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1st/2nd Year Revision > Liver/Pancreas Conditions > Flashcards

Liver/Pancreas Conditions Flashcards

1
Q

What is liver cirrhosis?

A

Irreversible liver damage

Loss of normal hepatic architecture

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2
Q

What are the causes of liver cirrhosis?

A 
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
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3
Q

What are the symptoms of liver cirrhosis?

A 
Related to cause
Lethargy
Splenomegaly
Jaundice
Leukonychia
Spider naevi
Gynaecomastia
Clubbing
Ascites
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4
Q

What investigations would be done if liver cirrhosis was suspected?

A 
LFT, FBC, U&Es
Albumin
Coagulation
Ultrasound
Ascites tap - if ascites
Liver biopsy
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5
Q

How is liver cirrhosis treated?

A 
Aimed at underlying cause
Good nutrition
Laxatives avoid hepatic encephalopathy
Vitamin K to correct clotting
Antibiotics
Liver transplant
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6
Q

What are the complications of liver cirrhosis?

A 
Malnutrition
Hepatic encephalopathy
Ascites/oedema
Vitamin deficiency
Hepatorenal carcinoma
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7
Q

What is the stepwise progression of alcohol related disease?

A

Alcohol related fatty liver - temporary, resolves in 2 weeks if no alcohol
Alcoholic hepatitis - inflammation
Cirrhosis - permanent

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8
Q

What are the symptoms of alcoholism?

A 
Jaundice
Hepatomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising
Ascites
Caput medusae
Asterixis
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9
Q

How is alcoholism investigated?

A 
CAGE
Increased GGT (and other LFTs)
Increased MCV, prothrombin time
Decreased albumin
Ultrasound
Liver biopsy
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10
Q

How is alcoholism managed?

A

Stop drinking
Nutrition
Vitamin replacement
Transplant

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11
Q

What are the complications of alcoholism?

A

Alcohol withdrawal
Delirium tremors
Wernicke’s-Korsakoff syndrome

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12
Q

What is the pathology of liver failure?

A

Acute necrotising hepatitis leads to cell destruction

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13
Q

What are the 3 types of liver failure?

A

Hyper-acute - encephalopathy within 1 week
Acute - within 2-4 weeks
Sub-acute - within 4-8 weeks

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14
Q

What are the causes of liver failure?

A 
Viral hepatitis
Infections
Drugs - paracetamol
Toxins
Alcohol
Malignancy
Fatty liver disease
Primary biliary cholangitis
Primary sclerosing cholangitis
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15
Q

What are the symptoms of liver failure?

A 
Jaundice
Hepatic encephalopathy
Fetor hepaticus - breath smells like pear drops
Asterixis
Cerebral oedema
Hypertension
Tachypnoea
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16
Q

How is liver failure investigated?

A 
FBC, U&Es, LFT
Clotting, glucose, paracetamol levels
Blood culture
Urine culture
CXR
Abdominal ultrasound
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17
Q

How is liver failure treated?

A

Supportive

Liver transplant

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18
Q

What are the complications of liver failure?

A

Renal failure
Sepsis
Circulatory failure
Pancreatitis

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19
Q

What is the pathology of autoimmune hepatitis?

A

Inflammatory liver disease, antibodies directed against hepatocyte surface antigens

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20
Q

Who is more likely to get autoimmune hepatitis?

A

Young women

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21
Q

What are the symptoms of autoimmune hepatitis?

A 
Fatigue
Abdominal discomfort
Decreased appetite
Myalgia
Hepatomegaly
Jaundice
Signs of cirrhosis
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22
Q

What investigations would be done if autoimmune hepatitis was suspected?

A 
All LFTs raised
Increased ESR
Positive ASMA antibodies (anti-smooth muscle antibodies)
Increased IgG
Liver biopsy
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23
Q

How is autoimmune hepatitis treated?

A

Steroids
Azathioprine
Ursodeoxycholic acid
Liver transplant

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24
Q

Are primary or secondary liver tumours more common?

A

Secondary - 90% are metastases
Men - stomach, colon, lung
Women - stomach, colon, breast, uterus

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25
Q

What are the symptoms of liver tumours?

A 
Fever
Malaise
Anorexia
RUQ pain
Jaundice - late except in cholangiocarcinoma
Hepatomegaly
Listen for liver bruits
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26
Q

What investigations would be done if a liver tumour was suspected?

A

FBC, clotting, LFT, hepatitis serology
Ultrasound
MRI
Liver biopsy

27
Q

How are secondary liver tumours treated?

A

Chemotherapy

Most is palliative

28
Q

What are the causes of hepatocellular carcinoma?

A

HBV
Cirrhosis
Fatty liver disease

29
Q

What are the symptoms of hepatocellular carcinoma?

A 
Fatigue
Decreased appetite
RUQ pain
Decreased weight
Jaundice
Ascites
Hepatomegaly
30
Q

What investigations would be done if hepatocellular carcinoma was suspected?

A 
Increased transaminases
Increased alpha-fetoprotein
Increased CRP and ESR
Ultrasound
CT, MRI
Liver biopsy
31
Q

How are hepatocellular carcinomas treated?

A

Resection

Liver transplant

32
Q

What is the pathology of primary biliary cholangitis?

A

Chronic inflammation and destruction of the small and medium bile ducts

33
Q

What sex is primary biliary cholangitis more common in?

A

Female

34
Q

What are the symptoms of primary biliary cholangitis?

A 
Fatigue
Pruritus
Arthralgia
Xanthelasma
Hepatomegaly
Splenomegaly
Jaundice
Signs of chronic liver disease
35
Q

What investigations would be done if primary biliary cholangitis was suspected?

A

Increased LFTs, IgM
Positive AMA (anti-mitochondrial antibodies)
Ultrasound

36
Q

How is primary biliary cholangitis treated?

A

Pruritus - colesyramine
Ursodeoxycholic acid
Steroids
Liver transplant

37
Q

What are the complications of primary biliary cholangitis?

A

Osteoporosis

38
Q

What is the pathology of primary sclerosing cholangitis?

A

Progressive cholestasis with bile duct inflammation and strictures

39
Q

What sex is primary sclerosing cholangitis more common in?

A

70% men - strong association with IBD (UC)

40
Q

What are the symptoms of primary sclerosing cholangitis?

A 
Asymptomatic
Fatigue
Weight loss
Pruritus
RUQ pain
Hepatomegaly
41
Q

What investigations would be done if primary sclerosing cholangitis was suspected?

A

Increased LFTs (ALP first)
Increased bilirubin
ERCP/MRCP
Liver biopsy

42
Q

How is primary sclerosing cholangitis treated?

A

Liver transplant

43
Q

What are the risk factors for cholestasis?

A

Obesity
Cirrhosis
CF
Haemolytic anaemia

44
Q

What are the symptoms of cholestasis?

A

RUQ pain

Depends where the stone is lodged

45
Q

What investigations would be done if cholestasis was suspected?

A

LFTs

Ultrasound

46
Q

How is cholestasis treated?

A

Dissolution

Cholecystectomy

47
Q

What are the complications of cholestasis?

A

Perforation

Abscess

48
Q

What are the causes of acute pancreatitis?

A 
GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Autoimmune
Scorpion venom
Hyperlipidaemia/hypercalcaemia/hypothermia
ERCP
Drugs
49
Q

What are the symptoms of acute pancreatitis?

A

Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards
Jaundice

50
Q

What investigations would be done if acute pancreatitis was suspected?

A 
Increased serum amylase and lipase
ABG
AXR
Erecr CXR
CT
51
Q

How is acute pancreatitis managed?

A

Severity assessment - Glasgow criteria
Nil by mouth
Analgesia
Treat cause and complications

52
Q

What are the complications of acute pancreatitis?

A 
Shock
ARDS
DIC
Sepsis
Pancreatic necrosis
Abscess
Bleeding 
Thrombosis
53
Q

What is the pathology of chronic pancreatitis?

A

Structure of the pancreas is permanently damaged

54
Q

What are the causes of chronic pancreatitis?

A 
CAMP:
Cystic fibrosis
Alcohol
Malnourishment
Pancreatic duct obstruction
Smoking
55
Q

What are the symptoms of chronic pancreatitis?

A

Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards
Jaundice

56
Q

What investigations would you do if chronic pancreatitis was suspected?

A

Ultrasound/CT - pancreatic calcifications confirm diagnosis
MRCP
Faecal elastase

57
Q

How is chronic pancreatitis treated?

A

Analgesia
No alcohol
Insulin
Pancreatic enzyme supplements

58
Q

What are the complications of chronic pancreatitis?

A

Pseudocyst
Diabetes
Biliary obstruction
Pancreatic carcinoma

59
Q

At what age does pancreatic carcinomas usually present?

A

> 70

60
Q

What is the pathology of pancreatic carcinoma?

A

Ductal adenocarcinoma - 65% head

61
Q

What are the risk factors for pancreatic carcinoma?

A

Smoking
Alcohol
Diabetes mellitus
Chronic pancreatitis

62
Q

What are the symptoms of pancreatic carcinoma?

A

Head - painless obstructive jaundice

Body/tail - epigastric pain radiating to back, relieved by sitting forwards

63
Q

What investigations would be done if pancreatic carcinoma was suspected?

A

Ultrasound
CT
ERCP/MRCO

64
Q

How is pancreatic carcinoma treated?

A

Resection if no mets
Chemotherapy
Palliation

1st/2nd Year Revision (15 decks)

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