Liver + Friends Flashcards

1
Q

How does alcohol withdrawal present?

A

x

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2
Q

How does delirium tremens present?

A

x

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3
Q

How is delirium tremens managed?

A

x

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4
Q

What scoring system can be used to assess the severity liver cirrhosis? What is included in this scoring system?

A
Child-Pugh classification
A - Albumin
B - Bilirubin
C - Clotting
D - distension (ascites)
E - encephalopathy
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5
Q

What is seen on ultrasound in liver cirrhosis?

A
Nodular surface of the liver
Corkscrew appearance of the arteries 
Enlarged portal vein.
Ascites
Splenomegaly
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6
Q

How is liver cirrhosis monitored?

A

Ultrasound and alpha feroprotein checked every 6 months

Check that it has not become hepatocellular carcinoma

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7
Q

Why does malnutrition occur in liver disease?

A

Liver cannot store glucose as glycogen as effectively

Reduced production of protein

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8
Q

What autoantibodies are present in autoimmune hepatitis?

A

Type 1 – ANA/anti-smooth muscle

Type 2 – Ant-kidney-liver ribosomes 1

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9
Q

What are drug causes of hepatocellular dysfunction?

A
Paracetamol
Alcohol
Sodium valproate+Phenytoin
Nitrofurantoin
Amiodarone
Methyldopa
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10
Q

What are drug causes of cholestasis?

A
COCP
Fluclox
Co-amox
Erythromycin
Sulfonylureas
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11
Q

In which of PBC or PSC can ursodeoxycholic acid improve outcomes?

A

PBC

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12
Q

How is chronic pancreatitis diagnosed?

A

CT = pancreatic calcification

Faecal elactase = Low

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13
Q

How does haemochromatosis present?

A
Early symptoms – fatigiue, erectile dysfunction, arthralgia
Liver cirrhosis
Diabetes
Joint pain(arthritis)
Dilated cardiomyopathy
Hypogonadotropic hypogonadism 
Bronze skin pigmentation
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14
Q

How does Wilson’s disease present?

A

In children – liver symptoms eg cirrhosis, pruritus, spider naevi, palmar erythema

In young adults – neurological symptoms eg memory problems, psychosis, mood disorders, Parkinsonism, concentration and co-ordination difficulties, speech difficulties, asterixis

Other:
Kayser-Fleischer rings
Blue nails

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15
Q

How is Wilson’s disease diagnosed?

A

First line = 24 hour urine collection for copper

Reduced serum copper
Reduced serum caeruloplasmin

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16
Q

In which of Wilson’s disease or haemochromatosis is there an increased risk of hepatocellular carcinoma?

A

Haemochromatosis

17
Q

What is seen on CT in pancreatic cancer?

A

Double duct sign = dilation of the pancreatic duct and the common bile duct

18
Q

What are signs of appendicitis?

A

Pain which starts at the umbilicus then localises to the RIF
Anorexia
Nausea
Tenderness at McBurney’s point
Tenderness on PR
Rovsing’s sign = tenderness in the R iliac fossa when palpating the L iliac fossa

19
Q

What is seen on blood tests in appendicitis?

A

Neutrophil predominant leukocytosis

20
Q

How does carcinoid syndrome present?

A

Diarrhoea
Flushing
Hypotension
Wheeze

21
Q

What is Budd-Chiari syndrome and how does it present? How can it be diagnosed?

A

Thrombosis of the hepatic vein

TRIAD=
Sudden onset severe abdominal pain
Ascites
Tender hepatomegaly

Diagnosis = Doppler ultrasound

22
Q

What are causes of Budd-Chiari syndrome?

A

Polcythaemia vera
Pregnancy
COCP
Thrombophilia

23
Q

What factors are used to determine severity of acute pancreatitis?

A
P – paO2 <7.9
A – Aged >55
N - neutrophila (high WCC)
C – calcium (low)
R  - renal function (high urea)
E – enzymes (raised LDH)
A - albumin (low)
S – sugar (HIGH glucose)
24
Q

How can you interpret an ascitic tap?

A

SAAG – serum ascites albumin gradient

SAAG >11 = Liver cirrhosis, heart failure, liver mets, Budd-chiari syndrome

SAAG <11 = Nephrotic syndrome, severe malnutrition

25
What is Maddrey's discriminant function?
Uses prothrombin time and bilirubin levels to determine whether oral prednisolone would help
26
What is Mirizzi's syndrome?
Complication of gallstones Cause of acute cholecystitis Gallstone becomes impacted in the distal cystic duct, causing extrinsic compression of the common bile duct
27
Compression of which part of the biliary tree causes jaundice?
Common bile duct Compression of the cystic duct does not cause jaundice
28
What is Rovsing's sign?
In appendicitis - palpation of the left iliac fossa causes pain in the right lilac fossa
29
What is Boas sign?
In acute cholesytisis - hyperaesthesia beneath the right scapula
30
When would a TIPS be used for oesophageal varicose?
For varices that are resistant to other prophylactic treatments
31
What are complications of PBC?
Cirrhosis Portal hypertension Hepatocellular carcinoma
32
How does PBC present and what marker is raised?
Middle aged female with history of autoimmune disease. Fatigue, pruritus, xanthomata, xanthelasma Anti-mitochondrial antibodies
33
How does PSC present and what marker is raised? What is seen on MRCP?
History of ulcerative colitis. Cholestasis - jaundice, pruritus, RUQ pain. Raised pANCA MRCP = beaded appearance
34
What can cause tender, pulsatile hepatomegaly?
Right sided heart failure
35
Post-cholecystectomy steatorrhoea - what medication can help with this?
Cholestyramine
36
What are complications of pancreatic cancer?
Jaundice Trousseau’s syndrome - thrombophlebitis DIC Diabetes
37
What is Courvoisier's sign?
Palpable painless gallbladder with jaundice — likely to be Pancreatic cancer
38
How to manage severe jaundice causeb by unresectable pancreatic cancer?
Biliary stenting
39
What is the criteria for liver transplantation in paracetamol induced liver failure?
Arterial pH <7.3 24 hours after ingestion OR Prolonged PT + Raised Creatinine + Encephalopathy