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Phase 2A revision > liver to work on COPY > Flashcards

liver to work on COPY Flashcards

1
Q

Give 4 causes of hepatic jaundice

A
  1. Liver disease
  2. Hepatitis - viral, drug, immune, alcohol
  3. Ischaemia
  4. Neoplasm - HCC, mets
  5. Congestions - CCF
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2
Q

Give 3 causes of post-hepatic jaundice

A

Duct obstruction

  1. Gallstones
  2. Stricture - Malignancy, ischaemia, inflammatory
  3. Blocked stent
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3
Q

Give 3 symptoms of jaundice

A
  1. Biliary pain
  2. Rigors - indicate an obstructive cause
  3. Abdomen swelling
  4. Weight loss
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4
Q

which conditions can cause Gallstones

A
  1. Obesity and rapid weight loss
  2. DM
  3. Contraceptive pill
  4. Liver cirrhosis
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5
Q

Give 4 symptoms of gallstones

A

Most are asymptomatic

  1. Biliary colic (sudden RUQ pain radiating to the back and epigastrium +/- nausea/vomiting) - AFTER EATING FATTY MEALS
  2. Acute cholecystitis (gallbladder distension –> inflammation, necrosis, ischaemia)
  3. Obstructive jaundice
  4. Cholangitis
  5. Pancreatitis
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6
Q

Give 5 causes of acute liver disease

A
  1. Viral hepatitis
  2. Drug induced hepatitis
  3. Alcohol induced hepatitis
  4. Vascular - Budd-Chiari
  5. Obstruction
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7
Q

Give 5 causes of chronic liver disease

A
  1. Alcohol
  2. NAFLD
  3. Viral hepatitis (B,C,E)
  4. Autoimmune diseases
  5. Metabolic
  6. Vascular - Budd-Chairi
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8
Q

Give 5 signs of acute liver failure

A
  1. Jaundice
  2. Fetor hepaticus (smells like pears)
  3. Coagulopathy
  4. Asterixis - liver flap
  5. Malaise
  6. Lethargy
  7. Encephalopathy
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9
Q

Give 5 signs of chronic liver disease

A 
Ascites/Oedema
Gynaecomastia 
Dupuytren’s contracture
Malaise
Anorexia 
Jaundice/Pruritus
Clubbing/Leukonychia 
Palmar erythema
Xanthelasma
Spider Naevi/Caput Medusae
Hepatosplenomegaly
Bleeding - haematemesis, easy bruising
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10
Q

Give 4 complications of of liver failure

A
  1. Hepatic encephalopathy
  2. Abnormal bleeding
  3. Jaundice
  4. Ascites
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11
Q

What drugs should be avoided in liver failure?

A

Constipators
Oral hypoglycaemics
Warfarin has enhanced effects
Opiates

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12
Q

Give 4 signs of cirrhosis

A
  • ascites
  • clubbing
  • palmar erythema
  • xanthelasma
  • spider naevi
  • hepatomegaly
  • peripheral oedema
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13
Q

Give 4 complications of cirrhosis

A

Ascites
portal hypertension

  1. Decompensation
  2. SBP
  3. Increased risk of HCC
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14
Q

what is the clinical presentation of portal hypertension?

A
  • often asymptomatic
  • splenomegaly
  • spider naevi
  • GI bleeding
  • ascites
  • hepatic encephalopathy
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15
Q

Describe the pathophysiology of ascites

A
  1. Increased intra-hepatic resistance leads to portal hypertension –> ascites
  2. Systemic vasodilation leads to secretion of RAAS, NAd and ADH –> fluid retention
  3. Low serum albumin
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16
Q

Give 3 signs of ascites

A
  1. Distension
  2. Dyspnoea
  3. Shifting dullness on percussion
  4. Signs of liver failure
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17
Q

Describe the treatment for ascites

A
  1. Restrict sodium and fluids
  2. Diuretics - spirolactone
  3. Paracentesis
  4. Albumin replacement
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18
Q

Describe the effects of alcoholic liver disease

A
  1. Fatty liver –> hepatitis –> cirrhosis and fibrosis
  2. GIT –> gastritis, varices, peptic ulcers, pancreatitis , carcinoma
  3. CNS –> Degreased memory and cognition, wernicke’s encephalopathy
  4. Folate deficiency –> anaemia
  5. Reproduction –> testicular atrophy, reduced testosterone/progesterone
  6. Heart –> dilated cardiomyoapthy, arrhythmias
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19
Q

What distinctive feature is often seen on biopsy in people suffering form alcoholic liver disease?

A

Mallory bodies

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20
Q

How does alcoholic hepatitis present?

A 
Jaundice
Anorexia
Nausea and vomiting
Fever
Encephalopathy 
Cirrhosis 
Hepatomegaly
Ascites, bruising, clubbing
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21
Q

Give 3 infective causes of acute hepatitis

A
  1. Hepatitis A-E infections
  2. EBV
  3. CMV
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22
Q

Give 3 symptoms of acute hepatitis

A
  1. General malaise
  2. Myalgia
  3. GI upset
  4. Abdominal pain
  5. Raised AST, ALT
  6. +/- jaundice
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23
Q

Describe the natural history of HBV in 4 phases

A
  1. Immune tolerance phase
    - unimpeded viral replication
    - HBV DNA = high
  2. Immune clearance phase:
    - the immune system ‘wakes up’
    - liver inflammation
    - ALT = high
  3. Inactive HBV carrier phase
    - HBV DNA = low
    - ALT levels = normal
    - no liver inflammation
  4. Reactivation phase
    - ALT = intermittent
    - HBV DNA = intermittent
    - liver fibrosis
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24
Q

What are the potential consequences of chronic HBV infection?

A
  1. Cirrhosis
  2. HCC
  3. Decompensated cirrhosis
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25
Give 3 side effects of alpha interferon treatment for HBV
1. Myalgia 2. Malaise 3. Lethargy 4. Thyroiditis 5. Mental health problems
26
Give 2 HBV specific symptoms
Arthralgia | Urticaria (hives)
27
Give 3 causes of non-alcoholic fatty liver disease
1. T2DM 2. Obesity 3. Hypertension 4. Hyperlipidaemia
28
How do you manage NAFLD?
Lose weight Control HTN, DM and lipids
29
What is Budd-Chiari syndrome?
Hepatic vein occlusion --> ischaemia and hepatocyte damage --> liver failure or insidious cirrhosis
30
90% of people with haemochromatosis have a mutation in which gene?
HFE - chromosome 6
31
Give 4 signs of haemochromatosis
* Fatigue, arthralgia, weakness * Hypogonadism – eg erectile dysfunction * SLATE-GREY SKIN (brownish/bronze) * Chronic liver disease, heart failure, arrythmias
32
Give 2 complications of haemochromatosis?
Liver cirrhosis --> failure/cancer | DM due to pancreatic depositions
33
Describe the pathophysiology of alpha 1 anti-trypsin deficiency?
● A mutation in the alpha-1-antitrypsin gene on chromosome 14 leads to reduced hepatic production of alpha-1-antitrypsin which normally inhibits the proteolytic enzyme, neutrophil elastase ● Deficiency results in emphysema, liver cirrhosis and hepatocellular carcinoma
34
How does Alpha 1 anti-trypsin deficiency present?
Liver disease in the young - cirrhosis, jaundice Lung disease in the old (smokers) - emphysema
35
What is the treatment for Alpha 1 anti-trypsin deficiency?
● No treatment ● Treat complications such as liver disease ● Stop smoking ● Those with hepatic decompensation should be assessed for liver transplant ● Manage emphysema
36
How does Wilson's disease present?
Children = liver disease - hepatitis, cirrhosis, fulminant liver failure Adults = CNS problems, mood changes, and Kayser-Fleischer rings
37
What CNS changes are seen in a patient with Wilson's disease?
``` Tremor Dysarthria Dyskinesia Ataxia Parkinsonism Dementia Depression ```
38
What is the treatment for Wilson's disease?
Lifetime treatment with penicillamine (chelating agent) Low Cu diet - no liver, nuts, chocolate, mushrooms, shellfish Liver transplant
39
How does autoimmune hepatitis present?
``` Fatigue, fever, malaise Hepatitis Hepatosplenomegaly Amenorrhoea Polyarthritis Pleurisy Lung infiltrates Glomuleronephritis ```
40
What diseases are associated with autoimmune hepatitis?
``` Autoimmune thyroiditis DM Pernicious anaemia PSC UC ```
41
What results would you see from the investigations of someone who you suspect has autoimmune hepatitis?
Raised LFTs - increased bilirubin, AST, ALT, ALP Hypersplenism = low WCC and platelets Autoantibodies = +ve ANA Liver biopsy = mononuclear infiltrate
42
How is autoimmune hepatitis treated?
Prednisolone - immunosuppression | Liver transplant
43
What is primary biliary cirrhosis?
An autoimmune disease where intra-hepatic bile ducts are destructed by chronic granulomatous inflammation --> cholestatis (bile in liver) --> cirrhosis, fibrosis, portal hypertension
44
Give 3 disease associated with primary biliary cirrhosis
1. Thyroiditis 2. RA 3. Coeliac disease 4. Lung disease Other autoimmune diseases
45
Give 3 symptoms of primary biliary cirrhosis
1. Pruritis 2. Fatigue 3. Hepatosplenomegaly 4. Obstructive jaundice 5. Cirrhosis and coagulopathy
46
What would investigations show in someone with primary biliary cirrhosis?
Bloods = LFT - GGT and ALP raised Positive anti-mitochondrial antibody (AMA) = diagnostic low albumin Liver biopsy = epithelial disruption and lymphocyte infiltration
47
What is the treatment for primary biliary cirrhosis?
early stage = Ursodeoxycholic acid + steroids + Cholestyramine ADEK vitamins severe = Liver transplant
48
Describe the pathophysiology of primary sclerosing cholangitis
Inflammation of the bile duct --> stricture and hardening --> progressive obliterating fibrosis of bile duct branches --> cirrhosis --> liver failure
49
Give 3 causes of primary sclerosing cholangitis
1. Primary = unknown causes 2. Infection 3. Thrombosis 4. Iatrogenic trauma
50
Give 3 symptoms of primary sclerosing cholangitis
1. Pruritus 2. Charcot's triad = fever with chills, RUQ pain, obstructive jaundice 3. Cirrhosis 4. Liver failure 5. Fatigue
51
What would the investigations show in someone with primary sclerosing cholangitis?
Bloods = high ALP, bilirubin, pANCA AMA negative Imaging = ERCP and MRCP Liver biopsy = fibrous and obliterative cholangitis
52
What is the treatment for primary sclerosing cholangitis?
- Cholestyramine for pruritus - Ursodeoxycholic acid - may protect against colon cancer and improve LFT - ADEK vitamins - Liver transplant
53
What complications might occur due to primary sclerosing cholangitis?
Increased risk of bile duct, gallbladder, liver and colon cancer
54
Give 3 causes of ascending cholangitis?
Gallstone Primary infection (Klebsiella, E. coli) Strictures following surgery Pancreases head malignancy
55
What other symptoms can present with Charcot's triad with ascending cholangitis?
Reynolds pentad - Charcot's triad (fever, RUQ pain, jaundice) - Hypotension - Confusion/altered mental state
56
What investigations might you do in someone who you suspect might have ascending cholangitis?
1. USS 2. Blood tests - LFTS 3. CT - excludes carcinoma 4. ERCP - definitive investigation
57
Describe the management of ascending cholangitis
``` Fluid resuscitation Treat infection with broad spectrum antibiotics (cefotaxime, metronidazole) ERCP to clear obstruction Stenting Laparoscopic cholecystectomy ```
58
What is the main difference between biliary colic and acute cholecystitis?
Acute cholecystitis has an inflammatory component
59
What complications can occur due to acute ascending cholangitis?
``` Sepsis Biliary colic Acute cholecystitis Empyema Carcinoma Pancreatitis ```
60
Give 3 symptoms of peritonitis
1. Abdominal pain and tenderness 2. Nausea and vomiting 3. Chills 4. Rigors 5. Fever
61
Give 3 signs of peritonitis on an abdomen examination
1. Guarding 2. Rebound tenderness 3. Rigidity 4. Silent abdomen 5. lying still
62
What investigations might you do in someone who you suspect could have peritonitis?
1. Blood tests: raised WCC, platelets, CRP, amylase, reduced blood count 2. CXR: look for air under the diaphragm 3. Abdominal x-ray: look for bowel obstruction 4. CT: can show inflammation, ischaemia or cancer 5. ECG: epigastric pain could be related to the heart 6. B-HCG: a hormone secreted by pregnant ladies
63
What is the management for peritonitis?
1. ABCDE 2. Treat the underlying cause - might be surgery if perforated bowel 3. IV fluids 4. IV antibiotics - first broad spectrum then specific 5. peritoneal lavage (clean the cavity surgically)
64
Give 5 potential complications of peritonitis
1. Hypovolaemia 2. Kidney failure 3. Systemic sepsis 4. Paralytic ileus 5. Pulmonary atelectasis (lung collapse) 6. Portal pyaemia (pus in portal vein)
65
Name a bacteria that can cause spontaneous bacterial peritonitis
1. E. coli | 2. S. pneumoniae
66
Describe the treatment for spontaneous bacterial peritonitis
Cefotaxime and metronidazole
67
What is acute pancreatitis?
An inflammatory process with release of inflammatory cytokines (TNF alpha, IL-6) and pancreatic enzymes (trypsin, lipase) the pancreas returns to functionally and structurallynormal after the episode Occurs as isolated or recurrent attacks
68
What are the causes of acute pancreatitis?
``` I GET SMASHED – remember I = Idiopathic G = Gallstones (60%) E = Ethanol = alcohol (30%) T = Trauma S = Steroids M = Mumps A = Autoimmune S = Scorpion venom H = Hyperlipidaemia/ hypothermia/ high Ca E = ERCP (endoscopic retrograde cholangiopancreatography) D = Drugs (furosemide, corticosteroid, NSAIDs, ACEi) ```
69
which drugs can cause acute pancreatitis?
furosemide, corticosteroid, NSAIDs, ACEi
70
Give 4 symptoms of acute pancreatitis
1. Severe epigastric pain that radiates to the back 2. Anorexia 3. Nausea, vomiting 4. Signs of septic shock - fever, dehydration, hypotension, tachycardia 5. Necrotising - umbilical (Cullens sign) vs flank (Grey Turners sign)
71
What investigations are done on someone you think has acute pancreatitis?
``` Raised serum amylase and lipase urinalysis - raised urinary amylase Erect CXR Contrast CT MRI ```
72
Describe the treatment for acute pancreatitis
- analgesia - nil by mouth - IV fluids - prophylactic antibiotics
73
Give 2 potential complications of acute pancreatitis
1. Systemic inflammatory response syndrome 2. Multiple organ dysfunction 3. Pancreatic necrosis - hyperglycaemia - hypocalcaemia - renal failure - shock
74
What is chronic pancreatitis?
Chronic inflammation of the pancreas leads to irreversible damage - Progressive loss of exocrine pancreatic tissue which is replaced by fibrosis
75
Describe the pathogenesis of chronic pancreatitis
Pancreatic duct obstruction leads to activation of pancreatic enzymes --> necrosis --> fibrosis
76
Name 3 causes of chronic pancreatitis
1. Excess alcohol - most common 2. CKD 3. Idiopathic 4. Recurrent acute pancreatitis 5. hereditary 6. CF - all have it from birth 7. autoimmune 8. tropical
77
What is the clinical presentation of chronic pancreatitis?
1. Severe epigastric pain that radiate through to the back - worse after alcohol/meal and better on leaning forward 2. Weight loss, malabsorption 3. Nausea, vomiting 4. Steatorrhea (lack of lipase) 5. Exocrine/endocrine dysfunction (DM) 6. jaundice
78
A sign of chronic pancreatitis is exocrine dysfunction, what can be consequence of this?
1. Malabsorption 2. Weight loss 3. Diarrhoea 4. Steatorrhoea
79
What immunoglobulin might be elevated in someone with autoimmune chronic pancreatitis?
IgG4
80
How is autoimmune chronic pancreatitis treated?
Steroids
81
What is the treatment for chronic pancreatitis?
Alcohol cessation Analgesia (NSAIDs, tramadol) Pancreatic enzyme (creon) and vitamin replacement pancreatin + omeprazole If DM = insulin Surgery - local resection, for unremitting pain and duct draining
82
What 2 enzymes, if raised, suggest pancreatitis?
LDH (lactate dehydrogenase) and AST
83
Give 3 complications of chronic pancreatitis
1. Diabetes 2. Pseudocyst 3. Biliary obstruction --> obstructive jaundice, cancer
84
Name a drug that can cause drug induced liver injury
1. Co-amoxiclav 2. Flucloxacillin 3. Erythromycin 4. TB drugs
85
Give 5 causes of diarrhoea infection
1. Traveller's diarrhoea 2. Viral - (rotavirus/norovirus) 3. Bacterial (E. coli) 4. parasites (helminths, protozoa) 5. Nosocomial (C. diff)
86
Give 5 causes of non-diarrhoeal infection
1. Gastritis/peptic ulcer disease (H. pylori) 2. Acute cholecystitis 3. Peritonitis 4. Thyphois/paratyphoid 5. Amoebic liver abscess
87
What is the diagnostic criteria for travellers diarrhoea?
> 3 unformed stools per day and a least one of: - abdominal pain - cramps - nausea - vomiting Occurs within 2 weeks (usually 3 days) of arrival in a new country
88
give 3 causes of travellers diarrhoea
1. Enterotoxigenic E. coli 2. Norovirus 3. Giardia
89
Which type of E. coli can cause bloody diarrhoea and has a shiga like toxin?
Enterohaemorrhagic E.coli (EHEC)
90
Give 5 symptoms of helminth infection
1. Fever 2. Eosinophilia 3. Diarrhoea 4. Cough 5. Wheeze
91
Why is c. diff infectious?
Spore forming bacteria (gram positive)
92
Give 5 risk factors for c.diff infection
1. Increasing age 2. Comordities 3. Antibiotic use 4. PPI 5. Long hospital admission 6. NG tube feeding and GI surgery 7. Immunocompromised - HIV, anti-caner drugs
93
Name 5 antibiotics that can cause c. diff infection
1. Ciprofloxacin (quinolones) 2. Co-amoxiclav (penicillins) 3. Clindamycin 4. Cephlosporins 5. Carbapenems RULE OF C's
94
what is the clinical presentation of biliary colic?
● Recurrent episodes of severe and persistent pain in the upper abdomen which subsides after several hours ● Pain may radiate to right shoulder and suprascapular region ● Vomiting ● Normal examination
95
what investigations should be undertaken for biliary colic?
● History and US showing gallstones ● Increases of serum alkaline phosphatase and bilirubin during an attack support the diagnosis of biliary pain ● Absence of inflammatory features differentiates this from acute cholecystitis
96
what is the management of biliary colic?
● Analgesics and elective cholecystectomy ● Abnormal liver biochemistry or a dilated CBD on US is an indication for preoperative MRCP ● CBD stone removed at ERCP
97
what is the clinical presentation of cholecystitis?
* Generalised epigastric pain migrating to severe RUQ pain. * Signs of inflammation like a fever or fatigue. * Pain associated with tenderness and guarding from inflamed gallbladder and local peritonitis. Tenderness worse on inspiration (Murphy's sign)
98
what are the investigations for cholecystitis?
* Positive Murphy’s Sign = Severe pain on deep inhalation with examiners hand pressed into the RUQ. * Inflammatory markers - FBCs, CRP * Ultrasound: Thick gallstone walls from inflammation
99
what is the management of cholecystitis?
• Antibiotics IV, heavy analgesia, IV fluids an eventual Cholecystectomy if needed.
100
what are the complications of cholecystitis?
● Empyema (pus) | ● Perforation with peritonitis
101
what is the pathophysiology of primary biliary cholangitis (primary biliary cirrhosis)?
* Due to prolonged bile duct blockage, bile isn’t ‘flushing’ out the tubes so bacteria can climb up from the GI tract and cause biliary tree infection and consolidation. * This prevents bile entering the GI tract and causes jaundice. * 5-10% mortality and infection can affect the pancreas too since it shares ducts with the gallbladder.
102
what is the clinical presentation of primary biliary cholangitis (primary biliary cirrhosis)?
* Severe RUQ pain, with fever (rigors) AND jaundice. | * Patient may present as septic and/or have developed some level of pancreatitis.
103
what are the investigations for primary biliary cholangitis (primary biliary cirrhosis)?
POSITIVE AMA Raised ALP and Bilirubin, raised CRP • Blood cultures/MC&S • Ultrasound +/- ERCP
104
what is the clinical presentation of ascending cholangitis?
RUQ pain, jaundice, & rigors (Charcot’s triad’)
105
what is the treatment for ascending cholangitis?
Cefuroxime IV & Metronidazole IV/PR.
106
what is primary sclerosing cholangitis?
a disease of the bile ducts that causes inflammation and obliterative fibrosis of bile ducts inside and/or outside of the liver. - This pathological process impedes the flow of bile to the intestines and can ultimately lead to cirrhosis of the liver, liver failure, and bile duct and liver cancer
107
what is the pathophysiology of portal hypertension?
- Increased resistance to blood flow leads to portal hypertension causes splanchnic vasodilation - This results in a drop in BP - CO increases to compensate for BP resulting in salt and water retention - Hyperdynamic circulation/increased portal flow leads to the formation of collaterals between portal and systemic systems
108
what is the treatment of GI varices?
● fluid resuscitation until haemodynamically stable ● If anaemic – blood transfusion ● Correct clotting abnormalities – vitamin K and platelet transfusion ● Vasopressin – IV terlipressin or octreotide ● Prophylactic antibiotics ● Variceal banding ● Balloon tamponade ● TIPS
109
what is the prevention of varices?
o Nonselective B blockade – propranolol – reduced resting pulse and decrease portal pressure o Variceal banding repeated to obliterate varices o TIPSS o Liver transplant
110
what are the risk factors for developing ascites?
- high sodium diet - HCC - splanchnic vein thrombosis causing portal hypertension
111
what are the causes of ascites?
``` ● liver failure - cirrhosis ● Portal hypertension e.g. cirrhosis ● Hepatic outflow obstruction ● Budd-Chiari syndrome ● Peritonitis ● Pancreatitis ● Cardiac failure ● Constrictive pericarditis ```
112
what investigations should be done for ascites?
● Diagnostic aspiration of 10-20ml of ascitic fluid o Raised white cell count indicates bacterial peritonitis o Gram stain and culture o Cytology for malignant cells o Amylase to exclude pancreatic ascites ● Protein measurement of ascitic fluid o Transudate (low protein) - Portal hypertension, constrictive pericarditis, cardiac failure, Budd-Chiari syndrome o Exudate (high protein) BAD!! - Malignancy, peritonitis, pancreatitis, peritoneal tuberculosis, nephrotic syndrome
113
what is the management of ascites?
- treat underlying cause - low sodium diet - spironolactone and furosemide - drain fluid - paracentesis
114
what investigations are undertaken for chronic pancreatitis?
- serum amylase and lipase - may be raised | - abdominal US, CT and MRI
115
what is alpha 1 antitrypsin deficiency?
- rare cause of cirrhosis - autosomal recessive condition - mutation of alpha-1-antitrypsin gene on chromosome 14
116
what investigations are undertaken for gallstones?
FBC and CRP: Looking for signs of an inflammatory response - suggestive of cholecystitis • LFTs: Raised ALP - Bilirubin and ALT usually normal. • Amylase: Check for pancreatitis • Ultrasound = diagnostic: 1.Stones 2.Gallbladder wall thickness (inflammation) 3.Duct dilation (suggests distal blockage)
117
what are the side-effects of chelating agents?
skin rash, fall in WCC, HB and platelets, haematuria, renal damage
118
what are the investigations for wilsons disease?
* Serum copper and ceruloplasmin reduced (but can be normal) * 24hr urinary copper excretion high * Liver biopsy – diagnostic
119
what are the causes of peritonitis?
bacterial = most common - gram -ve coliforms - e.coli - gram +ve staphylococcus chemical - bile, old clotted blood
120
what is the clinical presentation of HAV?
nausea, anorexia, distaste for cigarettes some become jaundiced - dark urine and pale stool
121
what are the risk factors for non-alcoholic fatty liver disease?
``` Obesity, diabetes, hyperlipidaemia, parental feeding, jejuno-ileal bypass, wilsons disease, drugs - Amiodarone, Tetracycline ,Methotrexate, Tetracycline ```
122
which drugs increase the risk of developing non-alcoholic fatty liver disease?
Amiodarone, Tetracycline ,Methotrexate
123
what are the clinical features of non-alcoholic fatty liver disease?
Usually no symptoms; liver ache in 10% | Fat, sometimes with inflammation & fibrosis
124
what are the investigations for non-alcoholic fatty liver disease?
Fat, sometimes with inflammation & fibrosis | Need biopsy to distinguish NAFL from NASH
125
what is the treatment for non-alcoholic fatty liver disease?
control risk factors, bariatric surgery - to treat obesity
126
what are the clinical features of fatty liver?
o No symptoms or signs | o Vague abdominal symptoms are due to general effects of alcohol on the GI tract
127
what are the investigations for fatty liver?
o Elevated MCV indicates heavy drinking o Raised ALT and AST o Ultrasound or CT/liver histology will demonstrate fatty infiltration
128
what are the investigations for alcoholic hepatitis?
o FBC – leucocytosis, elevated MCV, thrombocytopenia o Serum electrolytes abnormal – elevated serum creatinine o Elevated AST, ALT, bilirubin, prothrombin time o Microscopy and culture of blood, urine and ascites to search for infection o Liver and biliary US used to identify obstruction
129
what is the management for alcoholic hepatitis?
o Nutrition maintained with enteral feeding and vitamin supplements o Steroids show short term benefit – reduce inflammation o Infections treated and prevented
130
what are the primary bile salts?
colic acid and chenodeoxycholic acid`
131
what are the secondary bile salts?
deoxycholic acid and lithocholic acid
132
what are the investigations for NAFLD?
1st line - enhanced liver fibrosis test (<7.7 = non-mild, >7.7-9.8 = moderate, >9.8 = severe) - LFTs - increased AST and ALT (AST:ALT ratio close to 1) - FBC - anaemia or thrombocytopenia gold standard - liver US (diffuse fatty infiltration and abnormal echotexture) - liver biopsy (required for diagnosis)
133
how can you tell the difference between NAFLD and alcoholic liver disease?
AST:ALT ratio ratio close to 1 = NAFLD 2:1 ratio = alcoholic liver disease
134
what are the symptoms of pre-hepatic jaundice?
pallor fatigue exertional dyspnoea
135
what are the symptoms of intra-hepatic jaundice?
anorexia fatigue nausea abdominal pain
136
what are the symptoms of post-hepatic jaundice?
``` pale stools dark urine pruritus steatorrhea RUQ pain hepatomegaly ```
137
what are the investigations for chronic pancreatitis?
``` Secretin stimulation test CT or MRI - pancreatic duct dilation, calcification, atrophy or pseudocysts endoscopic ultrasound Erect CXR fecal elastase test - decreased elastase ```

Phase 2A revision (38 decks)

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