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My Phase 2a Medicine > Liver conditions > Flashcards

Liver conditions Flashcards

1
Q

What are gallstones?

A

=crystallised cholesterol from the bile in the gall bladder

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2
Q

What are the 2 types of gallstones?

A
  • cholesterol = form due to supersaturation of the bile with cholesterol and decrease motility of the gallbladder
  • bile pigment stones = stones formed from bile pigment
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3
Q

What are the symptoms of gallstones?

A
  • usually asymptomatic
  • biliary colic pain (epigastrium/right upper quadrant)
  • nausea
  • vomiting
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4
Q

What are the complications of gallstones?

A
  • acute cholecystitis = inflammation of the gall bladder
  • biliary obstruction = stones become trapped in the common bile duct, may lead to inflammation
  • pancreatitis = inflammation of the pancreas due to obstruction at the ampulla of vater
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5
Q

What are the symptoms of acute cholecystitis?

A
  • biliary colic pain
  • nausea
  • vomiting
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6
Q

How is acute cholecystitis treated?

A
  • IV fluids
  • analagesias
  • cholecystectomy
  • stone dissolution
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7
Q

What are the symptoms of biliary obstructions?

A
  • biliary colic pain
  • fever
  • jaundice
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8
Q

How is biliary obstruction treated?

A
  • antibiotics

- bile duct drainage

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9
Q

What is the treatment for gallstones?

A
  • monitor if asymptomatic
  • analgesics for pain
  • cholecystectomy
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10
Q

What is viral hepatitis?

A

inflammation of the liver caused by a viral infections

  • may be acute lasting only a few weeks
  • may be chronic lasting 6 months or longer
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11
Q

Which form of viral hepatitis are chronic and which are acute?

A

chronic: B, C, D

acute, A, B, C, D, E

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12
Q

Describe the features of hepatitis A

A

acute only (3-6 weeks)
faeco-oral spread
symptoms: malaise, nausea, jaundice, anorexia
immunisation

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13
Q

Describe the features of hepatitis B

A 
acute or chronic
vertical or horizontal transmission
symptoms: malaise, nausea, anorexia, jaundice
immunisation
treatment: symptomatic, antivirals
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14
Q

Describe the features of Hepatitis C

A

acute or chronic

acute: flu-like symptoms
chronic: malaise, fatigue, cirrhosis
treatment: monitor, antivirals

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15
Q

Describe the feature of Hepatitis D

A

acute or chronic
replication of virus only activated in the presence of Hep B virus
may cause cirrhosis

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16
Q

Describe the features of Hepatitis E

A

acute

transmitted via GI tract

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17
Q

What is portal hypertension?

A

increased blood pressure in the hepatic portal vein

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18
Q

How are the causes of portal hypertension classified?

A
  • pre-hepatic (thrombosis, congenital abnormality)
  • hepatic (cirrhosis, fibrosis)
  • post-hepatic (heart failure)
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19
Q

What are the symptoms of portal hypertension?

A

-often asymptomatic
-jaundice
-nausea
-abdominal pain
-vomiting
-confusion
symptoms usually due to liver failure

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20
Q

What are the complication of portal hypertension?

A

varices (dilation of submucosal veins) may rupture causing bleeding

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21
Q

How is portal hypertension managed?

A

bleeding: asceptic tap, IV fluids, blood transfusion, antibiotics
prevent bleeding: vasoconstriction therapy, beta-blocker

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22
Q

What is primary sclerosing cholangitis?

A

inflammation of the intra and extra hepatic bile ducts which results in fibrosis

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23
Q

What are the symptoms of primary sclerosing cholangitis?

A
  • often asymptomatic
  • pruritus
  • fatigue
  • jaundice
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24
Q

What are the complications of primary sclerosing cholangitis?

A
  • liver failure

- decreased bile flow

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25
Q

How is primary sclerosing cholangitis treated?

A
  • liver transplant

- temporary stent replacement

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26
Q

What are ascites?

A

abnormal accumulation of fluid in the peritoneal cavity

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27
Q

What are the causes of ascites?

A
  • cirrhosis
  • Budd-Chiari syndrome
  • portal hypertension
  • portal vein thrombosis
  • hypoalbuminaemia
  • infection
  • malignancy
  • pancreatitis
28
Q

What are the symptoms of ascites?

A
  • abdominal swelling
  • abdominal pain
  • respiratory destress
  • discomfort when eating
  • peripheral oedema
29
Q

What is the shifting dullness test and what does it investigate?

A

presence of ascites

  • patient lies of back and percus
  • patient then rolls on to side
  • hear dull sound when percusing lower side
30
Q

How are ascites managed?

A
  • reduce sodium intake
  • diuretic
  • avoid drugs high in sodium
  • paracentesis (insert needle into peritoneal cavity to drain fluid)
31
Q

What is alcoholic liver disease?

A

damage to the liver due to excessive alcohol intake

32
Q

What are the 3 stages of alcoholic liver disease?

A
  • alcoholic fatty liver disease
  • alcoholic hepatitis
  • alcoholic cirrhosis
33
Q

What is the first stage of alcoholic fatty liver disease?

A

acute reversible accumulation of fat in the liver

34
Q

Describe the cause and progression of alcoholic liver disease?

A
  • metabolism of ethanol causes an increase in NADH:NAD
  • increased fatty acid synthesis and glyceride formation
  • accumulation of leucocytes in the liver causing necrosis
  • impairment of metabolism by the liver
  • release of ROS
  • acetalydehyde produce which is toxic
  • fibrosis of liver
  • cirrhosis
35
Q

What are ascites?

A

abnormal accumulation of fluid in the peritoneal cavity

36
Q

What are the causes of ascites?

A
  • cirrhosis
  • Budd-Chiari syndrome
  • portal hypertension
  • portal vein thrombosis
  • hypoalbuminaemia
  • infection
  • malignancy
  • pancreatitis
37
Q

What are the symptoms of ascites?

A
  • abdominal swelling
  • abdominal pain
  • respiratory destress
  • discomfort when eating
  • peripheral oedema
38
Q

What is the shifting dullness test and what does it investigate?

A

presence of ascites

  • patient lies of back and percus
  • patient then rolls on to side
  • hear dull sound when percusing lower side
39
Q

How are ascites managed?

A
  • reduce sodium intake
  • diuretic
  • avoid drugs high in sodium
  • paracentesis (insert needle into peritoneal cavity to drain fluid)
40
Q

What is alcoholic liver disease?

A

damage to the liver due to excessive alcohol intake

41
Q

What are the 3 stages of alcoholic liver disease?

A
  • alcoholic fatty liver disease
  • alcoholic hepatitis
  • alcoholic cirrhosis
42
Q

What is alcoholic fatty liver disease?

A

acute reversible accumulation of fat in the liver

43
Q

Describe the cause and progression of alcoholic liver disease?

A
  • metabolism of ethanol causes an increase in NADH:NAD
  • increased fatty acid synthesis and glyceride formation
  • accumulation of leucocytes in the liver causing necrosis
  • impairment of metabolism by the liver
  • release of ROS
  • acetalydehyde produce which is toxic
  • fibrosis of liver
  • cirrhosis
44
Q

How is alcoholic fatty liver disease managed?

A

-stop alcohol intake

45
Q

What are the symptoms of alcoholic fatty liver disease?

A
  • usually asymptomatic
  • nausea
  • vomiting
  • diarrhoea
46
Q

What is alcoholic hepatitis?

A

=inflammation of the liver due to excessive alcohol intake

47
Q

What causes alcoholic hepatitis?

A
  • accumulation of leucocytes causing hepatocyte necrosis
  • impairment of carb/protein metabolism
  • release ROS
  • acetaldehyde produced by ethanol oxidation is toxic
48
Q

What are the symptoms of alcoholic hepatitis?

A
  • jaundice
  • ascites
  • abnormal biochemistry
  • coagulopathy
  • hepatomegaly
49
Q

How is alcoholic hepatitis managed?

A
  • stop alcohol intake
  • hospitalise
  • vitamin supplements
  • steorids
  • monitor blood
  • healthy diet
50
Q

What is alcoholic cirrhosis?

A

late stage scaring/fibrosis of the liver which impairs blood flow and function

51
Q

What causes alcoholic cirrhosis?

A
  • damage to tissue

- permanent fibrosis due to scarring because of repair of the damage

52
Q

What are the symptoms of alcoholic cirrhosis?

A
  • jaundice
  • clubbing/leukonychia
  • hepatomegaly
  • splenomegaly
  • coagulopathy
  • hypoalbuminaemia
53
Q

How is alcoholic cirrhosis managed?

A
  • stop drinking alcohol

- liver transplant

54
Q

What is primary biliary cirrhosis/cholangitis?

A

progressive auto-immune disease causing inflammation and damage to the interlobular bile ducts of the liver

55
Q

Define cholangitis

A

inflammation/infection of the biliary tract

56
Q

What causes primary biliary cirrhosis?

A
  • genetic predisposition

- environmental triggers

57
Q

What are the symptoms of primary biliary cirrhosis?

A
  • pruritus (itchy skin)
  • jaundice
  • xanthelasma (yellow pigment deposition around the eyes)
58
Q

What are the complications of primary biliary cirrhosis?

A
  • vitamin deficiency
  • osteoporosis
  • cirrhosis
59
Q

How is primary biliary cirrhosis treated?

A 
-symptomatically: 
colesytramine for pruritus
bisphospahtes for osteoporosis
-vitamin supplements
-ursodeoycholic acid
-liver transplant
60
Q

What is cirrhosis?

A

late stage scarring of the liver

61
Q

What are the causes of cirrhosis?

A
  • chronic alcohol use
  • chronic viral hepatitis
  • non-alcoholic fatty liver disease
  • primary biliary cholangitis
  • Budd-Chiari syndrome (hepatic veins become obstructed)
62
Q

What are the symptoms of cirrhosis?

A
  • tiredness/weakness
  • nausea
  • loss of appetite
  • loss of libido
  • itchy skin
  • jaundice
  • vomiting
  • oedema
63
Q

What are the signs of cirrhosis?

A
  • leuconychia (white spots on nails
  • Terry’s nails (nails appear white)
  • clubbing
  • splenomegaly
  • palmar erythema
  • hyperdynamic circulation (increased circulatory volume)
64
Q

What are the complications of cirrhosis?

A
  • hepatic failure (coagulopathy, hypoalbuminaemia, hypoglycaemia)
  • portal hypertension (ascites, splenomegaly)
  • varices
65
Q

What are biliary tract diseases?

A

disease affecting the gall bladder, bile ducts and associated structures

66
Q

What do biliary tract diseases often coexist with?

A

gallstones

67
Q

Name some examples of biliary tract disease

A
  • acalculous cholecystitis
  • cholesterolosis of the gallbladder
  • adenomyomatosis of the gallbladder
  • chronic cholecystitis
  • primary sclerosing cholangitis
  • autoimmune cholangitis
  • biliary cysts
  • benign bile duct strictures
  • haemobilia
  • gallbladder polyps
  • carcinoma of the gall bladder
  • cholangiocarcinoma

My Phase 2a Medicine (5 decks)

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