Liver + Friends Flashcards
1
Q
What are the functions of the liver
A
Oestrogen level regulation
Albumin
Clotting factors
Storage (VITS, Fe, Metabolism of carbs, Immunity, Detoxification, Bilirubin metabolism
2
Q
How do bilirubin, albumin and prothrombin time change with liver damage
A
Bilirubin and prothrombin time increase
Albumin decreases
3
Q
What does an AST:ALT ratio of 2:1 suggest
A
Alcoholic liver disease
4
Q
What does an AST:ALT ratio of 4.5:1 suggest
A
Wilson’s or hyperthyroid
5
Q
What does an AST:ALT ratio of <0.9:1 suggest
A
None alcoholic fatty liver disease
6
Q
Where are ALT and AST found other than the liver
A
Heart, kidney and muscles
7
Q
What is GGT
A
Gamma-glutamyl transferase, an enzyme found mostly in liver
8
Q
What does a raised GGT suggest
A
Alcoholic liver disease (helps differentiate raised ALP as an hepatic/ bony cause)
9
Q
What is ALP
A
Alkaline phosphate
10
Q
What does a raised ALP suggest
A
Biliary tree specific damage and bone pathology
11
Q
What is liver failure
A
When the liver loses regeneration/ repair ability
12
Q
What is acute liver failure
A
Liver injury accompanied with hepatic encephalopathy, jaundice, coagulopathy and ascites.
In patients with previously normal liver
13
Q
What is fulminant liver failure
A
Rare syndrome of massic hepatocyte necrosis
14
Q
What do you see histologically in fulminant liver failure
A
Multiacinar necrosis
15
Q
What are the three types of fulminant liver failure
A
Hyperacute:- HE within 7 days of jaundice
Acute:- HE within 8-28 days of jaundice
Subacute:- HE within 5-26 weeks of jaundice
16
Q
What is the main cause of fulminant liver failure
A
Paracetamol overdose
17
Q
What is acute on chronic liver failure
A
Abrupt decline in patient with chronic liver symptoms
18
Q
What is chronic liver failure
A
Patient with progressive history of liver disease
e.g. Hepatitis- fibrosis- compensated cirrhosis- decompensated cirrhosis
6+ months
19
Q
What are causes of liver failure
A
Viral (Hep A,B,E CMV EBV)
Autoimmun hep
Drugs:- Paracetamol, alcohol, ecstasy
Metabolic:- Wilsons, haemochromatosis
Budd Chiari
Hepatocellular carcinoma
20
Q
What are the signs/ symptoms of liver failure
A
Jaundice, coagulopathy, Hepatic encephalopathy
Spider naevi
Fetor hepaticus (rotten egg/ garlic breath)
Caput medusae (distended epigastric veins)
Duputryens contracture
21
Q
What is the West Haven Criteria
A
For grading Hepatic encephalopathy
1:- Altered mood, sleep issues
2:- lethargy, mild confusion, asterixis (hands flapping when wrist is extended)
3:- Marked confusion, somnolent
4:- Comatose (state of coma)
22
Q
What investigations do you carry out in suspected liver failure
A
LFTs (increased NH3, decreased glucose)
EEG to grade HE
Ultrasound to check Budd Chiari
Microbiology to rule out infection (blood culture, urine culture, ascitic tap)
23
Q
What is the treatment for acute liver failure
A
Administer to ITU ABCDE,
Fluid, Analgesia
Treat underlying causes + complications
24
Q
How do you treat the complications of liver failure
A
Increased ICP:- IV mannitol
HE:- Lactulose
Ascites:- Diuretics (spironolactone)
Haemorrhage:- Vitamin K
25
How does lactulose treat Hepatic encephalopathy
Increases NH3 excretion
26
What is the most common cause of chronic liver failure
Alcoholic liver disease
27
Other than ALD what are causes of chronic liver failure
Non-alcoholic fatty liver disease
Viral Hep B C/D
Metabolic, Budd Chiari, drugs, autoimmune, PBC + PSC)
28
What are risk factors for chronic liver failure
Alcohol, obesity, T2DM, drugs, Inherited metabolic disease/ existing autoimmunity
29
What is the Child-Pugh Score
Assesses the prognosis and extent of treatment required in chronic liver disease
30
What is decompensated cirrohis a massive risk factor for
Hepatocellular carcinoma
31
What is the MELD socre
Model for end-stage liver disease, stratifies severity of ESLD for transplant planning
32
What are the signs/ symptoms of chronc liver failure
Jaundice, ascites, HE, Portal Htn, oesophageal varices, caput musase, spider naveri, palmer erythema, gynecomastia, clubbing, fetor hepaticus, dupytrens contracture
33
What are the classes in the Child Pugh score
A:- 100% 1Y survival
B:- 80% 1Y survival
C:- 45% 1Y survival
34
What is the gold standard test for chronic liver failure
Liver biopsy
35
What is the treatment for chronic liver failure
Prevent progression, lifestyle modification
Consider liver transplant
Manage complications
36
How do you manage the complications of chronic lier failure
HE:- Lachilose
Ascities:- diruetics
37
What is the grams and mls of 1 unit of alcohol
8g and 10ml
38
What is the progression of alcoholic liver disease
Steatosis (fatty liver undamaged), alcoholic hepatitis (w/ mallory bodies), alcoholic cirrhosis
39
Name two alcohol dependency questionnaires
CAGE, Audit
40
What are the CAGE quations
should you Cut down
are people Annoyed by your drinking
feel Guilty about your drinking
do you drink in the morning (Eye opening)
41
What do LFTs show in ALD
LFTs:- Increased bilirubin, decreased albumin, increased pro thrombin time, increased GGT
AST:ALT >2
42
What anaemia do you often see with ALD
Macrocytic non megaloblastic anemia
43
Why do you do a biopsy in ALD
Confirm extent of cirrhosis or simply hepatitis
44
What do you see on a biopsy of ALD
Inflammation, necrosis, Mallory cytoplasmic inclusions bodies
45
How do you treat delirium tremours from alcohol withdrawal
Diazepam
46
What are pharmological options for treatment for ALD
Steroids short term
B1 + folate supplements
47
How long must a patient abstain prior to a liver transplant for ALD
3+ months
48
What are the complications of ALD
Pancreatitis
HE
Ascites
HCC
Malory West tear
Wernicke korsakoff syndrome
49
What is Werinicke Korsakoff syndrome
Combined b1 deficincey and alcohol withdrawal symptoms
50
What are symptoms of Werincke korsakoff syndrome
Ataxia, nystagmus, encephalopathy
51
What is the treatment for Wernicke Korsakoff syndrome
IV Thiamine
52
What are the risk factors for non-alcoholic fatty liver disease
Obesity, Htn, hyperlipidaemia, T2DM, Fhx, endocrine disorders, drugs (NSAIDS, amiodarone)
53
What is the progression of non-alcoholic fatty liver disease
Hypostatises, non alcoholic steatohepatitis, fibrosis, cirrhosis
54
Symptons of NAFLD
Typically asymptomatic
If v. severe, presents with signs of liver failure
55
What is the 1st line test for NFLAD
US abdomen
56
What does FBC show in NFLAD
Thrombocytopenia, hyperglycemia
57
How can you assess the risk of fibrosis
With a non-invasive scoring system
FIB-4 (fibrosis 4 score)
58
What is the treatment for NFLAD
Lose weight, control risk factors, Vitamin E
59
Which of the viral hepatitis can be chronic
Hep C and Hep B
60
Which of the Viral hepatitis are RNA and which DNA
Hep A+C+E+D; RNA
Hep B; DNA
61
What are the causes of acute pancreatitis
I GET SMASHED
Idiopathic
Gallstones 50+% of all acute cases
Ethanol 80% of all chronic cases
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom/ spider bite
Hypercalcemia/ hyperlipidemia
ERCP
Drugs (NSAIDS, ACEi)
62
What country has a high prevalence of Autoimmune Pancreatitis
Japan
63
What serum antibody is present in autoimmune pancreatitis
IgG4
64
What is the treatment for autoimmune pancreatitis
Oral prednisolone for 4-6 weeks
65
How do gallstones cause pancreatitis
Gallstones abstract pancreatic secretions which accumulate enzymes. The host defence is soon overwhelmed which then leads to auto digestion. Inflammation and enzymes leak into blood
66
What prevents autodigestion of the pancreas (host defence)
A1AT, pancreatic secretory transport inhibitors
67
What are the signs/ symptoms of acute pancreatitis
Sudden severe epigastric pain radiating to back
Jaundice, pyrexic, steatorrhoea, grey turner sign and Cullen sign.
68
What is Grey Turner sign
Flank bleeding/ bruisng
69
What is Cullen sign
Periumbiliacal bleeding/ discolouration
70
What is the gold standard investigation for acute pancreatitis
Serum amylase/ Lipase
71
Other than acute pancreatitis, what can increase serum amylase/ lipase.
Gastroduodenal perforation.
CXR to exclude
72
What is required to diagnose someone with acute pancreatitis
2 of
Characteristic symptoms
High amylase/ lipase
Radiological evidence
73
What scoring system can be used to assess the severity of acute pancreatitis within 24hr
APACHE2
74
What scoring system can be used to predict a severe attack in acute pancreatitis after 48hr
Glasgow score
75
What is the treatment for acute pancreatitis
NIL by mouth
IV fluid
Analgesia (IV morphine)
Catherterise
Abx prophylaxis
76
What is a complication of acute pancreatis
Systemic inflammatory response syndrome (SIRS)
2 or more of
Tachycardia
Tachypnoea
Pyrexia
Increased WCC
77
What is chronic pancreatitis
3+ months of pancreatic deterioration, irreversible pancreatic inflammation + fibrosis
78
What are the causes of chronic pancreatitis
Alcohol (MC)
CKD, Trauma, recurrent acute pancreatitis
79
What are the symptoms of chronic pancreatitis
Epigastric pain that radiates to back, exacerbated by alcohol
80
What are the exocrine and endocrine Sx of chronic pancreatitis
Steatorrhea and endocrine dysfuntion
81
What are the serum levels of amylase/ lipase in severe chronic pancreatitis
Not raised, none left to leak out
82
What is fecal elastase
An enzyme that breaks down proteins produced by the pancreas
83
Why would you do an US + CCT to investigate chronic pancreatitis
To detect pancreatic calcification + dilated pancreatic duct (diagnostic)
84
How to treat chronic pancreatitis
Stop alcohol
NSAIDS for analgesia
Pancreatic supplements (enzymes + Insulin)
85
What can cause pre-hepatic portal Htn
Portal Vein thrombosis
86
What can cause intrahepatic portal Htn
Cirrhosis (MC IN UK)
Schistomiasis
87
What are causes for post hepatic portal Htn
Budd Chiari
RHS heart failure
Constrictive pericarditis
88
How does cirrhosis cause portal Htn
Increases the resistance of flow and then splanchnic dilation and compensatory increased cardio output. This results in fluid overload in the portal vein.
89
What is usual portal pressure
5-8mmHg
90
How does portal Htn cause oesophageal varices
Blood shunting to gastroesophageal veins @ the cardia + lower oesophagus
91
What % of patients with portal Htn develop oesophageal varices
90%
92
What % of people with oesophageal varices due to portal Htn have a rupture
33%
93
What is a differential diagnosis for oesophageal varices rupture
Mallory west tear
94
How do you diagnose oesophageal varices
Oesophagaealgastroduoendoscopy
95
What is first-line treatment for ruptured oesophageal varices
Resus until haemodynamically stable
(consider bloood transfusion)
96
What is the treatment to stop bleeding oesophageal varices
IV Terupressin
Variceal banding
Transjugular intrahepatic portosystemic shunt (TiPPS) :- decreases portal pressure by diverting blood to other veins.
97
What is a side effect of TiPPS
Hepatic encepholopathy due to not properly filtered blood
98
How do you prevent bleeds in oesophageal varices
Non-selective beta-blocker:- propranolol + nitrates
Repeat variceal banding
Last resort:- liver transplant
99
What is most common cause of fulminant liver failure
Paracetamol overdose 50%
100
How much paracetamol needs to be ingested for an overdose
>75mg/kg
101
What are the symptoms of a paracetamol overdose
Severe RUQ pain, severe N+ V
102
What is the treatment for a paracetamol overdose
Activated charcoal within 1hr of paracetamol ingestion + N-acetyl-cysteine
103
What % of paracetamol usually undergoes phase 1 conjugation and what % phase 2
10% phase 1
90% phase 2
104
What is ascites
Accumulated free fluid in abdo cavity
105
What are causes of ascities
Local inflammation:- peritonitis abdo cancer
Low protein:- nephrotic syndrome, hypoalbuminemia
Flow stasis:- cirrhosis, budd chiari, congestive heart failure, constrictive pericardiatis
106
What are the signs/ symtpoms of ascities
Abdo distention
Shifting dullness
May have jaundice + pruritus
107
What is the treatment for ascites
Treat underlying cause
Diuretic to increase Na+ excretion (SPIRONOLACTONE)
Paracentesis
Liver transplant
108
How is Hep A spread
Faeco-oral
109
Which of the viral hepatitis are a picoRNA virus
Hep A
110
Where is Hep A endemic
Africa
111
What are risk factors for Hep A
Overcrowding, poor sanitation, shellfish, travel
112
How is Hep A excreted
In the bile
113
How long is the incubation period for Hep A
2 weeks
114
What are the initial symptoms of Hep A (1-2 weeks)
Malaise, N+V, fever
115
What are the symptoms you experience with Hep A after the initial ones
Jaundice, dark urine, pale stools, hepatosplenomegaly
115
What are the symptoms you experience with Hep A after the initial ones
Jaundice, dark urine, pale stools, hepatosplenomegaly
116
What do blood tests show in Hep A (not lft)
Raised ESR, leukopenia
117
What do LFTs show in Hep A
Raised bilirubin
118
What do HAV IgM antibodies mean
Acute infection of Hep A
119
What is the treatment for Hep A
Usually, resolve by itself in 1-3 months
Vaccine available
100% immune after infection
120
Which of the viral hepatitis are RNA
A, C, E, D
121
Which of the viral hepatitisis are blood borne
Hep C+ B
122
Which of the viral Hep has the biggest association with IVDU
Hep C
123
Other than IVDU, how else can Hep C be transmitted
Vertical, sexual transmission
124
Initial symptoms of hep C infection
Often asymptomatic, sometimes influenza-like symptoms
125
What does a later presentation of Hep C show
Chronic liver signs + hepatosplenomegaly
126
What do serology tests show in Hep C
HCV RNA= Current infection (calculate viral load)
HCV Ab= presents within 4-6 weeks of infection
127
What is the treatment for Hep C
Direct acting Antivirals (DAA)
Oral ribavirin + N55Ai/ N55Bi (needed for viral replication)
128
What % of Hep C infections progress to chronic liver failure
30%
129
How is Hep E transmitted
Faeco-oral spread
Water, dogs, pigs
Associated with undercooked pork
130
What is the treatment/ progression for Hep E
Self-limiting
Can cause chronic diseases in immunosuppressed
Fulminant liver 10-20% in prego
100% immune after infection
131
What hep is Hep D dependent on and why
HBV as it is incomplete and requires HBV for assembly. Manifests as co-infection; IgM HDV+ IgM HBV
132
What is treatment/ diagnosis/ risk factors for HDV
Same as HBV
Shellfish travel
Malaise, N+V
Jaundice, dark urine
133
What do you see on histology in all Hepatitis
Interface Necrosis (Piecemeal necrosis)
134
Which Hepatitis should you notify Public Health about
All viral
135
What are the risk factors for autoimmune hepatitis
Female, other AU disease, viral hep, HLADR3 or DRA
136
Who does type 1 autoimmune hepatitis affect
Adult females (80%) of cases
137
What does type 2 autoimmune hepatitis affect
Young females
138
What antibodies are present present in Type 1 AU Hep
ANA (antinuclear antibody):- found in many AU disease but very specific for T1 AU hep
ASMA (Anti smooth muscle Ab)
139
What antibodies are associated with Type 2 Autoimmune pancereatitis
ALC-1 (anti liver cytosol)
ALKM-1 (antiliver-kidney microsomal)
140
What % of patients with AU Hep are asymptomatic
25%
141
What are the signs/ symptoms of AU Hep
Jaundice, fever, hepatosplenomegaly
lupus-like rash
142
What is the treatment for AU Hep
Corticosteroids (prednisolone) + azathioprine
Hep A+B vaccine
Last resort transplant
143
What type of virsu is Hep B
HepaDNAvirus
144
How is hep B transmitted
Needles, sexual, vertical, horizontal
145
What are risk factors for HBV
IVDU, MSM, dialysis patients, healthcare workers
146
What are the signs/ symptoms of Hep B
Similar to Hep A
1-2 weeks, malaise, N+V, fever
then jaundice, dark urine, pale stools, hepatosplenomegaly, hives/ urticaria, joint pain
147
What do HBVs Ag show and how long present
Infected or carrier, 1-6 months
148
What do HBs AB show
Immunity, present after 6 months
149
What do HBc Ag
Exposed to Hep B at some point
150
What do HBc IgM show
Show active infection
151
What do HBc IgG show
Chronic infection, carrier, cleared
152
What do HBeAg show
Marker of patient infectiousness
153
What do HBeAB show
chronically infected or if cleared infection
154
What is the treatment for chronic Hep B
Sub Cutaneous pegylated interferon alpha 2a
(also can be used in chronic Hep C
155
Most common type of primary liver cancer
Heptocellular carcinoma
156
RF for heptocellular carcinoma
Chronic hepatitis virus C+B
Cirrhosis from ALD. NAFLD/ haemochromatosis
157
Where does hepatocellular carcinoma met too and by what type of spread
Lymph nodes, bones, lungs via haematogenous spread (hepatic/ portal veins)
158
Sx of hepatocellular carcinoma
Decompensated liver failure; Jaundice, ascites, HE
Cancer signs
Irregular hepatomegaly
159
What is 1st line imaging for hepatocellular carcinoma
Ultrasound
160
GS imagine for HCC
CT
161
Why is biopsy avoided in HCC
Prevents seeding of tumour elsewhere
162
What vaccine can protect against HCC
HBV
163
Tx of HCC
Surgical resection of tumour
Liver transplant if decompensated cirrhosis
164
What are most common primary sites for a secondary liver cancer
GIT, Lungs, Breast
165
What type of carcinoma is a cholangiocarcinoma typically
Adenocarcinoma
166
RF for cholangiocarcinoma
Parasitic flukeworms, biliary cysts, IBD, PSC
167
What is Courvoisier sign
Painless palpable gallbladder with jaundice
168
Sx of cholangiocarcinoma
Abdo pain, jaundice, weight loss, pruritis, fevers
Late constellation of Sx tumour is slow growing
169
1st line investigation in cholangiocarcinoma
Abdo Ultrasound + CT
170
GS investigation for cholangiocarcinoma
Endoscopic retrograde cholangiopancreatography
Can stent strictures + obtain a sample
171
Name 2 types of benign primary liver tumour
Haemangioma
Hepatic adenoma
172
What does a haemangioma present with
Strawberry mark on the skin in infants
173
Does pancreatic cancer usually affect the endocrine or exocrine pancreas
Exocrine 99%
174
What section of pancreas typically affected in pancreatic cancer
Head
175
RF for pancreatic cancer
Male, 60+, smoking, alcohol, DM, fH, chronic pancreatitis, genetic depostion
176
Sx of pancreatic cancer affecting the head
Courvoisier sign
Pale stool+ dark urine+ jaundice
177
Sx of pancreatic cancer affecting body + tail
Epigastric pain radiating to back relieved by sitting forward
178
GS investigation for pancreatic cancer
CT
179
What tumour marker is present in pancreatic cancer and can be used to monitor disease progression
CA19-9 (carbohydrate antigen)
180
Other than Courvoisier's sign, what other sign is present in pancreatic cancer
Trousseaus sign of malignancy; Migratory thrombophlebitis (when blood vessels inflamed with an associated blood clot in different locations over time)
181
What are gallstones commonly made up of
Cholesteral
182
RF for gallstones
Fat, Female, Forty, Fertile (prego/ many children), fair, fH, T2DM, NAFLD
183
What are Sx of gallstone blockage
RUQ biliary colic (constant severe pain for around 30 mins)
Worse after eating meals
184
Sx of Cholecystitis
RUQ pain + fever, tender gall bladder
Referred pain to top of right shoulder due to the phrenic nerve
Murphy sign
185
What is Murphys sign
Press on gall bladder and ask patient to inhale
They'll wince and stop inhaling due to pain
186
Sx of ascending cholangitis
CHarcots triad
RUQ pain, fever, jaundice (obstructive; dark urine + pale stool)
187
What is Retnolds pentad
Charcots triad + altered mental state+ hypotension
188
1st line investigstion for gallstones
Abdo Ultrasound
189
Treatment for gallstones
NSAIDs for mild pain
Elective laparoscopic cholecystectomy
Less fatty diet`
190
What is a strong NSAID
Diclofenac
191
Investigations in cholecystitis
FBC; Leukocytosis
LFT; normal
Abdo US; thickened GB wall
192
Investigations in ascending cholangitis
FBC; Leukocytosis+ neutrophils
LFT; High conjugated hyperbilirubinemia
Abdo US; CBD dilation + gallstones
Magnetic resonance cholangiopancreatography
193
1st and GS investigation in ascending cholangitis
1st; Abdo US
GS; Magnetic resonance cholangiopancreatography
194
Treatment for cholangitis
Surgery within 1 week; Laparoscopic cholecystectomy
Till then, IV fluid, analgesia
195
Treatment for ascending cholangitis
Endoscopic retrograde cholangiopancreatography
Then laparoscopic once stable to prevent a recurrence
196
What is primary biliary cirrhosis
An autoimmune condition in which the small bile ducts within the liver are targeted causes a blockage to the outflow of bile (cholestasis)
197
What are the intralobular ducts also known as
Canals of Hering
198
RF for primary biliary cirrhosis
Female, 40-50, other autoimmune, smoking
199
How would you describe the inflammation in primary biliary cirrhosis
Chronic autoimmune granulomatous
200
Sx of PBC
Often asymptomatic
Pruritis + fatigue earliest then jaundice then hepatomegaly + xanthelasma
201
Complications of PBC
Cirrhosis; Malabsoroptin of fats + ADEK
Stearrohoea, osteomalacia
fibrosis, portal htn, infection
202
What do LFTs show in PBC
Raised ALP, conjugated bilirubin
Low albumin
203
What antibody is mostly specific to PBC
Anti-mitochondrial antibodies
Anti-nuclear antibodies are also present
204
What is first live imaging in PBC
Ultrasound
205
What do you see on liver biopsy in PBC
Portal tract infiltrate(lymphocyte+ plasma cell)
206
What is first line treatment in PBC
Ursodeoxycholic acid; (bile acid analogue) reduces intestinal absorption of cholesterol (improves Sx)
207
Treatment for PBC
Ursodeoxycholic acid
ADEK sups
208
RF for primary sclerosing cholangitis
Male, 30-40, Ulcerative colitis, fH
209
Why is primary sclerosing cholangitis an 'atypical' autoimmune disease
Affects men more than women
210
Sx of PSC
Pruitis + fatigue, jaundice, Charcot's triad if CBD involved, hepatosplenomegaly, IBD
211
What do serology tests show in PSC
HBVaAG/HCVAb -ve
ANA -ve
anti tTG -ve
pANCA +ve in 33-88%
212
What is GS imaging for PSC
Magnetic resonance cholangiopancreatography
213
Do you give ursodeoxycholic acid in PSC
No
214
What can be given to help with pruritis
Colestyramine
215
Describe breakdown of RBC
SPLEEN; Hb into Haem+ Globin
Haem into Iron + Biliverdin
Biliverdin into unconj bilirubin by
biliverdin reductase
TRANSPORT IN BLOOD BOUND TO ALBUMIN
LIVER; Conj Bilirubin
VIA CBD INTO SI
SI; converted into urobilinogen by colonic flora
90% to stercobilin makes faeces brown
5% to urobilin makes wee yellow
216
Why do you get pale stool and dark urine in obstructive jaundice
As high kevels of conj bilirubin in blood but less in the intestine
217
Causes of pre-hepatic jaundice
Haemolytic anaemia
Sickle cell
G6PD def
Autoimmune haemolytic
Thalassemia
Malaria
218
Causes of intrahepatic jaundice
HCC
ALD/ NAFLD
Hepatitis
Gilbert syndrome
219
Causes of post hepatic jaundice
Choledocholathis
Pancreatic cancer
Mirizzi syndrome
Drug-induced cholestasis
PBC+ PSC
220
What is Mirizzi syndrome
Gallstone stuck in GB kneck can compress CBD + cause obstruction
221
What are primary causes of peritonitis
Ascites
Spontaneous bacterial peritonitis MC
222
Most common organisms causing peritonitis
E. coli, Klebsiella, Staph aureus
223
Sx of peritonitis
Sudden onset severe abdo pain then collapse + septic shock
Rigidity helps pain
Poorly localised
224
What investigations do you do in peritonitis
Ascitic tap shows neutrophilia
MC+S
Exclude pregnancy (-ve Beta-hCG)
Erect CXR shows air under the diaphragm; indicating a perforated colon
225
Treatment for peritonitis
ABCDE
Treat underlying cause; IV fluid + Abx
Surgery peritoneal lavage
226
Complications fo peritonitis
Septicemia, Pelvic abscess
227
What inheritance is haemochromatosis
Autosomal recessive
228
What gene is affected and on what chromsome is it on in haemochromatosis
Human Haemochromatosis protein (HFE)
Chromosome 6
229
Pathology of haemochromatosis
Excess iron uptake by transferrin 1 and decreased hepcidin synthesis
Fe accumulation + fibrosis of organs
230
What organs are affected in haemochromatosis
Liver, pancreas, kidney, Heart, skin, anterior pituitary
231
Sx of haemochromatosis
Fatigue, joint pain, hypogonadism, slate grey skin, liver cirrhosis, osteoporosis, heart failure
232
What are Sx of gross Fe overload
Bronze statue skin,
Hepatomegaly
T1DM
Hair loss
Joint pain
Chronic tiredness
233
What do Fe studies show in haemochromatosis
High serum fe
High transferrin saturation
High ferritin
Low total iron binding capacity
234
What stain do you use with a liver biopsy to assess liver damage in haemochromatosis
Perls stain
235
What is 1st line treatment for haemochromatosis
Venesection
236
What is the treatment if venesection is contraindicated in haemochromatosis
Desferrioxamine (chelation therapy)
237
What is the inheritance pattern of Wilson's disease
Autosomal receive
238
What gene is affected in Wilson's disease
ATP7B gene on chromosome 13
239
Pathology of Wilsons disease
Impaired Cu biliary excretion leading to lots of Copper accumulation in liver and CNS (basal ganglia)
240
Sx of Wilsons disease
Jaundice
Parkinsonism/ memory issues
Kayser Fleischer Rings; Cu deposits in cornea (greenish brown ringed appearance)
241
Is serum copper high or low in Wilsons disease
Low serum copper as more deposited in tissue
242
GS investigation for Wilsons disease
Liver biopsy
243
1st line treatment for Wilsons disease
D-Penicillinamwe (Cu chelation lifelong)
244
What dietary changes should you make in Wilson's disease
Avoid shellfish and muschroom
245
What gene is affected in A1AT deficency
Serpina-1 gene/
Protease inhibitor gene
246
What can A1AT deficency cause in the liver
Becomes fibrotic, cirrhosis + HCC risk
247
How would you describe chest in A1AT deficiency
Barrel chest
Hyper inflated lungs
248
What do you see on CT in A1AT deficiency
Panacinar emphysema
249
How much paracetamol ingested to be an overdose
>75mg/kg
250
Sx of paracetamol overdose
Acute severe RUQ pain, severe N+V
251
Explain pathology of Paracetamol overdose
Normal
90% phase 2 conjugation and excreted
10% phase 1 conj (CYP450) into NAPQ1 whic is toxic. Then phase 2 conj and excreted
In overdose phase 2 saturated so shunts more down phase 1 leading to glutathione depletion and accumulation of toxic NAPQ1 in liver
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What is the treatment for paracetamol overdose
Activated charcoal within 1hr
N-Acetyl-cysteine (increases available glutathione)
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What is Gilberts syndrome
Deficient or abnormal glucuronosyltransferase
So high levels of unconjugated bilirubin
254
What inheritance pattern is Gilberts syndrome
Autosomal recessive
255
RF for gilberts
T1DM, male
256
Sx of gilberts syndrome
Painless jaundice at young age
257
Examples of irreducible hernias
Obstructed
Strangulated
Incarcerated
258
What are 2 types of hiatal hernia
Rolling; LES stays in abdo, fundus rolls into abdo
Sliding; LES into abdo MC
259
Sx of Hiatal hernia
GORD
Dysphagia
260
GS investigation for hiatal hernia
Barium swallow
261
What is a femoral hernia
Bowel through the femoral cord
262
Femoral hernia more common in male or female
Female
263
Why are femoral hernias very likely to strangulate
Rigid femoral canal border
264
Sign of femoral hernia
Swelling in upper thigh pointing down
265
What is an ingunal hernia
Spermatic cord herniates through inguinal canal
266
Inguinal hernia more common in male or female
Male
267
RF for ingunal hernia
History of heavy lifting/ abdo pressure
268
Sx of ingunal hernia
Painful swelling in groin points along the groin margin
