Liver, pancreas, gallbladder, some acute abdo Flashcards
ALT>AST indicates
chronic liver disease
AST>ALT indicates
alcoholic liver disease
increase in ALP is indicative of
post-hepatic obstruction
test that best measures immediate functional capacity of liver
coagulation
autoantibodies in PBC
AMA
IgM
autoantibodies in PSC
pANCA
ANA
autoantibodies in autoimmune hepatitis
anti-smooth muscle
Anti-liver kidney microsomal (LKMA)
IgG
what kind of hepatitis does hep A cause
acute
not assocaited with chronic or HCC
what does hepatitis A igM indicate
acute infection
what does hepatitis A IgG indicate
previous infection, remains for life
is there a vaccine for hepatitis A
yes - given prophylactically to at risk groups
transmission of hepatitis A
faecal oral route
transmission of hepatitis B
blood, sex, vertical
what kind of hepatitis is hep B associated with
acute - symptomatic or asymptomatic
10% chronic
- either asymptomatic carrier
- or active chronic
is hepatitis B assoicated with cirrhosis or HCC
yes active chronic associated with both
can hepatitis B resolve spontaneously
yes
when is HBsAg seen
any active infection, acute or chronic
when is HBeAg seen
only seen in active acute infection - high transmissibility
when is anti-HBs seen
immunity - either from infection or vaccination
when is anti-HBc seen
IgM - active infection
IgG - chronic or resolved infection
when is anti-HBe seen
inactive carrier
immune
natural immunity
what is the only positive hepatitis B marker in immunity from vaccine
anti-HBs
is there a vaccine for hep B
yes
treatment for chronic Hep B
antiviral - tenovifir, entecavir
peginterferon
does antiviral treatment in chronic Hep B cure it
no, suppresses it
transmission of hep C
sex
blood
what kind of infection does Hep C cause
acute and majority go to chronic
does spontaneous resolution occur in hep C
no
is there a vaccine for hep C
no
is there a risk of cirrhosis and HCC with hep C
yes
what does hep C antibody indicate
past or present infection
how do you differentiate hep C current and past infection
Hep C RNA by PCR
- positive - current
- negative - past
tx hep C
Peg interferon + ribavarin +/- telaprevir
Hep D only exists with
hep B
Hep E causes fulminant hepatic failure in
pregnant women
spread of hep E
faecal oral
acute hepatitis
- LFTs
- synthetic function: protein, coag
LFTs abnormal
coag and protein normal
investigation of choice for chronic liver cirrhosis
transient elastography
what is budd chiari syndrome
hepatic vein thrombosis
drug to reduce portal hypertension
beta blocker - propranolol
ix for liver fibrosis
fibroscan
gold stand investigation for chronic liver disease
US guided biopsy
causative organism in SBP
ecoli
ix for SBP
ascitic tap
tx SBP
pass med and tayside
passmed - IV cefotaxime
tayside
- incidental finding - cotrim
- symptomatic - piperacillin/tazobactam IV and step down co trim PO
SBP antibiotic prophylaxis
ciprofloxacin
tx itch in liver disease
urseadeoxycolic acid
tx ascites
spironolactone/eplerenone
ascitic drain
mallory body formation
alcoholic fatty liver disease
tx acute alcoholic hepatitis
prednisolone
pentoxyphylline sometimes
ix for NAFLD
discovered incidentally via USS - increased echogenicity
- if so, do an enhanced liver fibrosis blood test to look for fibrosis (ELF)
tx NAFLD
weight loss and lifestyle changes
- rapid weight loss can precipitate it
ix NASH
US +/- biopsy
itching in middle aged women with jaundice and fatigue, RUQ pain and hyperpigmentation and xanthelasma is classic of
PBC
what kind of bilirubin is seen in PBC
conjugated
ix of PBC
RUQ US or MRCP
tx PBC
urseodeoxycolic acid
cholestyramine for itch
onion skin fibrosis
PSC
gold standard ix for PSC
ERCP or MRCP
what are you at increased risk of with PSC
cholangiocarcinoma
CRC
antibodies in type 1 AIH
anti smooth muscle
ANA
IgG
children and adults
antibodies in type 2 AIH
anti-LKM
children only
antibodies in type 3 AIM
soluble liver kidney antigen - adults
what is a common presentation of AIH in women
amenorrhoea
piecemeal necrosis and bridging necrosis
AIH
tx AIH
steroids
azathioprine
liver transplant
inheritance of A1ATD
AR
ix of A1ATD
serum A1AT
inheritance of wilsons
AR
investigation of wilsons
24 hour urine copper- high
serum copper and ceruloplasmin - low
tx wilsons
penicillamine
inheritance of haemochromatosis
AR
people with haemochromatosis are known as
bronze diabetic
haemochromatosis iron ferritin transferrin saturation TIBC
TIBC low
rest high
tx haemochromatosis
venesection
tx amoebic liver abscess
metronidazole
marker of HCC
AFP
ix HCC
ultrasound
tumour marker of cholangiocarcinoma
CA19.9
inheritance of gilberts
AR
RF for cholangiocarcinoma
IBD
PSC
most common liver cancer
metastases
triad of budd chiari
abdo pain
ascites
tender hepatomegaly
ix budd chiari
doppler US
tx budd chiari
TIPS
sugar levels in liver failure
hypoglycaemia
tx hepatic encephalopathy
lactulose 1st line
rifamixin 2ndry prophylaxis
fluid resus in liver failure
4.5% albumin
tx of coagulopathy in liver failure
vitamin K
dark urine, pale stools indicates
post hepatic jaundice
- conjugated bilirubin
unconjugated bilirubin (prehepatic jaundice) causes what to stools and urine
nothing - normal
intrahepatic liver failure causes what kind of jaundice
mixed - both types of bilirubin
dark urine, normal stools
measure of chronic hepatocyte function
albumin
best indication of liver cirrohosis in chronic liver diesase
thrombocytopenia
is there screening for HCC
yes high risk groups
ix for acute pancreatitis suspected
abdominal USS
ix if acute pancreatitis diagnosis is in doubt/assess severity and for complications
contrast CT
1st line ix for chronic pancreatitis
USS
best investigation for differentiating chronic pancreatitis from cancer
endoscopic US
cancer at head of pancreas
adencarcioma
pancreatic cancer marker
CA19.9
ix of choice for suspected pancreatic cancer - diagnostic
high res abdo CT
double duct sign
EUS if no mass but suspicion high
ix suspected gallstones
US
next step if gallstones identified in biliary tree
ERCP
tx biliary colic
elective lap cole
s/s biliary colic
episodic RUQ colicy pain
often after fatty meal
nausea
s/s acute cholecystitis
constant RUQ pain can radiate to right shoulder
N+V
fever and systemic upset
murphys sign
what is murphy’s sign
cessation of breathing with pressing on gallbladder
ix for acute cholecystitis
USS
2nd line ix for acute cholecystitis if 1st line unclear
HIDA scan (scintigraphy)
tx acute cholecystitis
lap cole within 48 hours
s/s ascending cholangitits
charcot’s triad - fever, jaundice and RUQ pain
murphys sign positive
most common cause of ascending cholangitis
e coli
tx ascending cholangitis
early ERCP
1st line ix for ascending cholangitis
US
s/s pancreatic cancer
weight loss painless jaundice light stools dark urine itch steatorrhoea palpable gallbladder
what is courvosiers law
painless obstructive jaundice with a palpable gallbladder is usually not due to gallstones
either pancreatic cancer or cholangiocarcinoma
s/s cholangiocarcinoma
persistent biliary colic
weight loss, jaundice
palpable mass in RUQ
SMJ and virchow nodes
causes of acute pancreatitis
IGETSMASHED idiopathic gallstones ethanol trauma steroids mumps autoimmune scorpion bites hyperlipidaemia, hypothermia, hypercalcaemia, hyperparathyroidism ERCP drugs - diuretics, steroids, azathioprine, methotrexate
where is mcburneys point
1/3 between ASIS and umbilicus on RHS
what is rosvigs sign
pain in RIF when pressing on LIF
ix of appendicitis
preg test
ultrasound in females if unsure might be reproductive pathology
clinical diagnosis
tx appenicitis
lap append +/- prophylactic IV abx
abx in acute abdo
amox met and gent
imaging in acute abdo
CT - gold standard
perforation/pneumonia - erect CXR
USS
most common artery involved in acute mesenteric ischaemia
SMA
ix of choice for acute mesenteric ischaemia
CT
tx of acute mesenteric ischamia
emergency laparotomy
tinkling bowel sounds
bowel obstruction
no bowel sounds
ileus
coffee bean sign on XR
volvulus
ix bowel obstruction first line small and large
AXR
investigation of cause of bowel obstruction
CT
complications of bowel obstruction: potassium
hypokalaemia
tx bowel obstruction
drip and suck - fluid resus, NBM and NG tube
where is an inguinal hernia found
superior and medial to pubic tubercle
which type of inguinal hernia reappears when deep ring occluded
direct
direct inguinal hernia is found where compared to inferior epigastric vessels
medial
indirect inguinal hernia is found where compared to inferior epigastric vessesl
lateral
scrotal mass unable to get above
indirect inguinal hernia
which inguinal hernia more common in paediatrics
indirect inguinal
tx indirect inguinal in paeds
urgent surgery - risk of strangluation
where are femoral hernias found
below and lateral to pubic tubercle
when are femoral hernias most often seen
thin elderly women
tx femoral hernia
urgent surgery risk of strangulation
where is hernia found: epigastric
midline mass above umbilicus
where is hernia found: umbilical
under umbilicus
do umbilical hernias need repaired
usually resolve by 3
where is hernia found: paraumbilical
above or below umbilicus
where is hernia found: spigelian
lateral edge of rectus sheath
pancreas exocrine function test in chronic pancreatitis
faecal elastase
quick investigation bloods in acute mesenteric ischaemia
lactate
key part of treatment of acute pancreatitis
aggressive fluid resus
blood test to monitor treatment in haemochromatosis
ferritin and transferin saturation
tx hepatorenal syndrome
terlipressin
TIPS
albumin 20%
