Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 2a > Liver + Friends > Flashcards

Liver + Friends Flashcards

1
Q

Liver functions

A 
Albumin production 
regulates excess oestrogen 
Produce clotting factors
Regulate bilirubin 
detoxification 
Immunity - reticuloendothelial 
Glycogen storage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is GGT raised

A

Alcoholic liver disease

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

When is ALP raised

A

Biliary tree damage

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

when is AST/ALT Raised

A

Hepatocyte damage

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

Acute liver conditions

A

Viral hep - A, B
Drugs
Alcohol

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

Chronic liver conditions

A 
Viral hep - B,C,E
AIH 
PBC
PSC
Haemochromatosis 
Wilsons 
Alpha-1 antitrypsin 
NAFLD
Alcoholic liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute liver conditions presentation

A 
Malaise 
lethargy 
fever
GI upset 
Abdo pain 
Signs:
Jaundice 
confusion - encephalopathy 
Ascites 
Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chronic liver conditions presentation

+ decompensated

A

Clubbing
spider navaei
Palmar erythema
Duptruptens contracture

Decompensated:
Coagulopathy - Increase PT and INR
Jaundice 
HYpoalbuminaemia 
Ascites 
Encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the liver’s synthetic function measured by

A
  • Prothrombin time
  • short half life
  • Vit K deficiency –> prolonged time
  • Serum Albumin
  • Serum bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would you see councilman bodies

A

Viral hepatitis

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

Blood bourne Viral hepatitis

A

B
C
D

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

Hepatitis A

  • route of transmission
  • DNA or RNA
  • incubation
  • tx
  • prevention
A

Faeco-oral

  • normal with travel hx
  • contaminated food or water
  • RNA
  • 2/6wks incubation
  • resolves without tx and provides 100% immunity
  • vaccines available for travellers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hepatitis E

  • route of transmission
  • incubation
  • tx
  • chronic
A

Faeco-oral

  • contaminated food or water
  • undercooked pork
  • RNA
  • 3-8weeks incubation
  • No tx - resolves in 1 month
  • Can develop in to CLD in:
    transplant pts and immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what % Hepatitis B is chronic

A

20%

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

Hepatitis B routes of transmission

A 
Blood bourne 
Vertical - mother to child 
IVDU 
sharing blood products
sexual
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hepatitis B risk groups

A

IVDU - Sexual partners
Health workers
Gay sexually active men
Baby from HbsAg +ve mum

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

Chronic hepatitis complications

A

HCC

Portal HTN

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

What percentage of patients with Hep C will develop chronic infection

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Decompensated cirrhosis presentation

A 
jaundice 
ascites 
encephalopthy 
coagulopathy 
Low albumin 
Virical bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hepatitis C testing process

A
  • HCV Ab screening test
  • HCV RNA
    confirms diagnosis + shows current infection
  • HCV RNA is then used to:
  • calculate viral load
  • Assess for individual genotype
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HCV Tx

A 
Direct acting antivirals 
- NS5A 
-NS5B 
\+ RIBAVIRIN 
Inhibit hep C:
. RNA production 
. New virus protein production 
.Viral assembling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which hep can you be reinfected with

A

Hep C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of hepatitis

A 
Viral 
AI 
NAFLD
Drug induced 
Alcoholic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What should you do if you identify a case of any Viral hepatits

A

Inform public health - notifiable disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Heaptitis C - transmission - incubation - CLD? - complications - tx
- blood bourne (blood and bodily fluids) - 1-3 months - Yes can progress to CLD in 70% of pts - Liver cirrhosis + HCC - Direct acting anti-virals
26
Heaptitis A management
- supportive as it's self limiting Avoid alcohol Basic analgesia Monitor liver - INR + Albumin Active and passive immunisation
27
Hepatitis D - requirements - route of transmission - incubation - CLD? - tx
- requires HBsAg to survive - Blood bourne - 2-6 months - Can progress to CLD - Interferon alpha
28
Hepatitis B - Incubation - DNA or RNA - tx
- 1-5 months - DNA - alpha - inteferon induces IS response - Tenevofir supresses viral rep
29
Hepatitis B prevention
- antenatal screening - blood screening - sterile equipment - immunise healthcare workers - Immunisation - screen sexual contacts
30
Hep B viral markers
HBsAg - active infection HBeAg - marker of viral rep and implies high infectivity HBcAb - Implies past or current infection HBsAb - implies vaccination or past/current infection HBV DNA - direct count of viral load
31
Hep B testing process
1. HBcAg (previous infection) + HBsAg (Active infection) If positive then do futher testing: 2. HBeAg and viral load
32
Hep B surface antigen
HBsAg given in vaccine | - Positive HBsAb may indicate vaccination or infection
33
Hepatits B core Ab
- Help distinguish between: acute, chronic and past infections - Measure IgM + IgG versions of HBcAb IgM - active infection * high titre - acute *low titre - chronic IgG - past infection where HBsAg is negative
34
Hepatits B e antigen
Presence indicates acute phase of infection - virus actively replicating Level correlates with infectivity If HBeAg is -ve but but HBeAb is +ve Benn through viral replication phase and virus has now stopped replicating and are less infectious
35
AI hepatitis forms
``` Type 1: Adults - women 40-50y/o - post menopausal - Less acute course - Anti-nuclear Ab (ANA) Anti - SM Ab (ASMA) - Increased Albumin + PT ``` ``` Type 2: Children - Anti-LKM1 Ab against microsomes of liver/kidney - Anti-LC-1 Ab Anti liver cystolic-1 Ab - Young girls ```
36
Autoimmune Hep presentation based on forms
Type 1 - Fatigue + features of liver disease Type 2 - acute hepatitis high transaminases jaundice
37
Autoimmune Hep investigations
- Increased bilirubin - raised transaminases ALT/AST - Raised IgG levels - Auto Ab presence - FBC --> Anaemia - Liver biopsy *CONFIRMS
38
Autoimmune Hep tx
- Prednisolone Steroids are gradually tapered off and replaced with: - Azathioprine Inhibits enzyme required for DNA synthesis High B+T cell proliferation during immune response - Transplant If end stage liver disease
39
Jaundice defenition
Yellowing of skin and sclera due to increased serum bilirubin (>50microlitres/L)
40
Pre heaptic jaundice causes
Gilberts - UDP Glucuronyl transferase deficiency Haemolysis - Sickle cell - Malaria
41
Precipitators to jaundice in Gilberts disease
Stress Infection Starvation - All lead to increased heamolysis
42
Intrahepatic jaundice causes
``` Liver disease Hepatitis - AI + Viral Carcinoma Haemochromatosis Alcoholic LD CCF --> Congestion ```
43
Post heaptic jaundice causes
Gallstones | Pancreatic cancer - head
44
Pre- heaptic jaudice presentation - urine - stools - itching - liver tests
All normal and no itching
45
Cholestatic jaudice presentation - urine - stools - itching - liver tests
- Dark urine - Pale stools - Only itching if post hepatic - Abnormal liver tests
46
Alcoholic liver disease progression
1. Alcoholic steatosis - fat build up in liver - reversible in 2wks if drinking stops 2. Alcoholic heaptitis - drinking over long period of time causes inflamm mild heaptits is usually reversible with permanet abstinence -neutrophil infiltration 3. Cirrhosis scar tissue stopping drinking prevents further damage poor prognosis if drinking continues
47
Alcohol metabolism routes (3) and end product
1. CYP450 - 2E Microsomes 2. Alcohol dehdrogenase (ADH) NAD+ --> NADH Remves H+ from alcohol 3. Catalase Peroxisomes end product: Acetaldehyde
48
Percenage of alcohol (%ABV)
Volume of each alcoholic drink x ABV% ---------------------------------------- Total volume of the drink
49
CAGE questions - use - meaning
``` screen for harmful alcohol use C - cut down A - annoyed G - guilty E - eye opener ```
50
AUDIT Questionnaire
ALcohol Use Disorders Identifcation Test - screens for harmful alcohol use - score > 8 gives indication of harmful use
51
ALD pathophysiology
- Decreased NAD+ due to alcohol excess leads to less fat oxidation - Accumilation of fat in heaptocytes - Increased ROS damages hepatocytes - Acetaldehyde damages liver CM - Leads to inflamm + neutophil infiltration
52
ALD organs affectd - CNS - Gut - Heart - Repro
CNS - dependance and withdrawl - Falls + Fits - Decrease memory and cognition - Wernickes encephalopathy Gut - Cancer - PUD - D+V - Obesity - pancreatits Heart - Increase BP - Sudden death in binge drinkers - Arrhythmias - cardiomyopathy Repro - Testicular atrophy - increase oestrogen - foetal alcohol syndrome
53
Liver steatosis - sx - investigations
Asymptomatic - Abdo pain - Nausea - D+V US of liver - fatty changes - Increased echogenicity
54
Alcoholic heaptits - sx - signs - investigations
sx - mild jaundice signs - CLD - Biopsy - DIAGNOSTIC - LFTs GGT - VERY RAISED AST/ALT mildy raised - FBC: Macrocytic anaemia
55
Signs of Liver disease
``` Jaundice hepatomegaly spider naevi Palmar erythema Bruising Ascites Asterixis - decompensated ```
56
What is delirium tremens
Medical emergency assoc with alcohol withdrawl
57
Delirium tremens presentation
``` Confusion agitation HTN Tahcycardia Tremor Ataxia Arrhthymia ```
58
Delirium tremens tx
Librium - benzodiazepine | Diazepam
59
What is wenicke - korsakoff syndrome
Thiamine (B1) deficeincy - poorly absorbed in presence of alcohol
60
NAFLD stages
1. NAFLD 2. NASH 3. Fibrosis 4. Cirrhosis
61
Metabolic synromes leading to NAFLD
``` Obesity HTN DM Hyperlipdaemia Hypertrygyceraemia ```
62
NAFLD investigations
Liver biochemistry - Raised ALT Enhanced liver fibrosis test
63
NAFLD management
``` weight loss excercise smoking cessation control DM/BP/choleterol Avoid alcohol ```
64
What is liver failure
Ability to regenrate and repair is lost | - recognised by development of coagulopathy (INR >1.5) and Encephalopathy
65
Difference between acute and chrnic liver failure
Acutte - occurs in previously normal liver Chronic - occurs on the background of cirrhosis
66
Fulminant hepatic failure
clincial syndorme resulting from massive necrosis of liver cells - Multiacinar necrosis of large parts of the liver
67
Liver failure aetiology
``` Virla Hep -B/C/CMV Alcohol Paracetamol overdose Haemochromatosis Fatty liver disease PBC Aplha 1 anti-trypsin Wilsons ```
68
Heaptic failure signs
``` Jaundice Heaptic encephalopathy - confusion -coma -drowsiness Coagulopathy Aterixis ```
69
What is asterixis
tremor of hand when wrist is extended - bird flapping wings
70
Hepatic encephalopathy patho
Liver failure --> NH3 build up - NH3 neurotoxic as it prevents krebs cycle leading to irreplaceable cell death + damage - NH3 in brain is cleared by astrocytes (Glutamate--> Glutamine) - Increase osmotic imbalance due to excess glutamine - shift of fluid into cells - Cerebral oedema
71
Encephalopathy tx
Lactulose
72
Heaptotoxic drugs
paracetamol methotrexate Isoniazid
73
DILI drug causes - Abx - CNS drugs - Analgesics
Abx - Flucloxacillin - Erythromycin - TB drugs - Co-amoxiclav CNS - Valporate - Carbamezapine Analgesics - Diclofenac
74
what dosage of paracetamol in adults ca be fatal
12g or more
75
Routes of paracetamol excretion (3)
1. Glucuronidation 2. Sulfation 3. CYP450 --> NAPQI + Glutathione
76
Pathophysiology of overdose
- Increased NAPQI levels leads to glutathione depletion | - build up of toxic metabolite in liver causes damage
77
Paracetamol overdose presentation
Nausea Vomitting R.U.Q pain Anorexia
78
Factors that determine the severity of a paracetamol overdose (4)
Metabolic acidosis - pH <7.3 Hypoglycaemia Prolonged PT Raised creatinine
79
Paracetamol overdose tx
- Fluids --> Prevent AKI - Activated charcoal within an hour of ingestion - IV N-Acetylcysteine
80
Why should you avoid alcohol during a paracetamol overdose
CYP450 inducers | - Metabolises paracetamol into toxic metabolites faster
81
Haemochromatosis - defenition - inheritence pattern
- Excessive total body iron - AR HFE in chromosome 6
82
Haemochromatosis pathophysiology
- Increase Fe2+ absorption from upper SI | - Can also be from mutation (HFE)
83
Haemochromatosis presentation
``` Tiredness Arthralgia - Pseudogout decreased libido grey-skin discouloration mood disturbances Hair loss Amenorrhoea ```
84
Haemochromatosis investigations
``` - Serrum ferritin levels AFR - Raised trasferrin saturation - Liver biopsy Perl's stain Iron conc shown in liver cells ```
85
Haemochromatosis complications
- restrictive cariomyopthy - Bronze DM T1 - Hypogonaidism - Liver damage --> Cirrhosis --> HCC
86
Haemochromatosis tx
``` - Venessection (<50mcg/L) 3-4 venessections/year Normalisation assessed by: - Serum ferrtin - Trasferrin saturation ``` - Desferrioxamine to remove excess iron - Genetic testing for 1st degree relatives
87
Wilsons disease - defenition - Inheritance pattern - gene
- Excess copper in the body with deposition in Liver + CNS - AR disorder of Chromosome 13 resulting in defect with Cu-trasporting ATPase - ATP7B gene
88
Wilsons presentation
``` Hepatitis Cirrhosis Tremor Dyshpagia Ataxia Parkinsonism Dementia Depression Personality change Arthiritis Keyser-fleischer rings ```
89
Wilsons - CNS effects
Basal ganglia - parkonsinism | Cerebral cortex --> Neuronal cell death--> Dementia
90
Wilsons - Cornea
Deposition in descements membrane | Kayser - Fleischer rings
91
Wilsons investigations
- Low serum cearuloplasmin - Urine: 24hr Cu excretion is high - Geneic testing - confirms - Liver biopsy
92
Wilsons diet modifications
Avoid foods high in Cu - Choclate - Mushrooms - Shellfish - Check water pipes
93
Wilsons disease tx
- Copper chelators - PENICILLAMINE - Zinc salts Reduces Cu absorption - Transplant
94
Penicillamine S/E
``` Nausea Rash Low WCC + Platelets Lupus Haematuria ```
95
Wilsons complications
Hepatosplenomegaly Renal disease - PCT damage Haemolytic damage - Cu damages RBC's
96
Alpha 1 antitrypsin
Protease that inhibits elastase function | - Coded for on chromosome 14 (SERPINA1 gene)
97
Alpha-1 antitrypsin deficiency pathophysiology
Elastin - provides strength + elasticity to alveoli Alpha-1 antitrypsin no longer present to protect elastin --> Elastin breakdown Alveoli loose elasticity and structural integrity - Pan acinar emphysema
98
Alpha-1 antitrypsin presentation
``` Dyspnoea S.O.B Mucous production Wheeze Chronic cough Cirrohosis - Heaptic encephalopathy - Decrease coag factors - Portal HTN - Increase HCC ```
99
Alpha-1 antitrypsin investigations
- Serum alpha-1 antitrypsin LOW (AFR) - Lung function tests LOW FEV1 - CXR --> Hyperinflation - Liver biopsy PAS (+ve) *Glycoproteins - pink Diastase resistant
100
Alpha1 antitrypsin deficiency tx
- IV infusion of Alpha1 - Smoking cessation - Inhalers
101
Ascites - definition - most common cause
- accumulation of fluid in peritoneal cavity (>25ml) | - Cirrhosis most common cause
102
Ascites pathophysiology in Cirrhosis
- Peripheral arterial vasodilation (NO) - reduction in effective blood volume - Activation of RAAS and SNS - Promotes salt and fluid retention - Hypoalbuminaemia encourages oedema formation - Portal HTN localises fluid build up in cavity
103
why is there a decrease in oncotic pressure in cirrhosis
Hypoalbuminaemia
104
Why does hydrostatic pressure increase in the formation of ascites
Portal HTN | RAAS activation
105
What is: - Transudate - Exudate
- Ascitic albumin conc of 11g/L or more below serum albumin | - Ascitic albumin conc less than 11g/L below serum albumin
106
Ascites: Transudate causes and apperance
Portal HTN - cirrhosis Cardiac failure Constricitve pericarditis - Clear fluid
107
Ascites: Exudate causes and apperance
``` Maliganacy Infections Pancreatitis Infammation - Increased vascualr permeability Nephrotic syndrome ``` - Cloudy fluid
108
Ascites signs
``` fullness in flanks - Shifting Dullness Mildo abdo pain Discomfort Tense ascites --> Resp distress Peripheral oedema Pleural effusion ```
109
Ascites investigations
Ascitic tap - culture - gram stain + culture - cytology for malignancy - protein - Raised WCC shows bacterial peritonitis - Amylase to exclude pancreatic ascites
110
Ascites tx
- restict fluid and sodium intake - Spirinolactone - Tx underlying condition
111
Causes of generalised peritonitis
Rupture of abdominal viscera - perforated duodenal ulcer - perforated appendix
112
When should SBP be suspected
Any ascitic pt that deteriorates
113
SBP Gram -ve coliforms causes
E.coli | Klebsiella
114
SBP Gram +ve staphylococcus causes
S.aureus
115
SBP Investigations and management
- Ascitic tap neutrophil count > 250cells/mm3 - Cefotaxamine initially whilst awaiting culture results
116
SBP prophylaxis
Ciprofloxacin
117
Hernia | - definition
petrusion of organ or part of an organ through the body wall that normally contains it
118
types of irreducible hernias
- Obstructed intestine obstructed due to pressure byt BF maintianesd - Incarcerated adhesions formed so tissue is trapped - Strangulated BF cut off Results in Iscaemia/gangrene w/without perforation
119
Inguinal hernia - defenition - which is more common
Protrusion of abdo contents through inguinal canal - points towards groin superior and medial to tubercle - indirect more common
120
Direct hernia
Through abdo wall --> Superficial ring - Medial to inferior epigastric artery - Occurs in Hesselbachs triangle
121
Indirect hernia - defenition - pathway - location in relation to IEA
peritonael sac goes via deep inguinal ring --> superficial ring --> scrotum - follows spermatic cord - Lateral to Inferior epigastric artery - can strangulate
122
Hesselbach's triangle boarders
I - Inguinal ligament L - IEA M - Rectus abdominus
123
Inguinal hernia presentation
Lump - enlarges when coughing discomfort pain + ache on exertion
124
Hiatus hernia types
Sliding - 80% - Gatro- oesophageal junction slides up - acid reflux - LOS less competant Rolling - 20% - bulge of stomach herniates into chest - Gastric volvus
125
Hiatus hernia investigations and tx
- barium swallow - GI endoscopy - weight loss - tx GORD sx
126
Peritonitis presentation
``` tender hard abdomen guarding - lies still fever tachycardia absent bowel sounds nasuea vomitting ``` * if perforation - sudden onset abdo pain - collapse - hypotension - hypoxia
127
peritonitis investigations
- Ascitic tap - Bloods: FBC/Amylase/LFT/U+E/Cultures - pregnancy test - USS - AXR
128
Peritonitis Management
- ABCDE - IV broad spectrum abx - Cephalosporin - fluids
129
Difference between Acute and Chronic pancreatitis
A: pancreas returns back to normal - functionally + structurally C: continuous inflamm Irreversible structural changes
130
Acute pancreatitis defenition +patho
Inflamm of pancreas - premature activation of pancreatic enzymes self perpetuating pancreatic mediated auto-digestion
131
Pancreatitis aetiology
``` I - Idiopathic G- Gallstones E- ethanol T - Trauma S - steroids M - Mumps A - AI (SLE) S - Scorpion venom H - Hyper - Ca2+/lipids E - ERCP D drugs: Azathioprine/Metronidazole/ tetracycline/ furosemide ``` Pregnancy Neoplasia
132
A. pancreatits presentation
``` Abdo pain - radiates to back * sitting foward relieves N+V Fever Abdo tenderness Distension Tachycardia ``` Cullen's sign - Periumbilical bruising Turners sign - Flank bruising
133
A. pancreatitis investigations
Bloods: - Serum amylase (3x normal) - Increase urinary amylase - Serum lipase increase (more specific) - CT abdo - Abdo US
134
Why is lipase more specific than amylase in investigation for A.pancreatitis
Amylase also increased in GI diseases - perforated peptic ulcer - Cholecystisis
135
A.pancreatits scoring system
``` Modified glasgow criteria - Predicts severity P - pao2 (<8kpa) A - age <55y/o N - Neutrophilia C - Ca2+ R - Renal function E - Enzymes A - Albumin S - Sugar (BG>10mm/mol) ```
136
A. pancreatitis management
- Nil by mouth --> NG tube - Catheter - Analgesia - Tramadol
137
Why is IV morphine avoided in A.pancreatitis
Causes sphincter of Oddi contraction aggrevating pancreatitis
138
acute Pancreatitis complications
early: - shock - renal failure - sepsis - hupocalcaemia late: - ARDS - DIC - Pancreatic necrosis
139
Chronic pancreatits investigations
CT - Pancreatic calcifications - ductal dilation Faecal elastase
140
Liver cirrhosis defenition
result of chronic inflammation | Irreversible liver damage due to fibrosis
141
Liver cirrhosis histology
- Loss of normal architecture - Bridging fibrosis - Nodular regeneration
142
Common Liver cirrhosis causes
ALD NAFLD Hep B Hep C
143
Features of compensated cirrhosis changing into decompensated cirrhosis
Jaundice Ascites Hepatic encephalopathy Variceal haemorrhage
144
Compenated liver cirrhosis
Liver can still function effectively and there is few clinical sx - weight loss - fatigue - weakness
145
Cirrhosis diagnosis
Liver biopsy | NAFLD - enhanced liver fibrosis test
146
What does decreased oestrogen lead to
Spider naveia | palmar erythema
147
Portal HTN causes - pre - intra - post
- Thrombosis (portal/splenic vein) - Cirrhosis Sarcoidosis PB Cirhhosis - RHF Constricitve pericarditis IVC obstruction
148
Oesophageal varices rupture
Thin vessels that cannot withstand high pressure blood flow so rupture rupture --> Haematemesis rupture --> blood digested --> melaena
149
Varices investigations
Upper GI endoscopy
150
Varices tx
``` Medical: - Beta blocker - decrease CO - Telipressin ADH analogue vasoconstricition + slows bleeding ``` Surgical: - elastic band ligation - Transjugular intrahepatic portosystemic shunt (TIPSS)
151
Gallstones RF
Fat Female Forty Fertile
152
Gallstone complications
Acute cholecystisis -cystic duct Biliary obstruction - CBD Gallstone pancreatitis - Ampulls of Vater
153
Biliary colic
Temp obstruction of cystic duct or CBD by stone
154
Biliary colic presentation
- recurrent episodes of sever abdo pain - pain subsides after few hours - Pain radiates --> back/R.shoulder - Pain follows fatty meal - Vomitting
155
Biliary colic investigations
- US shows gallstones - LFTs * Increase serum ALP * Increase bilirubin - Absence of inflamm features
156
Acute cholecystisis
Inflamm of gallbladder | - Gallstone obstruction of CD or bile duct neck
157
cholecystisis presentation
- RUQ pain --> referred to R.shoulder - fever - nausea - vomitting - Murphy's sign 2 fingers on inferior boarder of liver pt inspires --> pain * Only +ve if no pain in LUQ
158
Cholecystisis investigations
- Bloods: Increase WCC Increase CRP - Abdo USS Thickened wall + shrunken GB - LFTs
159
Cholecystisis tx
- Laproscopic cholecystectomy - Analgesia - Fluids - Abx - Cefotaxime
160
Ascending cholangitis defenition
Infection of biliary tree as stone is stuck in CBD | - Choledocholithiasis
161
Ascending cholangitis aetiology
- secondary to CBD obstruction | - Cncer of pancreatic head
162
Ascending cholangitis common pathogens
- E.coli - Klebsiells - Enterococcus (Group D step)
163
Ascending cholangitis presentation
``` - Charcots triad Fever/RUQ pain/ Jaundice - Pruritus - Dark urine -Pale stools ```
164
Ascending cholangitis investigations
- USS abdomen --> Dilated CBD - MRCP --> locate stone - Bloods: LFTs/ FBC - Blood culture
165
MRCP
Magnetic resonance cholangio-pancreatography | - detailed image of biliary tree via MRI
166
ERCP
Endoscopic retrograde cholangio-pancreatography | - endoscope to sphincter of Oddi
167
Ascending cholangitis
- ERCP - IV Abx * Cefotaxime + Metronidazole
168
Primary sclerosing cholangitis defenition
Inflammation and fibrosis of intra and extra hepatic bile ducts leading to cirrhosis
169
PSC assosciations
Ulcerative colitis
170
PSC auto-antibodies
Anti-neutophilic cytoplasmic Ab (ANCA)
171
PSC presentation
pruritus jaundice cholangitis RUQ pain
172
PSC investigations
- MRCP *beaded apperance of ducts - Liver biopsy *Onion skin fibrosis around ducts - Bloods: LFTs - Raised ALP
173
PSC tx
- Manage CLD complications - transplant - Extrahepatic strictures may be fixed by ERCP - High dose ursodeoxycholic acid may slow down disease progression
174
PSC - Complications
- Increase risk of CRC - Cirrhosis - Cholangiocarcinoma
175
Primary billiary cirrhosis
AI granulomatous inflammation destroying intrahepatic bile ducts
176
PBC presentation
fatigue pruritus cholestatic labs
177
PBC associations
Other AI disorders - SLE - RA
178
PBC complications
Cirrhosis
179
PBC autoantibodies
Anti-mitochondrial Ab (AMA) - Ab against subunit of pyruvate dehydrogenase kinase
180
PSC and PBC gender prefernces
PSC - Males | PBC - Females
181
What is acute gastritis + presentation
- Inflammation of the stomach | - N +V
182
What is enteritis + presentation
- Inflammation of intestines | - Diarrhoea
183
Viral gastroenteritis causes
Rotovirus - Vaccine available (12wks) - Affects children Norovirus - All age groups - Endemic Adenovirus - less common and presents with subactute diarrhoea
184
Gastroenteritis investigations + required individuals
- Rutine stool samples for M&C for ova and parasites (3 seperate samples) - Stool testing for C.diff ``` Immunouppressed IBD Bloody diarrhoea persistent diarrhoea severe sx recent Abx tx/hospitalisation ```
185
Management of acute diarrhoea
- Hydration + electrolytes - Loperamide - Abx to pts with severe sx
186
Name assosciated pathogen - Pets - small children - seafood - reheated rice
- campylobacter - Rotovirus - Staph - Bacillus cereus
187
Pregnancy main bacterial worry from food + tx
Listeriosis - non pasteurasied soft cheese - Increased risk of miscarraige/ premature delivery/ newborn infection - Ampicillin
188
Travellers diarrhoea - common causes - diagnosis - presentation - tx
- campylobacter jejuni - 3 unformed stools per day after recent travel - abdo pain cramps nausea dysentry - hydration
189
E.coli - gastroenteritis
- Shiga toxin production cramps bloody diarrhoea vomitting Haemolytic uraemic syndrome - RBC destruction (Avoid Abx)
190
Campylobacterjejuni - gastroenteritis - spread by: - sx - tx
- raw poultry - cramps bloody diarrhoea vomitting fever - Azithromycin/Ciprofloxacin
191
Shigella - gastroenteritis - sx - tx
Shiga toxin - bloody diarrhoea - cramps - fever - HUS Azithromycin/Ciprofloxacin
192
Clostridium difficile - bacteria - ingestion - RF
- Gram +ve spore forming bacteria - faecal-oral route - Elderly Abx PPI Long hosp admissions Immnocompromised
193
C.diff causative abx
``` rule of c Clindamycin Ciprofloxacin Co-amoxiclav cephalosporins ```
194
C.diff presentation
abdo pain water diarrhoea - possibly bloody too fever
195
C.diff complications
Pseudomembranous colitis Toxic megacolon + perforation--> multi organ failure
196
Pseudomembranous colitis presentation
Yellow adherent plaques on inflammed non-ulcerated mucosa
197
C.diff tx
- Isolate pt to prevent cross-infection - stop offending Abx - Metronidazole Vancomycin
198
C.diff investigations
- Toxin A+B in stool samples - Bloods: Raised CRP and WCC
199
Where does pancreatic adenocarcinoma arise from
Ductal epithelium
200
Pancreatic Adenocarcinoma point mutation
KRAS2 gene
201
Pancreatic adenocarcinoma presentation
- Abdo pain - Painless obstructive jaundice - weight loss - Steatorrhoea - Pale stools (lack of bile) - Dark urine (o.jaundice) - mass in epigastric region
202
Pancreatic adenocarcinoma signs
``` - Courvoiser's law painless jaundice + a non tender palpable gallbladder is pancreatic until proven otherwise - Hepatomegaly -Ascites - Epigastric mass ```
203
Pancreatic adenocarcinoma DD
``` Peptic ulcer Gallstones Chronic pancreatitis Cholangitis Cholecystisis ```
204
Pancreatic adenocarcinoma investigations
- Biopsy - US dialated bile ducts + lesion - Bloods increase lipase + amylase - CA19-9 Tumour marker
205
Pancreatic adenocarcinoma tx
Pancreatoduodenoctomy - Whipple * Tumour of pancreas head
206
HCC risk factors
- Cirrhosis NAFLD AFLD Hep B + C Screen for HCC every 6m
207
Mets from HCC
Lungs Bones Lymph nodes
208
Primary liver cancer
HCC | Cholangiocarcinoma
209
HCC presentation
``` weight loss abdo pain N + V Jaundice pruritus decreased appetitie fatigue ```
210
HCC investigations
- alpha fetoprotein - Liver US - CT/MRI - Biopsy under US guidance to confirm (ERCP)
211
Cholangiocarcinoma defenition
Cancer of biliary tree
212
Cholangiocarcinoma assosciations
- Biliary cysts | - PSC
213
HCC management
- Surgical resection - Radiofrequency ablation - Transarterial chemoembolisation therapy - chemotherapy
214
Cholangiocarcinoma presentation
- painless jaundice - fever - abdo pain - ascites - malaise signs: - periumbilical lymphadenopathy (sister-mary jospeh nodes) - Supraclavicualr adenopathy (virchows node)
215
Cholangiocarcinoma investigations
- CA19-9 tumour marker - US/CT Bile duct stricitre
216
Cholangiocarcinoma tx
- surgical resection - ERCP --> stent * where cancer is obstructing the duct - chemo + radio resistant
217
Benign hepatic tumours
Haemangiomas | Hepatic adenoma
218
Hepatic adenoma assosciations
oral contraceptive pill Anabolic steroids pregnancy
219
Hepatic adenoma tx
Surgical resection | - only for sx pts with tumours > 5cm
220
C.diff tx
Metronidazole + vancomycin

Phase 2a (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions