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AY Gastrointestinal > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

How are Hep B & C spread?

A

Blood, sexually, mother to child,

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2
Q

Investigation for Hep A

A

Hep A IgM

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3
Q

Treatment for Hep A

A

Hygiene

Vaccine prophylaxis

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4
Q

Investigation for Hep B

A

HBsAg

HBeAg normally present in highly infective individuals

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5
Q

Treatment for chronic Hep B

A

No alcohol

Antivirals

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6
Q

Antivirals used to treat chronic Hep B

A

Peginterferon alfa-2a

OR

Entecavir/ tenovir (suppresive antivirals)

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7
Q

How do you distinguish between a past or active Hep C infection?

A

Test for Hep C RNA by PCR

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8
Q

Management of acute viral hepatitis

A

No Antivirals

Monitor

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9
Q

Side effects of pegingerferon

A

Flu like symptoms

Thyroid disease
Autoimmune disease
Psychiatric disease

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10
Q

Advantages/disadvantages of peginterferon

A

Advantages
- sustained cure possible from a few months therapy

Disadvantages

  • side effects
  • injections
  • only minority gain benefit
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11
Q

Advantages/disadvantages of suppressive antiviral treatment of Hep B

A

Advantages

  • safer
  • a increasing range available

Disadvantages

  • suppression not cure
  • resistance can develop
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12
Q

Examples of new Hep C Antivirals

A

Simeprevir
Ledipasvir
Daclastasvir

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13
Q

Where does the portal vein carry outflow from?

A 
Spleen 
Oesophagus 
Stomach 
Pancreas 
Small & large intestine
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14
Q

Prehepatic causes of portal hypertension

A

Blockage of the portal vein before the liver

Portal thrombosis or occlusion secondary to congenital portal venous abnormalities

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15
Q

Intranepatic causes of portal hypertension

A

Presinusoidal - schistosomiasis
Postsinusoidal - cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis
Budd Chiari

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16
Q

3 most common causes of cirrhosis

A

Alcohol
Hep C
NASH (NAFLD)

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17
Q

What is the difference between compensated and de compensated cirrhosis?

A

Compensated - clinically normally

Decompensated - liver failure

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18
Q

Signs of compensated cirrhosis

A 
Spider naevi 
Palmar erythema 
Clubbing 
Gynaecomastia 
Hepatomegaly
Splenomegaly 
NONE
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19
Q

Signs of decompensated cirrhosis

A

Jaundice
Ascites
Encephalopathy
Bruising

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20
Q

Complications of cirrhosis

A

Ascites
Encephalopathy
Variceal bleeding
Liver failure

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21
Q

General principles to treat decompensated cirrhosis

A

Remove or treat underlying cause

Look for and treat infection

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22
Q

Treatment of Ascites

A 
Improve underlying liver disease
Reduce salt intake 
Spironolactone 
Paracentesis 
TIPSS 
Transplantation
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23
Q

How is Hep A spread?

A

Faecal-oral route

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24
Q

How are Hep B & C spread?

A

Blood, sexually, mother to child,

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25
Investigation for Hep A
Hep A IgM
26
Treatment for Hep A
Hygiene | Vaccine prophylaxis
27
Investigation for Hep B
HBsAg | HBeAg normally present in highly infective individuals
28
Treatment for chronic Hep B
No alcohol | Antivirals
29
Antivirals used to treat chronic Hep B
Peginterferon alfa-2a OR Entecavir/ tenovir (suppresive antivirals)
30
How do you distinguish between a past or active Hep C infection?
Test for Hep C RNA by PCR
31
Management of acute viral hepatitis
No Antivirals | Monitor
32
Side effects of pegingerferon
Flu like symptoms Thyroid disease Autoimmune disease Psychiatric disease
33
Advantages/disadvantages of peginterferon
Advantages - sustained cure possible from a few months therapy Disadvantages - side effects - injections - only minority gain benefit
34
Advantages/disadvantages of suppressive antiviral treatment of Hep B
Advantages - safer - a increasing range available Disadvantages - suppression not cure - resistance can develop
35
Examples of new Hep C Antivirals
Simeprevir Ledipasvir Daclastasvir
36
Where does the portal vein carry outflow from?
``` Spleen Oesophagus Stomach Pancreas Small & large intestine ```
37
How is Hep A spread?
Faecal-oral route
38
Causes of cirrhosis
``` Alcohol NAFLD Hep C PBC Autoimmune hepatitis Hep B Haemochromatosis PSC Wilson's disease Alpha-1-antitrypsin Budd Chiari Methotrexate ```
39
How is NASH diagnosed?
Liver biopsy
40
Treatment of NASH
Weight loss
41
How is simple steatosis diagnosed?
Ultrasound
42
Clinical presentation of PBC
Middle aged woman Fatigue Itch without rash Xanthomas & xanthelasma
43
How to diagnose PBC?
Positive AMA Cholestatic LFT's Liver biopsy
44
Treatment of PBC
Uresodeoxycholic acid
45
Clinical presentation of autoimmune hepatitis
``` Hepatomegalh Jaundice Stigmata of chronic liver disease Spleen omegas Elevated AST and ALT Elevated PT Malaise Fatigue Ethanol Nausea Abdo pain Anorexia ```
46
How to diagnose autoimmune hepatitis?
``` Elevated AST/ALT Elevated IgG Rule of other causes Presence of autoimmune antibodies Liver biopsy ```
47
Histological hallmark of autoimmune hepatitis
Interface hepatitis
48
Treatment of autoimmune hepatitis
Corticosteroids | Azathioprine
49
What is primary sclerosing cholangitis?
Autoimmune destructive disease of large and medium size bile ducts
50
Clinical finding in primary sclerosing cholangitis
Recurrent cholangitis
51
How to diagnose PSC
MRCP/ERCP of Billiary tree
52
Phrase used to describe patients with haemochromatosis
"bronzed diabetic"
53
Treatment of haemochromatosis
Venesection
54
Treatment of Wilsons disease?
Copper chelation drugs
55
What is Budd-Chiari?
Thrombosis of the hepatic veins | Protein C or S deficiency
56
Clinical presentation of Budd Chiari
Acute - jaundice - tender - hepatomegaly Chronic - Ascites
57
How to diagnose Budd Chiari?
Ultrasound of hepatic veins
58
Treatment of budd-Chiari
Recanalalization of TIPSS
59
How is cardiac cirrhosis caused?
Secondary to high right heart pressures
60
Causes of high right heart pressures
Incompetent tricuspid valve Congenital Rheumatic fever Constrictive pericarditis
61
Benign lesions in the liver
Hemangioma Focal nodular hyperplasia Adenoma Liver cysts
62
Malignant lesions of the liver
Hepatocellular carcinoma Cholangiocarcinoma METASTASES
63
How to diagnose live lesions
US CT scan MRI Fine needle aspiration
64
What liver lesion can contraceptive hormones cause?
Hepatic adenomas
65
What are multiple adenomas associated with?
Glycogen storage disease
66
What solid liver is more likely to bleed, adenomas or focal nodular hyperplasia?
Adenomas
67
Treatment of simple cyst?
Nothing
68
Treatment of hydatid cyst?
Marsuplization | Resection
69
What are Vom Mevenburg complexes?
Benign cystic nodules throughout the liver
70
Clinical presentation of liver abscess
``` High fever Leukocytosis Abdo pain History of abdominal or biliary infection Dental procedure ```
71
Management of liver abscess
Broad spectrum antibiotics Aspiration/drainage Echocardiogram
72
Risk factors for Hepatocellular carcinoma
Hep B Hep C Alcohol Alfatoxin
73
Clinical features of HCC
Weight loss RUQ pain Hard enlarged RUQ mass
74
What is a HCC tumour marker?
AFP

AY Gastrointestinal (21 decks)

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