Liver/Pancreas Conditions Flashcards
What is liver cirrhosis?
Irreversible liver damage
Loss of normal hepatic architecture
What are the causes of liver cirrhosis?
Chronic alcohol abuse Chronic HBV/HCV infection Non-alcoholic fatty liver disease Genetic disorders - eg Wilson's, alpha anti-1 antitrypsin deficiency Primary biliary cholangitis Primary sclerosis cholangitis
What are the symptoms of liver cirrhosis?
Related to cause Lethargy Splenomegaly Jaundice Leukonychia Spider naevi Gynaecomastia Clubbing Ascites
What investigations would be done if liver cirrhosis was suspected?
LFT, FBC, U&Es Albumin Coagulation Ultrasound Ascites tap - if ascites Liver biopsy
How is liver cirrhosis treated?
Aimed at underlying cause Good nutrition Laxatives avoid hepatic encephalopathy Vitamin K to correct clotting Antibiotics Liver transplant
What are the complications of liver cirrhosis?
Malnutrition Hepatic encephalopathy Ascites/oedema Vitamin deficiency Hepatorenal carcinoma
What is the stepwise progression of alcohol related disease?
Alcohol related fatty liver - temporary, resolves in 2 weeks if no alcohol
Alcoholic hepatitis - inflammation
Cirrhosis - permanent
What are the symptoms of alcoholism?
Jaundice Hepatomegaly Spider naevi Palmar erythema Gynaecomastia Bruising Ascites Caput medusae Asterixis
How is alcoholism investigated?
CAGE Increased GGT (and other LFTs) Increased MCV, prothrombin time Decreased albumin Ultrasound Liver biopsy
How is alcoholism managed?
Stop drinking
Nutrition
Vitamin replacement
Transplant
What are the complications of alcoholism?
Alcohol withdrawal
Delirium tremors
Wernicke’s-Korsakoff syndrome
What is the pathology of liver failure?
Acute necrotising hepatitis leads to cell destruction
What are the 3 types of liver failure?
Hyper-acute - encephalopathy within 1 week
Acute - within 2-4 weeks
Sub-acute - within 4-8 weeks
What are the causes of liver failure?
Viral hepatitis Infections Drugs - paracetamol Toxins Alcohol Malignancy Fatty liver disease Primary biliary cholangitis Primary sclerosing cholangitis
What are the symptoms of liver failure?
Jaundice Hepatic encephalopathy Fetor hepaticus - breath smells like pear drops Asterixis Cerebral oedema Hypertension Tachypnoea
How is liver failure investigated?
FBC, U&Es, LFT Clotting, glucose, paracetamol levels Blood culture Urine culture CXR Abdominal ultrasound
How is liver failure treated?
Supportive
Liver transplant
What are the complications of liver failure?
Renal failure
Sepsis
Circulatory failure
Pancreatitis
What is the pathology of autoimmune hepatitis?
Inflammatory liver disease, antibodies directed against hepatocyte surface antigens
Who is more likely to get autoimmune hepatitis?
Young women
What are the symptoms of autoimmune hepatitis?
Fatigue Abdominal discomfort Decreased appetite Myalgia Hepatomegaly Jaundice Signs of cirrhosis
What investigations would be done if autoimmune hepatitis was suspected?
All LFTs raised Increased ESR Positive ASMA antibodies (anti-smooth muscle antibodies) Increased IgG Liver biopsy
How is autoimmune hepatitis treated?
Steroids
Azathioprine
Ursodeoxycholic acid
Liver transplant
Are primary or secondary liver tumours more common?
Secondary - 90% are metastases
Men - stomach, colon, lung
Women - stomach, colon, breast, uterus
What are the symptoms of liver tumours?
Fever Malaise Anorexia RUQ pain Jaundice - late except in cholangiocarcinoma Hepatomegaly Listen for liver bruits
What investigations would be done if a liver tumour was suspected?
FBC, clotting, LFT, hepatitis serology
Ultrasound
MRI
Liver biopsy
How are secondary liver tumours treated?
Chemotherapy
Most is palliative
What are the causes of hepatocellular carcinoma?
HBV
Cirrhosis
Fatty liver disease
What are the symptoms of hepatocellular carcinoma?
Fatigue Decreased appetite RUQ pain Decreased weight Jaundice Ascites Hepatomegaly
What investigations would be done if hepatocellular carcinoma was suspected?
Increased transaminases Increased alpha-fetoprotein Increased CRP and ESR Ultrasound CT, MRI Liver biopsy
How are hepatocellular carcinomas treated?
Resection
Liver transplant
What is the pathology of primary biliary cholangitis?
Chronic inflammation and destruction of the small and medium bile ducts
What sex is primary biliary cholangitis more common in?
Female
What are the symptoms of primary biliary cholangitis?
Fatigue Pruritus Arthralgia Xanthelasma Hepatomegaly Splenomegaly Jaundice Signs of chronic liver disease
What investigations would be done if primary biliary cholangitis was suspected?
Increased LFTs, IgM
Positive AMA (anti-mitochondrial antibodies)
Ultrasound
How is primary biliary cholangitis treated?
Pruritus - colesyramine
Ursodeoxycholic acid
Steroids
Liver transplant
What are the complications of primary biliary cholangitis?
Osteoporosis
What is the pathology of primary sclerosing cholangitis?
Progressive cholestasis with bile duct inflammation and strictures
What sex is primary sclerosing cholangitis more common in?
70% men - strong association with IBD (UC)
What are the symptoms of primary sclerosing cholangitis?
Asymptomatic Fatigue Weight loss Pruritus RUQ pain Hepatomegaly
What investigations would be done if primary sclerosing cholangitis was suspected?
Increased LFTs (ALP first)
Increased bilirubin
ERCP/MRCP
Liver biopsy
How is primary sclerosing cholangitis treated?
Liver transplant
What are the risk factors for cholestasis?
Obesity
Cirrhosis
CF
Haemolytic anaemia
What are the symptoms of cholestasis?
RUQ pain
Depends where the stone is lodged
What investigations would be done if cholestasis was suspected?
LFTs
Ultrasound
How is cholestasis treated?
Dissolution
Cholecystectomy
What are the complications of cholestasis?
Perforation
Abscess
What are the causes of acute pancreatitis?
GET SMASHED: Gallstones Ethanol Trauma Steroids Autoimmune Scorpion venom Hyperlipidaemia/hypercalcaemia/hypothermia ERCP Drugs
What are the symptoms of acute pancreatitis?
Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards
Jaundice
What investigations would be done if acute pancreatitis was suspected?
Increased serum amylase and lipase ABG AXR Erecr CXR CT
How is acute pancreatitis managed?
Severity assessment - Glasgow criteria
Nil by mouth
Analgesia
Treat cause and complications
What are the complications of acute pancreatitis?
Shock ARDS DIC Sepsis Pancreatic necrosis Abscess Bleeding Thrombosis
What is the pathology of chronic pancreatitis?
Structure of the pancreas is permanently damaged
What are the causes of chronic pancreatitis?
CAMP: Cystic fibrosis Alcohol Malnourishment Pancreatic duct obstruction Smoking
What are the symptoms of chronic pancreatitis?
Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards
Jaundice
What investigations would you do if chronic pancreatitis was suspected?
Ultrasound/CT - pancreatic calcifications confirm diagnosis
MRCP
Faecal elastase
How is chronic pancreatitis treated?
Analgesia
No alcohol
Insulin
Pancreatic enzyme supplements
What are the complications of chronic pancreatitis?
Pseudocyst
Diabetes
Biliary obstruction
Pancreatic carcinoma
At what age does pancreatic carcinomas usually present?
> 70
What is the pathology of pancreatic carcinoma?
Ductal adenocarcinoma - 65% head
What are the risk factors for pancreatic carcinoma?
Smoking
Alcohol
Diabetes mellitus
Chronic pancreatitis
What are the symptoms of pancreatic carcinoma?
Head - painless obstructive jaundice
Body/tail - epigastric pain radiating to back, relieved by sitting forwards
What investigations would be done if pancreatic carcinoma was suspected?
Ultrasound
CT
ERCP/MRCO
How is pancreatic carcinoma treated?
Resection if no mets
Chemotherapy
Palliation
