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Year 3 > MedEd liver and biliary disease 1 > Flashcards

MedEd liver and biliary disease 1 Flashcards

1
Q

what does haeme break down into?

A

unconjugated bilirubin and iron

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2
Q

how is bilirubin carried in blood?

A

bound to albumin

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3
Q

where is bilirubin conjugated?

A

liver

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4
Q

what enzyme conjugates bilirubin?

A

UDPGT

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5
Q

what are the 2 causes of pre hepatic jaundice?

A

haemolysis

gilbert’s

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6
Q

what are some causes of hepatic jaundice

A

hepatitis- viral, alcoholic, AI, drug

cirrhosis

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7
Q

what are some causes of obstructive jaundice

A 
liver mass
gallstone
PBC
pancreatic cancer
cholangiocarcinoma 
drug causing ileus
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8
Q

in what jaundice do you get dark urine?

A

obstructive jaundice

pre hepatic haemolytic jaundice

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9
Q

what does dark urine, pruritus and pale stool indicate?

A

obstructive jaundice

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10
Q

what is raised in prehepatic jaundice in lfts?

A

only bilirubin

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11
Q

what is raised in hepatic jaundice on lfts?

A

ast and alt

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12
Q

what is raised in obstructive jaundice on lfts?

A

alp and ggt

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13
Q

what are some causes of hepatitis?

A 
viral
alcohol
autoimmune
drugs
NASH
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14
Q

what is raised in lfts in hepatitis?

A

ast and alt

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15
Q

how does hepatitis present?

A 
RUQ pain
jaundice
hepatomegaly
joint pain
nausea
fatigue 
dark urine
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16
Q

how may hepatitis progress?

A

acute hep then recovery
acute hep then liver failure
acute hep goes to chronic goes to cirrhosis goes to liver failure

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17
Q

what is the progression of alcoholic liver disease? describe symptoms

A

steatosis (fatty liver)- after few days heavy drinking, no symptoms
alcoholic hepatitis- after long term alcohol use but laso after binge, nausea, anorexia, weight loss, hepatomegaly
cirrhosis- scarring and fibrosis of liver

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18
Q

what ix are done for alcoholic hep and what do you see?

A 
fbc- macrocytic anaemia
lfts- ast/alt (ratio >2), high bilirubin, high GGT, low albumin
clotting- high PT
hepatic USS
liver biopsy- shows mallaory bodies
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19
Q

what is seen on liver biopsy in alcoholic hepatitis?

A

mallory bodies

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20
Q

what is a time sensitive marker of significan liver dmaage?

A

PT

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21
Q

how is alcoholic hep managed?

A

manage for withdrawal- chlordiazepoxide
nutrition- pabrinex to prevent wernicke-karsakoff
weight loss
stop smoking

22
Q

how does non alcoholic fatty liver disease progress?

A

steatosis
steatohepatitis
cirrhosis

23
Q

why might someone get nafld?

A

obesity, diabetes, hyperlipidaemia, hypetension etc

24
Q

what signs might you see in nafld and why?

A

insulin resistance eg acanthosis nigricans, polyuria and polydipsia

25
Q

what types of hepatitis is acute?

A

A and E

26
Q

whats the prognosis for hep A and E?

A

full recovery

27
Q

how are hep A and E transmissed and how do you remember this?

A

fAEcal oral

28
Q

are hep B and C acute or chronic

A

acute or chronic
C most commonly is Chronic
B usually just acute

29
Q

what is important to remember about hep D?

A

can only have it if you’ve had hep B

30
Q

what surface antigen does hep b have?

A

HBsAg

31
Q

what core antigen does hep b have?

A

HBcAg

32
Q

what is a surface vs core antigen

A 
surface= on surface of virus and exposed to blood 
core= inside the virus and not exposed to blood
33
Q

what antibody should someone with hep b vaccination have?

A

HBsAb

34
Q

what antibody is only present if someone has been infected with hep b?

A

HBcAb

35
Q

whats is anti HBs v anti HBc

A

anti HBs= antibody for hep B surface antigen

anti HBc= anitbody for hep B core antigen

36
Q

what class is the core antibody for hep b?

A

IgM

37
Q

what is cirrhosis?

A

normal liver replaced by fibrosis and nodules of regenerating hepatocytes

38
Q

what are signs of chronic stable liver disease?

A 
clubbing 
spider naevi (3 or more) 
dupuytrens contracture
erythema 
gynacomastia
39
Q

what is a complication of cirrhosis?

A

portal hypertension

40
Q

what are signs of portal hypertension?

A

caput medusae
lower oesophageal varices
ascites
splenomegaly

41
Q

how is cirrhosis managed?

A

treat cause eg viral hep
6 monthly USS
endoscopy every 3 yrs

42
Q

what are some complications of cirrhosis?

A

encephalopathy
variceal bleeds
spontaneous bacterial peritonitis

43
Q

what is a complication of ascites?

A

spontaenous bacterial peritonitis

44
Q

how is hepatic encephalopathy managed?

A

treat precipitating event eg GI bleed
short term low protein diet
oral lactulose, rifaximin, phosphate enema
avoid sedatives

45
Q

how does the liver clear ammonia?

A

breaks it down into urea

46
Q

how is ascites managed?

A

sodium restriction
diuretics
paracentesis if needed

47
Q

how is SBP managed?

A

abx- metronidazole and cefuroxime

48
Q

how are varicies managed?

A

primary prohylaxis- beta blocker is small EVL if big
ruptured- ABCDE, IV fluids/bloods, terlipressin and abx and EVL after resus (surgically band the varices)
secondary prohylaxis- non selective beta blocker
TIPs procedure

49
Q

what abx are given for SBP?

A

metronidazole and cefuroxime

50
Q

what is cholelithiasis?

A

gallstone in gallbladder

51
Q

what is biliary colic?

A

pain caused by gallstones

pain+ cholelithiasis

52
Q

what is acute cholecystitis?

A

cholelithiasis, inflammation and secondary infection

Year 3 (104 decks)

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