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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
Q

Investigation for Hep A

A

Hep A IgM

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26
Q

Treatment for Hep A

A

Hygiene

Vaccine prophylaxis

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27
Q

Investigation for Hep B

A

HBsAg

HBeAg normally present in highly infective individuals

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28
Q

Treatment for chronic Hep B

A

No alcohol

Antivirals

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29
Q

Antivirals used to treat chronic Hep B

A

Peginterferon alfa-2a

OR

Entecavir/ tenovir (suppresive antivirals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

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

A

Test for Hep C RNA by PCR

31
Q

Management of acute viral hepatitis

A

No Antivirals

Monitor

32
Q

Side effects of pegingerferon

A

Flu like symptoms

Thyroid disease
Autoimmune disease
Psychiatric disease

33
Q

Advantages/disadvantages of peginterferon

A

Advantages
- sustained cure possible from a few months therapy

Disadvantages

  • side effects
  • injections
  • only minority gain benefit
34
Q

Advantages/disadvantages of suppressive antiviral treatment of Hep B

A

Advantages

  • safer
  • a increasing range available

Disadvantages

  • suppression not cure
  • resistance can develop
35
Q

Examples of new Hep C Antivirals

A

Simeprevir
Ledipasvir
Daclastasvir

36
Q

Where does the portal vein carry outflow from?

A 
Spleen 
Oesophagus 
Stomach 
Pancreas 
Small & large intestine
37
Q

How is Hep A spread?

A

Faecal-oral route

38
Q

Causes of cirrhosis

A 
Alcohol 
NAFLD 
Hep C 
PBC 
Autoimmune hepatitis 
Hep B 
Haemochromatosis 
PSC
Wilson's disease 
Alpha-1-antitrypsin 
Budd Chiari 
Methotrexate
39
Q

How is NASH diagnosed?

A

Liver biopsy

40
Q

Treatment of NASH

A

Weight loss

41
Q

How is simple steatosis diagnosed?

A

Ultrasound

42
Q

Clinical presentation of PBC

A

Middle aged woman
Fatigue
Itch without rash
Xanthomas & xanthelasma

43
Q

How to diagnose PBC?

A

Positive AMA
Cholestatic LFT’s
Liver biopsy

44
Q

Treatment of PBC

A

Uresodeoxycholic acid

45
Q

Clinical presentation of autoimmune hepatitis

A 
Hepatomegalh 
Jaundice 
Stigmata of chronic liver disease 
Spleen omegas 
Elevated AST and ALT 
Elevated PT 
Malaise 
Fatigue 
Ethanol 
Nausea 
Abdo pain 
Anorexia
46
Q

How to diagnose autoimmune hepatitis?

A 
Elevated AST/ALT 
Elevated IgG 
Rule of other causes 
Presence of autoimmune antibodies 
Liver biopsy
47
Q

Histological hallmark of autoimmune hepatitis

A

Interface hepatitis

48
Q

Treatment of autoimmune hepatitis

A

Corticosteroids

Azathioprine

49
Q

What is primary sclerosing cholangitis?

A

Autoimmune destructive disease of large and medium size bile ducts

50
Q

Clinical finding in primary sclerosing cholangitis

A

Recurrent cholangitis

51
Q

How to diagnose PSC

A

MRCP/ERCP of Billiary tree

52
Q

Phrase used to describe patients with haemochromatosis

A

“bronzed diabetic”

53
Q

Treatment of haemochromatosis

A

Venesection

54
Q

Treatment of Wilsons disease?

A

Copper chelation drugs

55
Q

What is Budd-Chiari?

A

Thrombosis of the hepatic veins

Protein C or S deficiency

56
Q

Clinical presentation of Budd Chiari

A

Acute

  • jaundice
  • tender
  • hepatomegaly

Chronic
- Ascites

57
Q

How to diagnose Budd Chiari?

A

Ultrasound of hepatic veins

58
Q

Treatment of budd-Chiari

A

Recanalalization of TIPSS

59
Q

How is cardiac cirrhosis caused?

A

Secondary to high right heart pressures

60
Q

Causes of high right heart pressures

A

Incompetent tricuspid valve
Congenital
Rheumatic fever
Constrictive pericarditis

61
Q

Benign lesions in the liver

A

Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

62
Q

Malignant lesions of the liver

A

Hepatocellular carcinoma
Cholangiocarcinoma
METASTASES

63
Q

How to diagnose live lesions

A

US
CT scan
MRI
Fine needle aspiration

64
Q

What liver lesion can contraceptive hormones cause?

A

Hepatic adenomas

65
Q

What are multiple adenomas associated with?

A

Glycogen storage disease

66
Q

What solid liver is more likely to bleed, adenomas or focal nodular hyperplasia?

A

Adenomas

67
Q

Treatment of simple cyst?

A

Nothing

68
Q

Treatment of hydatid cyst?

A

Marsuplization

Resection

69
Q

What are Vom Mevenburg complexes?

A

Benign cystic nodules throughout the liver

70
Q

Clinical presentation of liver abscess

A 
High fever 
Leukocytosis 
Abdo pain 
History of abdominal or biliary infection 
Dental procedure
71
Q

Management of liver abscess

A

Broad spectrum antibiotics
Aspiration/drainage
Echocardiogram

72
Q

Risk factors for Hepatocellular carcinoma

A

Hep B
Hep C
Alcohol
Alfatoxin

73
Q

Clinical features of HCC

A

Weight loss
RUQ pain
Hard enlarged RUQ mass

74
Q

What is a HCC tumour marker?

A

AFP

AY Gastrointestinal (21 decks)

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