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Phase 2 Medicine > more liver > Flashcards

more liver Flashcards

1
Q

What are the symptoms of acute hepatitis?

A
  1. Asymptomatic
  2. General malaise
  3. Myalgia
  4. GI upset
  5. Abdo pain (RUQ)
  6. Jaundice (pale stools, dark urine)
  7. Tender hepatomegaly
  8. Raised AST/ALT, bilirubin may be raised
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2
Q

List 4 infectious, non-viral causes of hepatitis

A
  1. spirochetes - leptospirosis
  2. mycobacteria - TB
  3. parasites - toxoplasma
  4. Bacteria - coxiella (Q fever)
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3
Q

List 6 non-infectious causes of hepatitis.

A
  1. Alcohol
  2. NAFLD
  3. Drugs/toxins
  4. Autoimmune
  5. Pregnancy
  6. Hereditary metabolic
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4
Q

How can chronic decompensated liver disease present?

A
  1. Jaundice
  2. Ascites
  3. Low albumin
  4. Coagulopathy
  5. Encephalopathy
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5
Q

What are the complications of chronic liver disease?

A
  1. HCC

2. portal HTN - varices and bleeding

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6
Q

What drugs are given for acute HBV infection?

A

Nucleotide analogues: Tenofovir and Entecavir

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7
Q

What phases of chronic HBV infection are treated?

A
  1. Immune clearance phase

2. Reactivation phase

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8
Q

How is chronic HBV treated?

A
  1. Pegylated interferon alpha 2a - 48 weekly injection

2. Nucleotide analogues - lifelong

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9
Q

What is the test for hepatitis D?

A

Hepatitis D antibody. If positive, test for HDV RNA

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10
Q

What is the treatment for hepatitis D?

A

Treat with pegylated interferon alpha

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11
Q

What is the test for hepatitis C?

A

HCV Ab - may be negative if very recent exposure
If positive, look for HCV RNA - indicates current infection
If HCV RNA positive, find HCV genotype (1 and 3 most common in UK)

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12
Q

What are the side effects of ribavarin?

A
  1. Haemolytic anaemia
  2. Dyspnoea
  3. Insomnia
  4. Anxiety
  5. Agitation
  6. Tiredness
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13
Q

What is the treatment for hepatitis C?

A

Directly Acting Antivirals (DAA), classes:

- NS5A
- NS5B
- Protease inhibitors
Combination of 2 drug classes
sometimes add ribavarin

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14
Q

How is Hepatitis C prevented?

A
  1. Screening blood products
  2. Universal precautions around handling bodily fluids
  3. Lifestyle modification - needle exchanges
  4. Treatment and cure of those who are infected (transmitters)
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15
Q

List 10 causes of cirrhosis.

A
  1. Chronic alcohol abuse
  2. NAFLD
  3. Hep B +/- D
  4. Hep C
  5. Primary biliary cirrhosis
  6. AI Hepatitis (high ALT)
  7. Hereditary haemochromatosis
  8. Wilson’s disease
  9. Drugs
  10. Alpha 1 antitrypsin deficiency
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16
Q

What are the 11 symptoms of cirrhosis?

A
  1. Leukonychia (due to hypoalbuminaemia)
  2. Clubbing
  3. Palmar erythema
  4. Dupuytren’s contracture
  5. Spider naevi
  6. Xanthelasma
  7. Loss of body hair
  8. Hepatomegaly
  9. Bruising
  10. Ankle swelling and oedema
  11. Abdominal pain due to ascites
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17
Q

How is cirrhosis diagnosed?

A

Gold standard = biopsy

LFTs

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18
Q

List 4 complications of liver cirrhosis.

A
  1. Coagulopathy (fall in CF 2, 7, 9, 10)
  2. Encephalopathy (asterixis, confusion, coma)
  3. Hypoalbuminaemia -> oedema
  4. Portal HTN
    a. ascites
    b. oesophageal varices
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19
Q

What is the treatment for cirrhosis?

A

Prevent further damage by treating cause - e.g. treating viral hepatitis or alcohol abstinence
If advanced, liver transplant may be required.

20
Q

What are the symptoms of alcoholic hepatitis?

A
  1. Malaise
  2. Jaundice
  3. Anorexia
  4. Nausea
  5. Hepatomegaly
  6. Bleeding
  7. Ascites
  8. Macrocytic anaemia
21
Q

What would you find on blood test for someone with alcoholic hepatitis?

A
  1. High AST and ALT (AST more than ALT)
  2. Macrocytic anaemia (high MCV)
  3. Leukocytosis
  4. Thrombocytopaenia
  5. High INR
  6. High urea
22
Q

What drug would you give for alcohol withdrawal symptoms?

A

Chlordiazepoxide

23
Q

How would you treat alcoholic liver disease?

A

Vitamin B and K and optimise nutrition

24
Q

When would you give prednisolone for alcoholic liver disease?

A

If severe or if encephalopathy

25
Q

What would you give a patient for alcohol cravings or anxiety?

A

Acamprosate or disulfiram

26
Q

Define cirrhosis

A

Irreversible liver damage. Histologically, there is loss of normal hepatic architecture with fibrosis and nodular regeneration

27
Q

List 4 complications of pancreatitis.

A
  1. Shock
  2. ARDS
  3. GI bleeding
  4. Pancreatic pseudocyst
  5. DM
  6. Malabsorption - steatorrhoea
28
Q

What causes GORD?

A

Dysfunction of the LOS leads to gastro-oesophageal reflux of acid and stomach content.

29
Q

What are the symptoms of GORD?

A
  • heartburn
  • water brash
  • acid brash
  • odynophagia
  • nocturnal asthma
30
Q

What are the alarm bell signs of GORD?

A
  • dysphagia
  • haematemesis
  • weight loss
31
Q

What are the associations for GORD?

A
  • smoking
  • alcohol
  • obesity
  • pregnancy
  • hiatus hernia
  • big meals
32
Q

What are the differential diagnoses for GORD?

A
  • CAD
  • oesophagitis
  • infections - candida
  • duodenal ulcer
  • non-ulcer dyspepsia
  • gastric ulcers/cancers
33
Q

What are the complications of GORD?

A
  • oesophagitis
  • Barrett’s oesophagus
  • benign oesophageal stricture
  • iron deficiency anaemia
34
Q

How would you investigate for GORD?

A

Investigate if symptoms ongoing for >4wks, or alarm bell signs
- endoscopy, using Los Angeles classification

35
Q

What is Barrett’s oesophagus?

A

Metaplasia of the distal oesophageal epithelium from squamous to columnar

36
Q

What is Barrett’s oesophagus a precursor for?

A

Barrett’s oesophagus is pre-malignant for adenocarcinoma of the oesophagus

37
Q

What is the treatment of GORD?

A
  • lifestyle changes - lose weight stop smoking, drinking, eat >3hr before bed, raise bed height?
  • antacids - magnesium trisilicate
  • alginates (gaviscon)
  • PPI - lansoprazole
  • H2RA - cimetidine
  • surgery: nissen fundoplication
38
Q

What are the symptoms of peptic ulcer disease?

A
  1. Epigastric pain
  2. Bloating
  3. Belching
  4. Vomiting
  5. Weight loss (gastric ulcers)
39
Q

What are the differential diagnoses for peptic ulcers?

A
  • non-ulcer dyspepsia

- duodenal Crohn’s

40
Q

What investigations would you do for peptic ulcers?

A

Non-invasive: - H. Pylori C Urea breath test, serology, faecal antigen test

Invasive: Endoscopy and biopsy

41
Q

What is the treatment for peptic ulcer disease?

A
  • Lifestyle mod
  • H Pylori eradication
  • NSAID discontinuation
  • H2RA
42
Q

What are the complications of peptic ulcer disease?

A
  • bleeding
  • perforation
  • gastric duct obstruction ->N/V
43
Q

What investigation would you do for bowel obstruction?

A

Abdominal XR plain film

44
Q

What antibiotics would you give for appendicitis?

A

Metronidazole and cefuroxime

45
Q

What are the differential diagnoses for appendicitis?

A
  • Ectopic pregnancy
  • Acute terminal Ilitis due to Crohn’s
  • UTI
  • Diverticulitis
  • Perforated ulcer
  • Food poisoning

Phase 2 Medicine (10 decks)

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