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BPT > Summary Book Hepatology > Flashcards

Summary Book Hepatology Flashcards

1
Q

DDx of isolated hepatomegaly (>12cm)

A

Cardiac (constrictive pericarditis, right heart failure). Haematological (lymphoproliferative disorders, lymphoma, myeloproliferative disorders, CML). Infective (hydatid cyst, viral = CMV/EBV/hepatitis). Metabolic (haemochromatosis and steatohepatitis). Neoplastic (primary hepatocellular carcinoma, metastatic cancers). Infiltrative (amyloidosis, sarcoidosis).

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2
Q

Signs of right heart failure

A

leg oedema, raised JVP, smooth and tender liver

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3
Q

Signs of lymphoma

A

smooth and non-tender liver, generalised lymphadenopathy

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4
Q

Liver findings for hydatid cyst

A

irregular and non-tender

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5
Q

Liver findings for viral causes of hepatomegaly

A

smooth and tender

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6
Q

Liver findings for haemochromatosis

A

smooth and non-tender. Also bronze pigmentation, diabetes, cardiac failure and arthropathy.

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7
Q

Liver findings for primary hepatocellular carcinoma

A

Irregular, non-tender with weight loss and jaundice

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8
Q

Liver findings for metastatic cancer

A

Irregular, non-tender with cachexia

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9
Q

Liver findings for amyloidosis

A

Smooth and non-tender

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10
Q

Causes of massive hepatomegaly

A

HCC/mets (cachexia), myeloproliferative (anaemia), right heart failure (pulsatile), EtOH with fatty infiltration

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11
Q

Causes of moderate hepatomegaly

A

haemochromatosis, CML, lymphoma, fatty liver disease

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12
Q

DDx of isolated splenomegaly >12cm

A

Connective Tissue (rheumatoid arthritis, SLE). Haematological (haemolytic anaemia, thalassemia, sickle cell disease, lymphoproliferative disorder, lymphoma/CLL, myeloproliferative disorder, myelofibrosis/CML). Infective (infective endocarditis, viral = EBV). Portal hypertension (prehepatic = portal vein thrombosis, splenic vein thrombosis; intrahepatic = cirrhosis; post-hepatic = mostly hepatosplenomegaly). Infiltrative (amyloidosis, metastatic solid organ cancer, sarcoidosis, storage disease - gaucher disease).

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13
Q

Findings for haemolytic anaemia

A

anaemia, jaundice, slight increase in spleen size

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14
Q

Findings of lymphoproliferative disorders

A

moderate splenomegaly, lymphadenopathy

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15
Q

Findings of myelofibrosis

A

anaemia, lymphadenopathy, massive splenomegaly

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16
Q

Findings of CML

A

bruising, anaemia, massive splenomegaly

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17
Q

Spleen findings in cirrhosis

A

hard, moderate splenomegaly

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18
Q

DDx of hepatosplenomegaly

A

Connective Tissue (SLE). Haematological (haemolytic anaemia, lymphoproliferative disorders, myeloproliferative disorders). Infective (viral = HIV / CMV / EBV / hepatitis). Portal Hypertension (cirrhosis, hepatic vein thrombosis, IVC thrombosis, right heart failure, constrictive pericarditis). Infiltrative (amyloidosis, sarcoidosis).

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19
Q

Causes of xanthomata

A

pbc, chronic biliary tract obstruction

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20
Q

Define and causes of leukonychia

A

White nails due to HIV, cirrhosis or chemotherapy

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21
Q

Causes of palmar erythema

A

cirrhosis, haemochromatosis or wilsons disease

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22
Q

Define and causes of koilonychia

A

spoon nails caused by anaemia

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23
Q

Causes of pigmentation of lips

A

Peutz-jeghers syndrome

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24
Q

Causes of telangiectasia of lips

A

Hereditary haemorrhagic telangiectasia

25
Q

Causes of atrophic glottis

A

anaemia, vitamin b deficiency, infection

26
Q

Causes of lymphadenopathy

A

Lymphoma (rubbery and firm), leukaemia (CLL, ALL), malignant disease, viral (CMV, EBV, TB), connective tissue disease (SLE, RA), infiltrative disease (sarcoid, amyloid)

27
Q

DDx of renal mass

A

PCKD, RCC, hydronephrosis, acute renal vein thrombosis

28
Q

Causes of ascites

A

75% cirrhosis. 25% malignancy

29
Q

Serum ascites albumin gradient > or < 11

A

transudate >11. exudate <11.

30
Q

Symptoms of inflammatory bowel disease

A

GI bleeding, diarrhoea (mild <4, severe >6, fulminent >10), fever, abdo pain, weight loss, malabsorption. Extracolonic manifestations = uveitis, arthritis, primary sclerosing cholangitis, cirrhosis.

31
Q

Risk factors for inflammatory bowel disease

A

Smoking (increase in Crohns, decrease in ulcerative collitis), family history, age over 40, NOD2/CARDI5, deep ulcer, strictures, extensive disease, high antibody count (ASCA, pANCA), raised CRP

32
Q

Investigations for inflammatory bowel disease

A

3x stool samples. AXR to exclude tozic megacolon. Faecal calprotecrtin. Colonoscopy. FBC, Fe, LFT, CRP, electrolytes, pANCA (US), ASCA (CD).

33
Q

Management of acute flares of inflammatory bowel disease

A
  1. Steroids, 2. Anti-TNF or cyclospo, 3. Surgery
34
Q

Maintenance management of Crohns Disease

A

Azathioprine, mercaptopurine, anti TNF if fistulating. Note all increase risk of lymphoma and melanoma (risk increases further with duration, severity and if PSC)

35
Q

How often to scope those with primary sc cholangitis?

A

After 8 years post diagnosis the annually

36
Q

When to consider use of antibiotics with inflammatory bowel disease and which?.

A

If severe or peri-anal disease consider metronidazole or ciprofloxacin

37
Q

Surgical management of ulcerative collitis

A

Colectomy

38
Q

What testing is required prior to starting Azathioprine

A

Genetic testing for TMPT

39
Q

Complications for inflammatory bowel disease

A

Infection, strictures, toxic megacolon, bowel cancer

40
Q

Side effects of ciclosporin

A

Hypertension, gout, gum hyperplasia, high cholesterol

41
Q

Side effects of tacrolimus

A

Neurotoxicity, diabetes, BK/CMV, tremor

42
Q

Expected prognosis of chronic liver disease, compensated vs decompensated

A

Compensated = 12 years. Decompensated = 6 to 12 months.

43
Q

4 steps of management for chronic liver disease

A
  1. Slow disease by treating underlying causes
  2. Prevent further insults - avoid alcohol, have vaccinations, rationalise medications
  3. Manage symptoms - low salt diet and monitoring for issues with low platelets
  4. Consider transplant (MELD score = dialysis more then 2 per week, creatinine, bilirubin, INR, sodium) If MELD >10 then can comsi transplant
44
Q

Complications of chronic liver disease

A
  1. Portal hypertension, with:
    A. Ascites (SAG >11)- spironolactone, low salt, hypertension control, avoid PPI, treat infections aggressively (ceftriaxone, bactrim, ciprofloxacin), careful diuretics as risk of HRS.
    B. Cirrhotic cardiomyopathy
    C. Varicies screening - propranolol, banding, TIPS, endoscope 2 or 3 years if portal hypertension
  2. Synthetic with malnutrition, bleeding, encephalopathy (lactose, avoid sedatives, rifaxamin if chronic)
  3. Malignancy with HCC screening (6 monthly ultrasound)
45
Q

Investigations to consider for chronic liver disease

A
  1. LFT, FBC (aneamia), UEC (low Na), ascitic tap, ultrasound to exclude biliary obstruction/infiltration (also assess nodularity, change in size, heratogenity, portal vein dilatation, ascites, splenomegaly
  2. Fibroscan (stiffness)
  3. Underlying cause (hep B/C), iron, alpha 1 antrypsin, anti mitochondrial, anti LKM, anti smooth muscle, ANA, Ig subsets, caeruloplasmin, ANCA
  4. HCC surveillance
  5. Biopsy
46
Q

Risk factors for chronic liver disease

A

Hepatitis, alcohol, drug use, diabetes, heart failure, haemochromatosis, viral infection, NASH, autoimmune conditions

47
Q

Components of child pugh score

A

Albumin, bilirubin, coag (INR), ascites, encephalopathy

48
Q

Symptoms of chronic liver disease

A

Jaundice, abdo pain, GIB, encephalopathy

49
Q

Management of Hep B

A

Entacavir or Tenofavir, if ALT or viral load high, immunosuppressed or cirrhosis

50
Q

Management of Hep C

A

NS5B inhibitor (sufoslovir) + NS5A inhibitor (velpatasivir) for over 12 months; or galecaprivir with NS5A inhibitor for 8 weeks

51
Q

Risk factors of liver transplant

A
  1. Peri and post op - graft failure, rejection, bleeding, renal failure
  2. Immunosuppressant- opportunistic infections
  3. Steroid side effects
  4. Steroid or Steroid sparing agent side effects
52
Q

Liver transplant surgical work up

A

ECHO, MPS, PFT, UEC, LFT

53
Q

Indications for TIPS procedure

A
  1. Recurrent variceal bleed
  2. Refractory ascites
  3. Budd chiari/ portal vein thrombosis
  4. Hepatic veno occlusive disease
54
Q

Risk factors for irritable bowel disease

A

Chronic infections, anxiety/ depression, food intoler

55
Q

Management of irritable bowel disease

A

High fibre, FODMAP, loperamide, TCA or SSRI for pain

56
Q

Investigations for malabsorption

A
  1. FBC, B12, folate, iron, soluble vitamins, coag, albumin, ESE, CRP
  2. Coeliac testing = tissue transglutaminase (95% sensitivity), endomysial antibody (100% specific), HLA DQ2/ DG8 (99% sensitivity)
  3. Stool must- giardia, c diff
  4. Faecal elastase- pancreatic insufficiency
  5. Faecal calprotectin- IBD
  6. Colonoscopy- bacterial overgrowth
  7. Hydrogen breath test
57
Q

Post liver transplant screening

A

LFT/INR/ U/S or CT. Ciclosporin levels. On steroids then BSL and BMD. Viral screening. Prophylactic antibiotics or antivirals

58
Q

Contraindications for liver transplant

A

Sepsis, malignancy, alcohol, HIV, end organ disease

BPT (11 decks)

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