Passmed/pastest Flashcards
Isolated hyperbilirubinaemia in asymptomatic person?
Gilbert syndrome
In Gilbert syndrome why is bilirubin not seen in the urine?
Disorder of bilirubin conjugation; causes build-up of unconjugated bilirubin which is not water-soluble
Sudden onset abdominal pain, tender hepatomegaly and ascites due to hepatic vein thrombosis
Budd-Chiari syndrome
What test is used to distinguish between ascites due to portal hypertension or other causes?
Serum-ascites albumin gradient (SAAG). Raised SAAG indicates portal hypertension
Budd-Chiari syndrome is usually seen in the context of…
Underlying pro-coagulant condition e.g. thrombophilia, pregnancy, malignancy
Transaminitis (elevated ALT and AST) in the 10,000s is most commonly caused by…
Paracetamol overdose
Treatment of paracetamol overdose?
Acetylcysteine if:
staggered overdose/doubt over time of ingestion;
plasma paracetamol concentration is above the treatment line from 4hrs-15hrs
How is the number of units of alcohol in a drink calculated?
Volume in ml * ABV / 1000
Guidelines for alcohol intake?
Men and women- max 14 units, ideally spread over 3 days or more
Autosomal dominant condition characterised by multiple telangiectasia over the skin and mucuous membranes
Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
Most common cause of liver disease in the developed world?
Non-alcoholic fatty liver disease (NAFLD)
NAFLD associations?
Obesity, hyperlipidaemia, T2DM (metabolic syndrome)
Describe the spectrum of NAFLD?
Steatosis –> steatohepatitis –> fibrosis –> cirrhosis
Test results in NAFLD? (2)
Elevated transaminases (ALT usually greater than AST) Increased echogenicity on USS
Management of NAFLD?
Lifestyle changes and monioring
? possible role for gastric banding/metformin
Commonest causative organisms in pyogenic liver abscesses?
Staph aureus in children
E coli in adults
Management of pyogenic liver abscess?
Antibiotics + image guided percutaneous drainage
What is the most important factor indicating need for liver transplant following paracetamol overdose?
Arterial pH under 7.3
Histology in bowel wall, demonstrating pigment laden macrophages
Melanosis coli
Melanosis coli is associated with…
laxative abuse
Sudden onset severe abdominal pain +/- PR bleeding, PMHx of atrial fibrillation/atherosclerotic disease
?Ischaemic colitis
Where does ischaemic colitis most commonly occur and why?
Splenic flexure; this is a watershed area between the areas supplied by the superior and inferior mesenteric arteries
Symptoms of the classic carcinoid syndrome?
Wheezing, flushing and diarrhoea
Commonest causes of an exudative ascites?
Infection, malignancy
Causes of a transudative ascites? (4)
Hepatic failure
Portal hypertension
Budd-Chiari
Cardiac failure
Malabsorption + thickened small bowel folds on barium enema
History of living/working in India/Asia/S.America/Carribean
Tropical sprue
Malabsorption, large-joint arthralgia and lymphadenopathy
Whipple’s disease
Triad of dysphagia, glossitis and iron deficiency anaemia
Plummer-Vinson syndrome
Severe vomiting –> mucosal lacterations –> haematemesis
Mallory-Weiss syndrome
Oesophageal rupture as a result of severe vomiting
Boerhaave syndrome
Cysts in the liver/lungs, often as a result of eating infected undercooked meat
Also- history of sheep farming
Hydatid disease
History of abdominal surgery, presenting with malabsorption and low vitamin B12
Small intestinal bacterial overgrowth (SIBO)
Treatment for SIBO?
Antibiotics
