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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
Causes of atrophic glottis
anaemia, vitamin b deficiency, infection
26
Causes of lymphadenopathy
Lymphoma (rubbery and firm), leukaemia (CLL, ALL), malignant disease, viral (CMV, EBV, TB), connective tissue disease (SLE, RA), infiltrative disease (sarcoid, amyloid)
27
DDx of renal mass
PCKD, RCC, hydronephrosis, acute renal vein thrombosis
28
Causes of ascites
75% cirrhosis. 25% malignancy
29
Serum ascites albumin gradient > or < 11
transudate >11. exudate <11.
30
Symptoms of inflammatory bowel disease
GI bleeding, diarrhoea (mild <4, severe >6, fulminent >10), fever, abdo pain, weight loss, malabsorption. Extracolonic manifestations = uveitis, arthritis, primary sclerosing cholangitis, cirrhosis.
31
Risk factors for inflammatory bowel disease
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
Investigations for inflammatory bowel disease
3x stool samples. AXR to exclude tozic megacolon. Faecal calprotecrtin. Colonoscopy. FBC, Fe, LFT, CRP, electrolytes, pANCA (US), ASCA (CD).
33
Management of acute flares of inflammatory bowel disease
1. Steroids, 2. Anti-TNF or cyclospo, 3. Surgery
34
Maintenance management of Crohns Disease
Azathioprine, mercaptopurine, anti TNF if fistulating. Note all increase risk of lymphoma and melanoma (risk increases further with duration, severity and if PSC)
35
How often to scope those with primary sc cholangitis?
After 8 years post diagnosis the  annually
36
When to consider use of antibiotics with inflammatory bowel disease and which?.
If severe or peri-anal disease consider metronidazole or ciprofloxacin
37
Surgical management of ulcerative collitis
Colectomy
38
What testing is required prior to starting Azathioprine
Genetic testing for TMPT
39
Complications for inflammatory bowel disease
Infection, strictures, toxic megacolon, bowel cancer
40
Side effects of ciclosporin
Hypertension, gout, gum hyperplasia, high cholesterol
41
Side effects of tacrolimus
Neurotoxicity, diabetes, BK/CMV, tremor
42
Expected prognosis of chronic liver disease, compensated vs decompensated
Compensated = 12 years. Decompensated = 6 to 12 months.
43
4 steps of management for chronic liver disease
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
Complications of chronic liver disease
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
Investigations to consider for chronic liver disease
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
Risk factors for chronic liver disease
Hepatitis, alcohol, drug use, diabetes, heart failure, haemochromatosis, viral infection, NASH, autoimmune conditions
47
Components of child pugh score
Albumin, bilirubin, coag (INR), ascites, encephalopathy
48
Symptoms of chronic liver disease
Jaundice, abdo pain, GIB, encephalopathy
49
Management of Hep B
Entacavir or Tenofavir, if ALT or viral load high, immunosuppressed or cirrhosis
50
Management of Hep C
NS5B inhibitor (sufoslovir) + NS5A inhibitor (velpatasivir) for over 12 months; or galecaprivir with NS5A inhibitor for 8 weeks
51
Risk factors of liver transplant
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
Liver transplant surgical work up
ECHO, MPS, PFT, UEC, LFT
53
Indications for TIPS procedure
1. Recurrent variceal bleed 2. Refractory ascites 3. Budd chiari/ portal vein thrombosis 4. Hepatic veno occlusive disease
54
Risk factors for irritable bowel disease
Chronic infections, anxiety/ depression, food intoler
55
Management of irritable bowel disease
High fibre, FODMAP, loperamide, TCA or SSRI for pain
56
Investigations for malabsorption
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
Post liver transplant screening
LFT/INR/ U/S or CT. Ciclosporin levels. On steroids then BSL and BMD. Viral screening. Prophylactic antibiotics or antivirals
58
Contraindications for liver transplant
Sepsis, malignancy, alcohol, HIV, end organ disease

BPT (11 decks)

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