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1. 4th year > Liver, pancreas, gallbladder, some acute abdo > Flashcards

Liver, pancreas, gallbladder, some acute abdo Flashcards

1
Q

ALT>AST indicates

A

chronic liver disease

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2
Q

AST>ALT indicates

A

alcoholic liver disease

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3
Q

increase in ALP is indicative of

A

post-hepatic obstruction

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4
Q

test that best measures immediate functional capacity of liver

A

coagulation

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5
Q

autoantibodies in PBC

A

AMA

IgM

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6
Q

autoantibodies in PSC

A

pANCA

ANA

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7
Q

autoantibodies in autoimmune hepatitis

A

anti-smooth muscle
Anti-liver kidney microsomal (LKMA)
IgG

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8
Q

what kind of hepatitis does hep A cause

A

acute

not assocaited with chronic or HCC

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9
Q

what does hepatitis A igM indicate

A

acute infection

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10
Q

what does hepatitis A IgG indicate

A

previous infection, remains for life

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11
Q

is there a vaccine for hepatitis A

A

yes - given prophylactically to at risk groups

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12
Q

transmission of hepatitis A

A

faecal oral route

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13
Q

transmission of hepatitis B

A

blood, sex, vertical

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14
Q

what kind of hepatitis is hep B associated with

A

acute - symptomatic or asymptomatic
10% chronic
- either asymptomatic carrier
- or active chronic

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15
Q

is hepatitis B assoicated with cirrhosis or HCC

A

yes active chronic associated with both

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16
Q

can hepatitis B resolve spontaneously

A

yes

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17
Q

when is HBsAg seen

A

any active infection, acute or chronic

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18
Q

when is HBeAg seen

A

only seen in active acute infection - high transmissibility

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19
Q

when is anti-HBs seen

A

immunity - either from infection or vaccination

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20
Q

when is anti-HBc seen

A

IgM - active infection

IgG - chronic or resolved infection

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21
Q

when is anti-HBe seen

A

inactive carrier
immune
natural immunity

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22
Q

what is the only positive hepatitis B marker in immunity from vaccine

A

anti-HBs

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23
Q

is there a vaccine for hep B

A

yes

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24
Q

treatment for chronic Hep B

A

antiviral - tenovifir, entecavir

peginterferon

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25
Q

does antiviral treatment in chronic Hep B cure it

A

no, suppresses it

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26
Q

transmission of hep C

A

sex

blood

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27
Q

what kind of infection does Hep C cause

A

acute and majority go to chronic

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28
Q

does spontaneous resolution occur in hep C

A

no

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29
Q

is there a vaccine for hep C

A

no

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30
Q

is there a risk of cirrhosis and HCC with hep C

A

yes

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31
Q

what does hep C antibody indicate

A

past or present infection

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32
Q

how do you differentiate hep C current and past infection

A

Hep C RNA by PCR

  • positive - current
  • negative - past
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33
Q

tx hep C

A

Peg interferon + ribavarin +/- telaprevir

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34
Q

Hep D only exists with

A

hep B

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35
Q

Hep E causes fulminant hepatic failure in

A

pregnant women

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36
Q

spread of hep E

A

faecal oral

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37
Q

acute hepatitis

  • LFTs
  • synthetic function: protein, coag
A

LFTs abnormal

coag and protein normal

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38
Q

investigation of choice for chronic liver cirrhosis

A

transient elastography

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39
Q

what is budd chiari syndrome

A

hepatic vein thrombosis

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40
Q

drug to reduce portal hypertension

A

beta blocker - propranolol

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41
Q

ix for liver fibrosis

A

fibroscan

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42
Q

gold stand investigation for chronic liver disease

A

US guided biopsy

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43
Q

causative organism in SBP

A

ecoli

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44
Q

ix for SBP

A

ascitic tap

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45
Q

tx SBP

pass med and tayside

A

passmed - IV cefotaxime
tayside
- incidental finding - cotrim
- symptomatic - piperacillin/tazobactam IV and step down co trim PO

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46
Q

SBP antibiotic prophylaxis

A

ciprofloxacin

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47
Q

tx itch in liver disease

A

urseadeoxycolic acid

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48
Q

tx ascites

A

spironolactone/eplerenone

ascitic drain

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49
Q

mallory body formation

A

alcoholic fatty liver disease

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50
Q

tx acute alcoholic hepatitis

A

prednisolone

pentoxyphylline sometimes

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51
Q

ix for NAFLD

A

discovered incidentally via USS - increased echogenicity

- if so, do an enhanced liver fibrosis blood test to look for fibrosis (ELF)

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52
Q

tx NAFLD

A

weight loss and lifestyle changes

- rapid weight loss can precipitate it

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53
Q

ix NASH

A

US +/- biopsy

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54
Q

itching in middle aged women with jaundice and fatigue, RUQ pain and hyperpigmentation and xanthelasma is classic of

A

PBC

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55
Q

what kind of bilirubin is seen in PBC

A

conjugated

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56
Q

ix of PBC

A

RUQ US or MRCP

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57
Q

tx PBC

A

urseodeoxycolic acid

cholestyramine for itch

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58
Q

onion skin fibrosis

A

PSC

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59
Q

gold standard ix for PSC

A

ERCP or MRCP

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60
Q

what are you at increased risk of with PSC

A

cholangiocarcinoma

CRC

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61
Q

antibodies in type 1 AIH

A

anti smooth muscle
ANA
IgG
children and adults

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62
Q

antibodies in type 2 AIH

A

anti-LKM

children only

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63
Q

antibodies in type 3 AIM

A

soluble liver kidney antigen - adults

64
Q

what is a common presentation of AIH in women

A

amenorrhoea

65
Q

piecemeal necrosis and bridging necrosis

A

AIH

66
Q

tx AIH

A

steroids
azathioprine
liver transplant

67
Q

inheritance of A1ATD

A

AR

68
Q

ix of A1ATD

A

serum A1AT

69
Q

inheritance of wilsons

A

AR

70
Q

investigation of wilsons

A

24 hour urine copper- high

serum copper and ceruloplasmin - low

71
Q

tx wilsons

A

penicillamine

72
Q

inheritance of haemochromatosis

A

AR

73
Q

people with haemochromatosis are known as

A

bronze diabetic

74
Q 
haemochromatosis
iron
ferritin
transferrin saturation
TIBC
A

TIBC low

rest high

75
Q

tx haemochromatosis

A

venesection

76
Q

tx amoebic liver abscess

A

metronidazole

77
Q

marker of HCC

A

AFP

78
Q

ix HCC

A

ultrasound

79
Q

tumour marker of cholangiocarcinoma

A

CA19.9

80
Q

inheritance of gilberts

A

AR

81
Q

RF for cholangiocarcinoma

A

IBD

PSC

82
Q

most common liver cancer

A

metastases

83
Q

triad of budd chiari

A

abdo pain
ascites
tender hepatomegaly

84
Q

ix budd chiari

A

doppler US

85
Q

tx budd chiari

A

TIPS

86
Q

sugar levels in liver failure

A

hypoglycaemia

87
Q

tx hepatic encephalopathy

A

lactulose 1st line

rifamixin 2ndry prophylaxis

88
Q

fluid resus in liver failure

A

4.5% albumin

89
Q

tx of coagulopathy in liver failure

A

vitamin K

90
Q

dark urine, pale stools indicates

A

post hepatic jaundice

- conjugated bilirubin

91
Q

unconjugated bilirubin (prehepatic jaundice) causes what to stools and urine

A

nothing - normal

92
Q

intrahepatic liver failure causes what kind of jaundice

A

mixed - both types of bilirubin

dark urine, normal stools

93
Q

measure of chronic hepatocyte function

A

albumin

94
Q

best indication of liver cirrohosis in chronic liver diesase

A

thrombocytopenia

95
Q

is there screening for HCC

A

yes high risk groups

96
Q

ix for acute pancreatitis suspected

A

abdominal USS

97
Q

ix if acute pancreatitis diagnosis is in doubt/assess severity and for complications

A

contrast CT

98
Q

1st line ix for chronic pancreatitis

A

USS

99
Q

best investigation for differentiating chronic pancreatitis from cancer

A

endoscopic US

100
Q

cancer at head of pancreas

A

adencarcioma

101
Q

pancreatic cancer marker

A

CA19.9

102
Q

ix of choice for suspected pancreatic cancer - diagnostic

A

high res abdo CT
double duct sign

EUS if no mass but suspicion high

103
Q

ix suspected gallstones

A

US

104
Q

next step if gallstones identified in biliary tree

A

ERCP

105
Q

tx biliary colic

A

elective lap cole

106
Q

s/s biliary colic

A

episodic RUQ colicy pain
often after fatty meal
nausea

107
Q

s/s acute cholecystitis

A

constant RUQ pain can radiate to right shoulder
N+V
fever and systemic upset
murphys sign

108
Q

what is murphy’s sign

A

cessation of breathing with pressing on gallbladder

109
Q

ix for acute cholecystitis

A

USS

110
Q

2nd line ix for acute cholecystitis if 1st line unclear

A

HIDA scan (scintigraphy)

111
Q

tx acute cholecystitis

A

lap cole within 48 hours

112
Q

s/s ascending cholangitits

A

charcot’s triad - fever, jaundice and RUQ pain

murphys sign positive

113
Q

most common cause of ascending cholangitis

A

e coli

114
Q

tx ascending cholangitis

A

early ERCP

115
Q

1st line ix for ascending cholangitis

A

US

116
Q

s/s pancreatic cancer

A 
weight loss 
painless jaundice 
light stools 
dark urine 
itch 
steatorrhoea
palpable gallbladder
117
Q

what is courvosiers law

A

painless obstructive jaundice with a palpable gallbladder is usually not due to gallstones
either pancreatic cancer or cholangiocarcinoma

118
Q

s/s cholangiocarcinoma

A

persistent biliary colic
weight loss, jaundice
palpable mass in RUQ
SMJ and virchow nodes

119
Q

causes of acute pancreatitis

A 
IGETSMASHED
idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune 
scorpion bites
hyperlipidaemia, hypothermia, hypercalcaemia, hyperparathyroidism
ERCP
drugs - diuretics, steroids, azathioprine, methotrexate
120
Q

where is mcburneys point

A

1/3 between ASIS and umbilicus on RHS

121
Q

what is rosvigs sign

A

pain in RIF when pressing on LIF

122
Q

ix of appendicitis

A

preg test
ultrasound in females if unsure might be reproductive pathology
clinical diagnosis

123
Q

tx appenicitis

A

lap append +/- prophylactic IV abx

124
Q

abx in acute abdo

A

amox met and gent

125
Q

imaging in acute abdo

A

CT - gold standard
perforation/pneumonia - erect CXR
USS

126
Q

most common artery involved in acute mesenteric ischaemia

A

SMA

127
Q

ix of choice for acute mesenteric ischaemia

A

CT

128
Q

tx of acute mesenteric ischamia

A

emergency laparotomy

129
Q

tinkling bowel sounds

A

bowel obstruction

130
Q

no bowel sounds

A

ileus

131
Q

coffee bean sign on XR

A

volvulus

132
Q

ix bowel obstruction first line small and large

A

AXR

133
Q

investigation of cause of bowel obstruction

A

CT

134
Q

complications of bowel obstruction: potassium

A

hypokalaemia

135
Q

tx bowel obstruction

A

drip and suck - fluid resus, NBM and NG tube

136
Q

where is an inguinal hernia found

A

superior and medial to pubic tubercle

137
Q

which type of inguinal hernia reappears when deep ring occluded

A

direct

138
Q

direct inguinal hernia is found where compared to inferior epigastric vessels

A

medial

139
Q

indirect inguinal hernia is found where compared to inferior epigastric vessesl

A

lateral

140
Q

scrotal mass unable to get above

A

indirect inguinal hernia

141
Q

which inguinal hernia more common in paediatrics

A

indirect inguinal

142
Q

tx indirect inguinal in paeds

A

urgent surgery - risk of strangluation

143
Q

where are femoral hernias found

A

below and lateral to pubic tubercle

144
Q

when are femoral hernias most often seen

A

thin elderly women

145
Q

tx femoral hernia

A

urgent surgery risk of strangulation

146
Q

where is hernia found: epigastric

A

midline mass above umbilicus

147
Q

where is hernia found: umbilical

A

under umbilicus

148
Q

do umbilical hernias need repaired

A

usually resolve by 3

149
Q

where is hernia found: paraumbilical

A

above or below umbilicus

150
Q

where is hernia found: spigelian

A

lateral edge of rectus sheath

151
Q

pancreas exocrine function test in chronic pancreatitis

A

faecal elastase

152
Q

quick investigation bloods in acute mesenteric ischaemia

A

lactate

153
Q

key part of treatment of acute pancreatitis

A

aggressive fluid resus

154
Q

blood test to monitor treatment in haemochromatosis

A

ferritin and transferin saturation

155
Q

tx hepatorenal syndrome

A

terlipressin
TIPS
albumin 20%

1. 4th year (23 decks)

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