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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
Most common cause of congenital hyperbilirubinaemia
Gilbert's syndrome. Raised unconjugated but normal liver and blood smear.
26
What can cholestatic jaundice be broken into
Intrahepatic and extrahepatic. Both cause pale stools and dark urine and conjugated bilirubin
27
Early hepatitis ALP and AST
High AST lower ALP
28
ALP and AST in extrahepatic obstruction
high ALP lower AST
29
Is viral heptitis reportable?
All types of viral hepititis are
30
Most common cause of acute viral hepititis
Type A - oral faecal
31
Serum markers for acute and previous hepA
IgM anti-HAV acute, IgG anti-HAV previous
32
Which viral hepititis types cause an increased risk of liver cancer?
Types B and C
33
Hep B transition
Body fluids
34
What antibody to Hep B means you have won?
Anti surface antibody
35
First antibody produced against hep B
Anti HBc IgM
36
The presence of what suggests chronic hep B
HBsAg
37
Who isn't given HepB treatment
Inactive carriers, normal ALT and HBV DNA less than 2000
38
Medication for Hep B
Interferon, tenofovir and entecavir
39
When can HepB become active again
immunosurpressed and chemo - must screen any patient going to receive chemo
40
Treatment for Hep D
Pegylated alpha-2a interferon
41
How is Hep C transmitted
Blood and sex.
42
Are most people with chronic hep C symptomatic?
No
43
Clinical triad for acute hepatic failure
hepatic encephalopathy, severe jaundice and marked coagulopathy.
44
Blood results of alcohol excess
Raised gamma GT and raised red cell mean corpuscular volume MCV
45
Cause of Wenicke's encephalopathy
Vitamin B1 (Thiamine) deficiency
46
Triad or Wenicke's encephalopathy
Confusion, ataxia and ophthalmoplegia, only happens in a minority of patients. Treat with injections of B things.
47
Prophylaxis for WE
one pair of ampoules of high potency b vit daily for 4-5 days and oral B vit on discharge
48
Treatment for alcohol withdrawal
chlordiazepoxide
49
Common electrolyte imbalances in alcohol withdrawral
hypophosphataemia and hypomagnesaemia
50
medication for autoimmune hepititis
steroids (Pred in acute) and azathioprine
51
Type of cirrhosis in chronic viral hepititis
Macronodular cirrhosis
52
Features of decompensated cirrhosis
encephalopathy, ascites or variceal haemorrhage
53
FBC findings in liver cirrhosis
thrombocytopenia and leukopenia and anaemia later on
54
A high level of what fetal protein suggests HCC
serum alpha-fetoprotein
55
What is the hepatic portal vein made from?
splenic and superior mesenteric veins
56
Pharmacological intervention in variceal haemorrhage
Terlipressin I.V 2mg 6-hourly. If heart failure give I.V somatostatin.
57
Albumin level for ascites being transudate and exudate
More than 11 g/L less than serum albumin transudate, a difference less than 11 suggests exudate
58
What neutrophil count in ascitic fluid suggests underlying bacterial peritonitis?
more than 250
59
Drug for portal hypertension ascites
spironolactone or failing response furosemide - if creatinine or hyponatraemia, slow down for kidneys
60
Antibodies specific to primary biliary cholangitis
M2 antibodies, AMAs are also high. Diagnosis if ALp high, IgM high and antimitochondrial antiboy test positive.
61
Treatment for primary biliary cholangitis
ursodeoxycholic acid. cholestyramine given for pruritus
62
Secondary biliary cirrhosis investigations and treatment
US then MRCP. Treatment with ERCP
63
Iron levels in hereditary haemochromatosis
High iron, low total iron-binding capacity TIBC
64
What is wilsons disease and what is the treatment
copper deposited in liver, brain eyes. test by low copper and low caeruloplasmin. Treat with penicillamine or trientene
65
What enzyme causes liver and lung problems
a1-antitrypsin deficiency
66
What two electrolyte changes should you be aware of in alcohol liver problems
hyponatraemia and high creatinine (hepato-renal syndrome)
67
What is higher in alcoholic hepatitis AST or ALT
AST two times higher than ALT. both bellow 500 or suspect other causes .
68
Type of cholangitis assocaited with ulcerative colitis
Primary Sclerosing Cholangitis PSC, 60% also have ANCA.
69
Syndrome where the drainage from the hepatic vein is blocked causing congestion with liver failure
Budd-Chiari synderome
70
Cause of amoebic abscess
spread of Entamoeba histolytica frfom bowel to live via portal venus system
71
Cause of pyogenic abscess
E. coli or streptococcus milleri
72
Treatment for amoebic liver abscess
metronidazole
73
treatment for pyogenic abscess
percuraneous aspiration and i/v metronidazole and cefuroxime
74
Most common type of gallstone
Cholesterol gallstone 80% of them. Other type is Pigment stones from bilirubin. seen in chronic harmolysis.
75
Differentiate biliary stone from acute cholectstitis
No systemic features such as fever, local peritonism or white cell count. both have similar pain
76
Treatment for biliary stoen
Analgesics and elective cholecystectomy
77
What is Murphys sign
tenderness worse on inspiration due to acute cholcystitis
78
When does acute cholecystitis happen
inflammation following impactation of a stone. whie cell count shows leucocytosis
79
What is Charcot's triad and what does it diagnose?
Fever, RUQ pain and jaundice. Diagnoses acute cholangitis. Treat with ERCP and antibiotics
80
Blood test for acute pancreatitis
High serum amalyase

Year 3 (26 decks)

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