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TCA 3 - Liver, Biliary and Pancreatic disease > Patient Presentation, Tests and Alcoholism > Flashcards

Patient Presentation, Tests and Alcoholism Flashcards

1
Q

What are the important risk factors?

A 
o	Alcohol intake
o	Drug use
o	Travel
o	Blood transfusions
o	Tattoos
o	Unprotected sexual activity
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2
Q

What is important to identify on examination?

A 
o	Fever, cachexia
o	Hepatic encephalopathy / flap
o	Signs of chronic liver disease
o	Scars off surgery – cholecystectomy
o	RUQ / epigastric pain
o	Hepatomegaly
o	Splenomegaly and ascites
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3
Q

What is cachexia?

A

Extreme weight loss and muscle wasting

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4
Q

When should you suspect cancer in a patient?

A
  • Looking cachectic
  • Have lymphadenopathy
    diseased lymphnodes causing them to become enlarged and unequal in size
  • Hard, craggy liver edge
  • Unintentional weight loss
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5
Q

What is the most common cancer in this region of the abdomen?

A

Carcinoma of the head of the pancreas

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6
Q

When should you exclude carcinoma of the head of the pancreas in patients?

A
  • > 40 yrs

- Have painless, obstructive jaundice

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7
Q

What is liver cancer usually caused by?

A
  • Metastases from other primary cancers (lung cancer)
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8
Q

When would you suspect cholangiocarcinoma (cancer of the gallbladder)?

A

When you can palpate the gallbladder on examination

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9
Q

What condition is primary hepatocellular cancer is more common in?

A

Cirrhosis

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10
Q

How would you test for primary hepatocellular cancer?

A
  • Ultrasound

- Raised Alpha-fetoprotein (AFP)

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11
Q

What are liver function tests?

A
  • INR / Prothrombin time

- Albumin

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12
Q

What are liver enzyme tests?

A
  • Transaminases (AST, ALT)
  • Alkaline phosphatase
  • GGT (Gamma-GT)
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13
Q

What is prothrombin time / INR?

A

A laboratory measurement of how long it takes blood to form a clot. It is used to determine the effects of oral anticoagulants on the clotting system.

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14
Q

What does a rise in ALT, AST&raquo_space; rise in alkaline phosphate indicate?

A

Hepatocellular damage

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15
Q

What does a rise in ALT, AST &laquo_space;rise in alkaline phosphate indicate?

A

Obstructive cause

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16
Q

When would you look at gamma-GT (GGT)?

A

When there is a doubt in the tissue of origin of AST

17
Q

What are transaminases?

A

Enzymes involved with amino acid metabolism in the liver.

They are released by hepatocytes when the liver becomes damaged.

18
Q

What is the clinically relevant subcellular localisation of AST?

A
  • Found in cytoplasm and mitochondria

- Is abundant in muscle and hepatocytes

19
Q

What is the clinically relevant subcellular localisation of ALT?

A
  • Found in cytoplasm

- Predominatly hepatic

20
Q

Where is alkaline phosphatase found?

A
  • Liver - 55%; in hepatocytes next to biliary canaliculi
  • Bone - 45%; in osteoblasts
  • Gut - 5%
  • Kidney
  • Placenta
21
Q

What could a raised alkaline phosphatase indicate?

A 
- Hepatobiliary disease
     Cholestasis
     Hepatocyte disease
- Bone disease
     Paget's Disease
     Osteomalacia and rickets
     Renal osteodystrophy
     Bone metastases
     Primary bone tumour 
     Recent fracture
     Growing child - especially at puberty
- Pregnancy
- Malignancy
22
Q

What are the infective causes that can make LFTs abnormal?

A

o Epstein Barr virus
o Cytomegalovirus (CMV)
o Hepatitis A, B or C

23
Q

What are the lifestyle causes that can make LFTs abnormal?

A

o Obesity
o Alcohol excess
o Diabetes mellitus

24
Q

What are the drug causes that can make LFTs abnormal?

A 
o	Anti-epileptics
o	Methotrexate
o	Rifampicin 
o	Flucloxacillin
o	Paracetamol overdose
25
Q

What are the extra-heaptic (obstructive) causes that can make LFTs abnormal?

A

o Carcinoma of the pancreas

o Gallstones

26
Q

What are the autoimmune causes that can make LFTs abnormal?

A

o Autoimmune hepatitis
o Primary sclerosing cholangitis
o Primary biliary cholangitis

27
Q

What are the hereditary causes that can make LFTs abnormal?

A

o Wilson’s disease
o Alpha-1-antitrypsin deficiency
o Hereditary haemochromatosis

28
Q

What is an alcohol unit?

A

1 unit = 10ml or 8g of pure alcohol

29
Q

What are the recommendations for drinking alcohol?

A

14 units per week, best spread out over 3+ days. Pregnant women shouldn’t be drinking at all

30
Q

What patients experience alcohol withdrawals?

A
  • In patients who are alcohol dependent and who have stopped or reduced their alcohol intake within hours or days of presentation.
  • Symptoms typically begin 6-12 hours after the patient’s last alcoholic drink
31
Q

What are delirium tremens?

A

Acute confusional state that results when someone who drinks excess alcohol daily, suddenly stops drinking

32
Q

What can happen if delirium tremens are left untreated?

A
  • Seizures

- Death

33
Q

What are the key diagnostic factors of alcoholism?

A 
•	CAGE questionnaire
•	AUDIT Questionnaire
o	Score >8 gives an indication of harmful alcohol use
•	Anxiety 
•	Nausea and vomiting
•	Autonomic dysfunction:
o	Tremor
o	Tachycardia
o	Sweating
o	Palpitations
•	Insomnia
34
Q

What is the CAGE questionnaire?

A

o C: Have you felt the need to CUT down on your drinking?
o A: Have you ever felt ANNOYED by someone criticising your drinking?
o G: Have you ever felt bad or GUILTY about your drinking?
o E: Have you ever had an EYE-OPENER - a drink first thing in the morning to steady your nerves?

35
Q

How do you treat delirium tremens?

A
  • 1st line: oral lorazepam

- Then: parenteral lorazepam or haloperidol

36
Q

What is the management of alcohol withdrawals?

A
  • 1st line: Chlordiazepoxide

- Then: Diazepam

37
Q

When would you give parenteral thiamine followed by oral thiamine for alcohol withdrawals?

A

To prevent Wernicke-Korsakoff syndrome in people who are:

  • Malnourished
  • At risk of malnourishment
  • Have decompensated liver disease
38
Q

What are the complications of alcoholism?

A
  • Alcoholic liver disease
  • Cirrhosis and complications of cirrhosis including hepatocellular carcinoma
  • Alcohol dependence and withdrawal
  • Wernicke-Korsakoff Syndrome (WKS)
  • Pancreatitis
  • Alcoholic cardiomyopathy
39
Q

What is Wernicke-Korsakoff Syndrome (WKS)?

A

Thiamine (vitamin B1) deficiency

  • Thiamine is poorly absorbed in the presence of alcohol
  • Alcoholics tend to have poor diets

TCA 3 - Liver, Biliary and Pancreatic disease (6 decks)

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