Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y1 GI > Liver Disease + Gall Bladder + Pancreas > Flashcards

Liver Disease + Gall Bladder + Pancreas Flashcards

1
Q

What does excessive bilirubin level in blood cause

A

Jaundice

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

What is the prehepatic cause of jaundice

A

Haemolytic anaemia - excess breakdown of RBC, releasing excess bilirubin
Sickle cell disease

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

What organs breakdown RBC

A

spleen

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

How is bilirubin metabolised

A

Metabolised in the liver, undergoes phase 2 metabolism - glucoronidation, making bilirubin more water soluble so it can be excreted in bile

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

What is glucoronidation

A

Addition of glucuronic acid by glucuronosyltransferase (UGT1A1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Two types of hepatic causes of jaundice

A

Unconjugated - abnormal metabolism of bilirubin

Conjugated - abnormal excretion of conjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the unconjugated hepatic causes of jaundice

A

Gilbert’s syndrome
hyperthyroidism
high serum levels of gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the conjugated hepatic causes of jaundice

A

hepatocellular injury - viral hepatitis / autoimmune hepatitis / alcoholic hepatitis / non-alcoholic fatty liver disease/ drug induced liver injury

Cholestatic liver disease - PBC, PSC

Sarcoidosis / amyloidosis / tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the post hepatic causes of jaundice

A

Cholestatic liver diseases (PBC, PSC, malignancy, gallstones)
biliary atresia
strictures of biliary duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are cholestatic liver diseases

A

Decrease in bile flow due to abnormal excretion or obstruction of the bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Examples of cholestatic diseases

A

Malignancy at head of pancreas
primary sclerosing cholangitis
primary biliary cholangitis
gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is acute liver failure

A

Loss of liver function due to acute massive necrosis of hepatocytes
In absence of chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of acute liver failure

A

Drug induced liver injury
viral hepatitis
alcohol
Budd chiari syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of acute liver failure

A

Drug induced liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drugs can cause drug induced liver injury

A

Paracetamol overdose
Co-amoxiclav / flucloxacillin / NSAID
Statins, ecstasy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristic findings of acute liver failure

A

Hepatic encephelopathy + coagulopathy + hypoglycaemia + jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is hepatic encephelopathy

A

Altered mental state
Confusion
Asterixis (liver flap)
Due to build up of toxic ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of ALF

A 
Jaundice 
HE
easy bruising (due to coagulopathy) 
Abdominal pain 
Infection 
circulatory failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes circulatory failure

A

Massive necrosis leads to massive inflammation, massive vasodilation -> very low SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnosis of ALF

A 
INR - coagulability 
Blood glucose level
Ammonia level 
LFT - albumin / ALP / gGT / bilirubin
Imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment of ALF

A

IV fluids
Vitamin K and fresh plasma with clotting factors
Transplant
Sepsis 6 bundle if indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complications of acute liver failure

A 
Infections 
Circulatory failure 
High output HF
Cerebral injury
Haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why does circulatory failure occur in ALF

A

Because massive necrosis -> inflammation -> vasodilation -> low SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the end stage of liver disease

A

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Timeline of liver disease

A

Chronic liver disease -> persistent inflammation -> fibrosis -> cirrhosis -> acute liver failure / decompensated cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does decompensated cirrhosis mean

A

The point where there is so much fibrosis and scarring causing the liver to fail ultimately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Examples of chronic liver diseases (conditions that can develop into chronic liver disease)

A 
Alcoholic hepatitis 
Non-alcoholic fatty liver disease
Viral hepatitis 
Autoimmune hepatitis 
Malignancy 
Primary biliary cholangitis / primary sclerosing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Development of alcoholic liver disease

A

Alcoholic fatty liver -> alcoholic hepatitis -> fibrosis -> cirrhosis
Disease progresses as you continue drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why should you treat alcoholic fatty liver / alcoholic hepatitis as soon as possible

A

Because they are reversible; once you stop drinking, they can resolve and not develop into cirrhosis

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

What causes alcoholic fatty liver

A

Metabolism of alcohol leads to excess fat deposits in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What will be seen on histology of alcoholic fatty liver

A

fat vacuoles (steatosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What products from alcohol metabolism are toxic to the liver

A

Ethanol and acetaldehyde

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How long does it usually take for alcoholic hepatitis to develop

A

Weeks or months of excessive alcohol consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What happens in alcoholic hepatitis

A

Toxic ethanol and acetaldehyde -> necrosis -> inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What immune cells infiltrate the liver in alcoholic hepatitis

A

Neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What stain is used to identify collagen fibres

A

Masson Trichome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How long does it take for fibrosis to occur in alcoholic hepatiits

A

months to years of excessive alcohol consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Histological features of cirrhosis

A

Collagen fibres surrounding regenerative nodules of hepatocytes, cutting off blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does cirrhosis make the hepatocytes no longer functional

A

Because the collagen fibres surrounding the hepatocytes cuts off the blood supply to the hepatocytes, meaning that

  • the hepatocytes cannot receive portal blood from portal vein = cannot filter the nutrient rich blood
  • the hepatocytes cannot receive blood from hepatic artery = no oxygen so dies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why are there regenerative nodules in cirrhosis

A

Because of the persistent liver injury and necrosis in that area, causing the hepatocytes have to proliferate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Symptoms of alcoholic hepatitis

A 
Jaundice
Pain
tender on palpation
hepatomegaly 
signs of decompensated cirrhosis / liver failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the signs of decompensated cirrhosis

A

Ascites
Portal hypertension
Easy bruising - coagulopathy
HE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Management of alcoholic hepatitis

A

Stop alcohol consumption
Ensure good nutrition and hydration
corticosteroid therapy for severe hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Complication of chronic liver disease

A

Cirrhosis
Malnutrition
Increase risk of hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is NAFLD

A

Fatty liver in absence of excess alcohol consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Risk factors for NAFLD

A

Obesity
Metabolic syndrome - hypertension / hyperlipidaemia / low HDL
Diabetes
Genetic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Changes in what genes are associated with NAFLD

A

PNPLA3

TM6SF2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When should you suspect that the patient’s NAFLD is caused by genetic changes

A

When the patient is young and lean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Symptoms of NAFLD

A

Usually asymptomatic
Hepatomegaly
Signs of decompensated cirrhosis / liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pathogen for hepatitis A

A

Ebstein Barr virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Pathogen for hepatitis B

A

yellow fever virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Pathogen for hepatitis C

A

Herpes simplex virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Pathogen for hepatitis E

A

cytomegalovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which type of viral hepatitis is least likely to cause chronic liver disease

A

Hepatitis A and E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which type of viral hepatitis has a high chance of developing into chronic liver disease

A 
Hepatitic B (the younger the patient is, the greater the risk) 
Hepatitis C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is considered as chronic viral hepatitis B

A

Failure to clear hepatitis B, causing presence of HBsAg antigen for over 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Does hepatitis B have a short or long incubation period

A

Long - takes 1 - 4months to develop symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Transmission of hepatitis B

A

By blood or sexual fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Can hepatitis B be transmitted from mother to child? And why is it bad?

A

Yes (vertical transmission); bad because the younger the patient gets hepatitis B, the more likely it is to develop into chronic liver disease and eventually cause cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How long is the incubation period of hepatiits C

A

2 to 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Chronic hepatitis caused by which virus is more associated with increased risk of hepatocellular carcinoma

A

Hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What may be a histological finding for hepatitis caused by hepatitis C

A

Steatosis

Infiltration of inflammatory cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the LFT pattern for cholestatic disease

A

Raised ALP and gGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What would the LFT result be for viral hepatitis

A

Raised ALT and AST, normal ALP and gGT

Low albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Which hepatitis causes chronic hepatitis

A

Hepatitis C

Hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Symptoms of acute hepatitis

A 
Fever
Jaundice
Abdominal pain
Nausea/vomiting 
Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the most common cause of cirrhosis

A

Alcoholic hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Symptoms of chronic hepatitis

A

Usually asymptomatic till develop decompensated cirrhosis / ALF or exacerbations (symptoms of acute hepatitis)
Signs of deceompensated cirrhosis: HE, ascites, easy bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What conditions increases the risk of hepatocellular carcinoma

A

Chronic viral hepatitis B
Alcoholic hepatitis
NAFLD
PBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Transmission of hepatitis A

A

Faecal-oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which age group does hepatitis A more commonly affect

A

young people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What needs to be done to confirm diagnosis for Hepatitis A

A

clotted blood for HAV IgM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which group of hepatitis B patients need to be treated

A

Those with hepatitis B for more than 4 weeks
Those with coagulopathy
Those with acute liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Diagnosis of hepatitis B

A

Serology and LFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What would serology for active hepatitis B infection be

A

HBsAg positive
HBeAg positive
HBV DNA PCR positive
IgM anti-HBc positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What signifies a chronic hepatitis B

A

HBsAg for more than 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Serology for chronic hepatitis B

A 
IgM anti HBc negative
IgG anti HBc positive
HBsAg positive
anti-Hbs negative 
HBV DNA PCR positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

How long will IgM anti HBc be present

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which anti HBc will be present after 6 months of infection (in chronic hepatitis)

A

IgG HBc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What does HBeAg indicate

A

Indicates high viral replication / infectivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What does anti-HBs indicate

A

clearance of disease or vaccinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What does anti HBe indicate

A

decrease in viral replication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Serology for hepatitis B vaccinated person

A

anti HBs positive

others negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Risk factors for Hepatitis B

A

Infected mother
Multiple sex partners
IV drug usage (repeated use of needle / contaminated needle)

85
Q

What type of PCR is used in hepatitis C

A

RNA PCR

86
Q

Which hepatitis are detected by RNA PCR

A

Hepatitis C

Hepatitis D

87
Q

Treatment for hepatitis B

A

Anti-virals:
tenofovir / entecavir
PegIFN-alpha

88
Q

Examples of anti virals

A

tenofovir / entecavir

PegIFN-alpha

89
Q

How is hepatitis C transmitted

A

By blood

90
Q

Why is hepatitis C serious

A

Because there is low level of spontaneous clearance, most develop into chronic hepatitis

91
Q

Diagnosis of Hepatitis C

A

HCV RNA PCR

presence of HCV IgG

92
Q

What can HCV IgG indicate

A

If positive -> can be active or past infection
Then test for HCV RNA by PCR
If HCV RNA PCR is positive -> active infection
If HCV RNA PCR is negative -> past infection

93
Q

Management for hepatitis C

A

8-12 weeks of combination DAA (direct acting antivirals)

94
Q

Which hepatitis cause acute hepatitis only

A

Hepatitis A

Hepatitis E

95
Q

Transmission of hepatitis E

A

Faecal oral

96
Q

Incubation period of Hepatitis E

A

15 to 60 days

97
Q

What does hepatitis D need in order to be present

A

HBsAg, so it needs the presence of Hepatitis B as well

98
Q

Treatment for hepatic encephalopathy

A

Lactulose - increases excretion of ammonia

Rifaximin

99
Q

Cirrhosis mechanism

A

Liver injury -> activating Hepatic stellate cells -> HSC proliferate and cause fibrosis

100
Q

Where are HSC found

A

space between hepatocytes and sinusoids

101
Q

How does cirrhosis cause portal hypertension

A

Massive structural change, causing increase in vascular resistance

102
Q

Hepatic portal vein carries blood from which organs back to liver

A 
Spleen
Small and large intestines
Pancreas
Stomach
Oesophagus
103
Q

What vessels drain into hepatic portal vein

A

superior and inferior mesenteric vein
splenic vein
gastrin vein

104
Q

Blood flow from hepatic portal vein to right atrium

A

Hepatic portal vein -> sinusoids -> Central vein -> IVC -> right atrium

105
Q

Location of anastamosis between portal and circulatory sytem

A

Oesophageal plexus
Umbilical vein
Haemorrhoidal venous plexus
Retroperitoneal collateral vessels

106
Q

What is the significance of the anastamoses between portal and systemic circulation

A

During portal hypertension, because there is an increased resistance of blood flowing into liver then back into the circulatory system, blood will flow to the collateral vessels, bypassing the liver, flowing back to circulatory system (so basically, blood is finding an alternate way to go back to the heart)

107
Q

What occurs due to portal hypertension

A

Ascites
Oesophageal varices
Haemorrhoids

108
Q

How does ascites occur

A

Portal hypertension; increase in pressure forces fluid out of vessels

109
Q

What is the vicious cycle of portal hypertension

A

1) Portal hypertension
2) Formation of collateral vessels, increase in blood flow in collateral vessels
3) sphlanchic vasodilation to increase blood flow into portal vein to compensate the loss of portal blood to collateral vessels
4) decrease in MAP, SVR -> stimulate baroreceptors and RAAS
5) RAAS increases water and sodium retention
6) increases blood flow in portal system = worsening portal hypertension

110
Q

What are the other causes of portal hypertensionW

A

Portal embolism / portal thrombosis

Budd Chiari syndrome

111
Q

What are the common causes of cirrhosis

A

Alcoholic hepatitis
NAFLD
Chronic viral hepatitis (HCV , sometimes HBC)

112
Q

Why do patients with cirrhosis need to be on heparin

A

Because they are likely to bleed or clot (imbalance)

If they are not bleeding, they are likely to clot hence need to be on anti-coagulant to prevent clotting

113
Q

What is Budd Chiari syndrome

A

Blockage of hepatic vein that drains the liver

114
Q

What is decompensated cirrhosis

A

When the extent of cirrhosis is so great, the liver fails to function normally anymore

115
Q

Symptoms of compensated cirrhosis

A 
Mostly asymptomatic
Hepatomegaly
Splenomegaly 
Varices
Clubbing
Gynaecomastia
116
Q

Signs of decompensated cirrhosis

A

HE
Coagulopathy - easy bruising
Ascites
Jaundice

117
Q

Causes of ascites

A

Most commonly cirrhosis - portal hypertension
Peritonitis
Malignancy in peritoneal cavity

118
Q

Types of ascitic fluid

A 
Exudate = presence of proteins, immune cells; usually due to infection increasing vascular permeability
Transudate = without presence of proteins and only a few cells; usually due to high pressure forcing fluid out of vessels
119
Q

What type of ascitic fluid would portal hypertension cause

A

Transudate

120
Q

Diagnosis of ascites

A

Dullness in percussion
Ascitic tap
Albumin level / WCC
Ultrasound

121
Q

Ascitic tap procedure

A

Insert small needle to get a sample of ascitic fluid and send for microbiological sampling.

122
Q

What does elevated neutrophil in ascitic fluid mean

A

Spontaneous bacterial infection

123
Q

Management of ascites without spontaneous bacterial infection

A

First line: Spironalactone
Second line: Spironalactone + loop diuretics
Paracentesis - drain fluid
TIPSS

124
Q

Management of ascites with spontaneous bacterial infection

A

Broad spectrum antibiotics

IV terlipressin

125
Q

What drug is used to prevent varices from bleeding

A

Non selective Beta blockers - carvedilol / propanolol

126
Q

What is cholelithiasis

A

Gall stones within gall bladder

127
Q

What is choledocholithiasis

A

Gallstones escaped the gallbladder, lodges within biliary tree

128
Q

Components of bile

A

Bile acids, cholesterol, water, bilirubin, phospholipid

129
Q

How do cholesterol galltones form

A

Due to excess cholesterol in bile

Supersaturation in gallbladder causes crystallization of the cholesterol -> gallstone

130
Q

Types of gallstones

A

Cholesterol
Bilirubin
Mixed cholesterol and bilirubin
Calcium bilirubinate and calcium salts

131
Q

What causes black gallstones

A

Gallstones formed due to excess bilirubin

132
Q

What causes brown gallstones

A

Calcium bilirubinate and calcium salts

133
Q

Risk factors for gallstones

A 
Female 
Fat
Middle age
Crohn's disease
family history of cholelithiasis 
Rapid weight loss / prolonged fasting 
diabetes
Oral contraceptive pill
134
Q

What is biliary colic

A

It is abdominal pain caused by gallbladder contracting while gallstone blocking the cystic duct, increasing pressure in gallbladder

No infection

135
Q

Symptoms of biliary colic

A

RUQ pain - colicky
Worse after eating / eating fatty meal
Pain may radiate to shoulder or interscapular region
Nausea and vomiting

136
Q

Biliary colic is commonly seen in

A

Fair (caucasian), Fat, Forty, Female

137
Q

LFT for biliary colic

A

Normal, no signs of infection

138
Q

Are gallstones usually symptomatic

A

No, usually asymptomatic till they cause other conditions

139
Q

Imaging for symptomatic gallstones

A

USS (ultrasound)

MRCP

140
Q

What does MRCP show

A

special type of MRI that shows the gallbladder, cystic duct, pancreas and pancreatic duct

141
Q

Management for biliary colic

A

Analgesia (avoid morphine)
Lifestyle modification
Cholecystectomy

142
Q

Why is cholecystectomy commonly performed in patients with biliary colic

A

Because once a gallstone forms, more will form so it is better to just remove the GB to prevent recurrence

143
Q

What conditions can gallstones cause

A 
Biliary colic 
Ascending cholangitis 
Cholecystitis 
Acute pancreatitis 
empyema
Gallstone ileus
144
Q

What is cholecystitis

A

Inflammation of the GB due to gall stones blocking the cystic duct

145
Q

How do gallstones cause cholecystitis

A

Gallstones block cystic duct -> causing impaired drainage -> inflammation

146
Q

Complications of cholecystitis

A

Empyema
Rupture of GB
Infection backing up to the liver

147
Q

What may a GB with chronic cholecystitis look like

A

Thickened wall due to fibrosis

148
Q

Symptoms of cholecystitis

A 
RUQ pain 
Fever
Nausea + vomiting 
Malaise
Murphy's sign
149
Q

What is Murphy’s sign

A

inspiratory arrest upon palpation of RUQ

Ask the patient to hold in a deep breath then palpate the RUQ, if pain occurs -> Murphy’s sign

150
Q

Diagnosis of Cholecystitis

A

USS + Murphy’s sign is diagnostic

MRCP

151
Q

What may USS show for cholecystitis

A

Cholelithiasis
Thickening of gall bladder wall
Pericholecystic fluid

152
Q

management of Cholecystitis

A 
IV antibiotics
IV fluids 
Analgesia 
Cholecystectomy within 1 week of diagnosis 
Percutaneous cholecystostomy
153
Q

When is percutaneous cholecystotomy used

A

to drain pus (empyema) / fluid

154
Q

What should be done before cholecystectomy

A

Remove gallstones via ERCP

155
Q

What can rupture of GB cause

A

release of contents into peritoneal cavity -> peritonitis

156
Q

What is ascending cholangitis

A

Infection of the biliary tree

secondary to gallstones or biliary stricture

157
Q

Is ascending cholangitis common

A

No

158
Q

Causes of biliary strictures

A

PSC / malignancy at head of pancreas / cholangiocarcinoma

159
Q

Symptoms of ascending cholangitis

A

Charcot’s triad or Reynold’s pentad
Malaise
Vomiting and nausea

160
Q

What is Charcot’s triad

A

RUQ pain
Fever
Jaundice

161
Q

What is Reynold’s pentad

A 
RUQ pain
fever
jaundice
Hypotension 
Confusion
162
Q

When will shock and confusion show in ascending cholangitis

A

in Sepsis

163
Q

Common pathogen causing ascending cholangitis

A

E.coli

164
Q

LFT result for ascending cholangitis

A

Raised bilirubin , ALP
Raised CRP
Raised inflammatory markers

165
Q

What would Ultrasound for ascending cholangitis show

A

Dilated bile duct

Gallstones at bile duct

166
Q

Management of acute cholangitis

A

IV antibiotics
IV fluids, analgesia
ERCP for drainage / relieve obstruction (remove stones)

167
Q

What antibiotics are used for cholecystitis

A

IV augmentin

168
Q

What antibiotics are used for ascending cholangitis

A

IV augmentin or tazocin

169
Q

What is primary biliary cholangitis (Primary biliary cirrhosis)

A

An autoimmune cholestatic liver disease that causes destruction of own bile ducts

170
Q

How is cholestasis caused in PBC

A

Autoimmune destruction of bile ducts mediated by T cells -> bile duct loss -> cholestasis

171
Q

How does cholestasis in PBC cause cirrhosis

A

Cholestasis -> build up of toxic substances in liver -> persistent inflammation -> fibrosis, cirrhosis

172
Q

Characteristics of PBC

A

Anti-mitochondrial autoantibodies

Increased IgM

173
Q

LFT and serology findings of PBC

A

Cholestatic pattern LFT = raised ALP, gGT, albumin

Increased IgM

174
Q

PBC is commonly seen in which group of people

A

Middle aged females

175
Q

Risk factors of PBC

A

Age - 30-60
Female
Family history of PBC

176
Q

Symptoms of PBC

A 
Pruritus (itchy skin) 
Fatigue
RUQ pain
Xanthomas, xanthelasmas
Clubbing 
Hepatomegaly / splenomegaly
Jaundice
177
Q

Management of PBC

A

Ursodeoxycholic acid
Obeticholic acid
Liver transplantation

178
Q

What is used to treat pruritus

A

cholestyramine (bile acid sequestrant)

179
Q

Complications of PBC

A

Increases risk for HCC
Osteoporosis
Osteomalacia
Decompensated cirrhosis

180
Q

What is primary sclerosing cholangitis

A

Autoimmune disorder causing cholestatic liver disease due to persistent inflammation hence fibrosis of intra and extrahepatic bile ducts

181
Q

What condition is associated to Primary sclerosing cholangitis

A

Ulcerative colitis

HIV

182
Q

Risk factors for PSC

A

UC
HIV
Men
Between 30-40 years old

183
Q

Symptoms of PSC

A

Pruritus
Jaundice
Recurrent bacterial cholangitis

184
Q

LFT of PSC

A

Raised ALP, gGT

185
Q

Difference between PSC and PBC

A

PBC has raised IgM and presence of anti-mitochondrial antibodies whereas PSC does not

PSC may have positive p-ANCA and anti-smooth muscle antibodies

PBC only affects intrahepatic bile ducts whereas PSC affects intra and extra hepatic ducts

PBC is more common among middle aged females whereas PSC is more common among middle aged males

186
Q

Test for PSC

A

LFT

p-ANCA

187
Q

What is p-ANCA

A

Test for Antineutrophil cytoplasmic antibodies

188
Q

What may be seen on MRCP or ERCP in primary sclerosing cholangitis

A

Multiple biliary strictures - looks like beads

189
Q

Management of PSC

A

Liver transplant

190
Q

Primary sclerosing cholangitis increases the risk of

A

Cholangiocarcinoma

191
Q

Cholangiocarcinoma type of carcinoma

A

Adenocarcinoma

192
Q

Risk factors of cholangiocarcinoma

A 
Cholelithiasis 
PSC
UC 
smoking 
Obesity
193
Q

Is the prognosis for cholangiocarcinoma good

A

No

Symptoms are often only presented at late stage

194
Q

Symptoms of cholangiocarcinoma

A

Palpable mass at RUQ
Persistent biliary colic symptoms
Weight loss
Anorexia

195
Q

What is courvoisier sign

A

Palpable mass at RUQ, occurs in cholangiocarcinoma

196
Q

How to obtain biopsy for cholangiocarcinoma

A

via ERCP

197
Q

Management of cholangiocarcinoma

A

Cholecystectomy

Palliation

198
Q

Signs of cholestasis

A

Darker urine

Pale stool

199
Q

Pale stool is a sign of

A

not enough bile produced

Secretion of bile is blocked / reduced

200
Q

What can amiodarone cause

A

It is toxic to hepatocytes, can cause hepatic jaundice

201
Q

Characteristics of primary sclerosing cholangitis

A

Anti smooth muscle antibodies

ANCA (anti nuclear antibodies)

202
Q

Characteristics of autoimmune hepatitis

A

Anti smooth muscle antibodies

Maybe antinuclear antibodies

203
Q

What conditions are at higher risk if the patient has primary sclerosing cholangitis

A

Cholangiocarcinoma

Colorectal cancer

204
Q

What are the drugs that can cause prehepatic jaundice

A

Rifampicin (used in IE)

205
Q

What are the drugs that can cause hepatic jaundice (drug induced liver injury)

A 
Paracetamol overdose
Statins 
Ecstasy 
Co-amoxiclav 
Flucloxacillin
NSAID
Amiodarone
206
Q

What are the drugs that can cause post hepatic jaundice (cholestatic jaundice)

A

Co-amoxiclav
Nitrofurantonin
steroids
Flucloxacillin

207
Q

What is a marker for hepatocellular cancer

A

AFP

208
Q

What may low albumin level indicate

A

Liver disease
Inflammation
Kidney disease

Y1 GI (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions