected haemangioma

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20
Q

Three major complications of liver cirrhosis

A

Ascites
Haematemesis and melaena due to bleeding oesophageal varices
Confusion and drowsiness due to hepatic encephalopathy

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21
Q

When does pruritis happen?

A

cholestatic jaundice, mainly in primary biliary cirrhosis

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22
Q

Level of bilirubin for jaundice

A

50 umol/L

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23
Q

Where is bilirubin conjugated?

A

The liver

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24
Q

Test results for haemolytic jaundice

A

raised serum unconjugated bilirubin and normal liver biochemistry. Raised urinary urobilinogen. blood results show haemolysis

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25
Q

Most common cause of congenital hyperbilirubinaemia

A

Gilbert’s syndrome. Raised unconjugated but normal liver and blood smear.

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26
Q

What can cholestatic jaundice be broken into

A

Intrahepatic and extrahepatic. Both cause pale stools and dark urine and conjugated bilirubin

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27
Q

Early hepatitis ALP and AST

A

High AST lower ALP

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28
Q

ALP and AST in extrahepatic obstruction

A

high ALP lower AST

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29
Q

Is viral heptitis reportable?

A

All types of viral hepititis are

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30
Q

Most common cause of acute viral hepititis

A

Type A - oral faecal

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31
Q

Serum markers for acute and previous hepA

A

IgM anti-HAV acute, IgG anti-HAV previous

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32
Q

Which viral hepititis types cause an increased risk of liver cancer?

A

Types B and C

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33
Q

Hep B transition

A

Body fluids

34
Q

What antibody to Hep B means you have won?

A

Anti surface antibody

35
Q

First antibody produced against hep B

A

Anti HBc IgM

36
Q

The presence of what suggests chronic hep B

A

HBsAg

37
Q

Who isn’t given HepB treatment

A

Inactive carriers, normal ALT and HBV DNA less than 2000

38
Q

Medication for Hep B

A

Interferon, tenofovir and entecavir

39
Q

When can HepB become active again

A

immunosurpressed and chemo - must screen any patient going to receive chemo

40
Q

Treatment for Hep D

A

Pegylated alpha-2a interferon

41
Q

How is Hep C transmitted

A

Blood and sex.

42
Q

Are most people with chronic hep C symptomatic?

A

No

43
Q

Clinical triad for acute hepatic failure

A

hepatic encephalopathy, severe jaundice and marked coagulopathy.

44
Q

Blood results of alcohol excess

A

Raised gamma GT and raised red cell mean corpuscular volume MCV

45
Q

Cause of Wenicke’s encephalopathy

A

Vitamin B1 (Thiamine) deficiency

46
Q

Triad or Wenicke’s encephalopathy

A

Confusion, ataxia and ophthalmoplegia, only happens in a minority of patients. Treat with injections of B things.

47
Q

Prophylaxis for WE

A

one pair of ampoules of high potency b vit daily for 4-5 days and oral B vit on discharge

48
Q

Treatment for alcohol withdrawal

A

chlordiazepoxide

49
Q

Common electrolyte imbalances in alcohol withdrawral

A

hypophosphataemia and hypomagnesaemia

50
Q

medication for autoimmune hepititis

A

steroids (Pred in acute) and azathioprine

51
Q

Type of cirrhosis in chronic viral hepititis

A

Macronodular cirrhosis

52
Q

Features of decompensated cirrhosis

A

encephalopathy, ascites or variceal haemorrhage

53
Q

FBC findings in liver cirrhosis

A

thrombocytopenia and leukopenia and anaemia later on

54
Q

A high level of what fetal protein suggests HCC

A

serum alpha-fetoprotein

55
Q

What is the hepatic portal vein made from?

A

splenic and superior mesenteric veins

56
Q

Pharmacological intervention in variceal haemorrhage

A

Terlipressin I.V 2mg 6-hourly. If heart failure give I.V somatostatin.

57
Q

Albumin level for ascites being transudate and exudate

A

More than 11 g/L less than serum albumin transudate, a difference less than 11 suggests exudate

58
Q

What neutrophil count in ascitic fluid suggests underlying bacterial peritonitis?

A

more than 250

59
Q

Drug for portal hypertension ascites

A

spironolactone or failing response furosemide - if creatinine or hyponatraemia, slow down for kidneys

60
Q

Antibodies specific to primary biliary cholangitis

A

M2 antibodies, AMAs are also high. Diagnosis if ALp high, IgM high and antimitochondrial antiboy test positive.

61
Q

Treatment for primary biliary cholangitis

A

ursodeoxycholic acid. cholestyramine given for pruritus

62
Q

Secondary biliary cirrhosis investigations and treatment

A

US then MRCP. Treatment with ERCP

63
Q

Iron levels in hereditary haemochromatosis

A

High iron, low total iron-binding capacity TIBC

64
Q

What is wilsons disease and what is the treatment

A

copper deposited in liver, brain eyes. test by low copper and low caeruloplasmin.

Treat with penicillamine or trientene

65
Q

What enzyme causes liver and lung problems

A

a1-antitrypsin deficiency

66
Q

What two electrolyte changes should you be aware of in alcohol liver problems

A

hyponatraemia and high creatinine (hepato-renal syndrome)

67
Q

What is higher in alcoholic hepatitis AST or ALT

A

AST two times higher than ALT. both bellow 500 or suspect other causes .

68
Q

Type of cholangitis assocaited with ulcerative colitis

A

Primary Sclerosing Cholangitis PSC, 60% also have ANCA.

69
Q

Syndrome where the drainage from the hepatic vein is blocked causing congestion with liver failure

A

Budd-Chiari synderome

70
Q

Cause of amoebic abscess

A

spread of Entamoeba histolytica frfom bowel to live via portal venus system

71
Q

Cause of pyogenic abscess

A

E. coli or streptococcus milleri

72
Q

Treatment for amoebic liver abscess

A

metronidazole

73
Q

treatment for pyogenic abscess

A

percuraneous aspiration and i/v metronidazole and cefuroxime

74
Q

Most common type of gallstone

A

Cholesterol gallstone 80% of them. Other type is Pigment stones from bilirubin. seen in chronic harmolysis.

75
Q

Differentiate biliary stone from acute cholectstitis

A

No systemic features such as fever, local peritonism or white cell count. both have similar pain

76
Q

Treatment for biliary stoen

A

Analgesics and elective cholecystectomy

77
Q

What is Murphys sign

A

tenderness worse on inspiration due to acute cholcystitis

78
Q

When does acute cholecystitis happen

A

inflammation following impactation of a stone. whie cell count shows leucocytosis

79
Q

What is Charcot’s triad and what does it diagnose?

A

Fever, RUQ pain and jaundice. Diagnoses acute cholangitis. Treat with ERCP and antibiotics

80
Q

Blood test for acute pancreatitis

A

High serum amalyase

Year 3 (26 decks)

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