Liver + Friends Flashcards
How does alcohol withdrawal present?
x
How does delirium tremens present?
x
How is delirium tremens managed?
x
What scoring system can be used to assess the severity liver cirrhosis? What is included in this scoring system?
Child-Pugh classification A - Albumin B - Bilirubin C - Clotting D - distension (ascites) E - encephalopathy
What is seen on ultrasound in liver cirrhosis?
Nodular surface of the liver Corkscrew appearance of the arteries Enlarged portal vein. Ascites Splenomegaly
How is liver cirrhosis monitored?
Ultrasound and alpha feroprotein checked every 6 months
Check that it has not become hepatocellular carcinoma
Why does malnutrition occur in liver disease?
Liver cannot store glucose as glycogen as effectively
Reduced production of protein
What autoantibodies are present in autoimmune hepatitis?
Type 1 – ANA/anti-smooth muscle
Type 2 – Ant-kidney-liver ribosomes 1
What are drug causes of hepatocellular dysfunction?
Paracetamol Alcohol Sodium valproate+Phenytoin Nitrofurantoin Amiodarone Methyldopa
What are drug causes of cholestasis?
COCP Fluclox Co-amox Erythromycin Sulfonylureas
In which of PBC or PSC can ursodeoxycholic acid improve outcomes?
PBC
How is chronic pancreatitis diagnosed?
CT = pancreatic calcification
Faecal elactase = Low
How does haemochromatosis present?
Early symptoms – fatigiue, erectile dysfunction, arthralgia Liver cirrhosis Diabetes Joint pain(arthritis) Dilated cardiomyopathy Hypogonadotropic hypogonadism Bronze skin pigmentation
How does Wilson’s disease present?
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
How is Wilson’s disease diagnosed?
First line = 24 hour urine collection for copper
Reduced serum copper
Reduced serum caeruloplasmin
In which of Wilson’s disease or haemochromatosis is there an increased risk of hepatocellular carcinoma?
Haemochromatosis
What is seen on CT in pancreatic cancer?
Double duct sign = dilation of the pancreatic duct and the common bile duct
What are signs of appendicitis?
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
What is seen on blood tests in appendicitis?
Neutrophil predominant leukocytosis
How does carcinoid syndrome present?
Diarrhoea
Flushing
Hypotension
Wheeze
What is Budd-Chiari syndrome and how does it present? How can it be diagnosed?
Thrombosis of the hepatic vein
TRIAD=
Sudden onset severe abdominal pain
Ascites
Tender hepatomegaly
Diagnosis = Doppler ultrasound
What are causes of Budd-Chiari syndrome?
Polcythaemia vera
Pregnancy
COCP
Thrombophilia
What factors are used to determine severity of acute pancreatitis?
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)
How can you interpret an ascitic tap?
SAAG – serum ascites albumin gradient
SAAG >11 = Liver cirrhosis, heart failure, liver mets, Budd-chiari syndrome
SAAG <11 = Nephrotic syndrome, severe malnutrition
What is Maddrey’s discriminant function?
Uses prothrombin time and bilirubin levels to determine whether oral prednisolone would help
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
Compression of which part of the biliary tree causes jaundice?
Common bile duct
Compression of the cystic duct does not cause jaundice
What is Rovsing’s sign?
In appendicitis - palpation of the left iliac fossa causes pain in the right lilac fossa
What is Boas sign?
In acute cholesytisis - hyperaesthesia beneath the right scapula
When would a TIPS be used for oesophageal varicose?
For varices that are resistant to other prophylactic treatments
What are complications of PBC?
Cirrhosis
Portal hypertension
Hepatocellular carcinoma
How does PBC present and what marker is raised?
Middle aged female with history of autoimmune disease. Fatigue, pruritus, xanthomata, xanthelasma
Anti-mitochondrial antibodies
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
What can cause tender, pulsatile hepatomegaly?
Right sided heart failure
Post-cholecystectomy steatorrhoea - what medication can help with this?
Cholestyramine
What are complications of pancreatic cancer?
Jaundice
Trousseau’s syndrome - thrombophlebitis
DIC
Diabetes
What is Courvoisier’s sign?
Palpable painless gallbladder with jaundice — likely to be Pancreatic cancer
How to manage severe jaundice causeb by unresectable pancreatic cancer?
Biliary stenting
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
