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Year 3 - Medicine > Week 10 - Hepatobiliary and Pancreatic Disease > Flashcards

Week 10 - Hepatobiliary and Pancreatic Disease Flashcards

1
Q

How can you differentiate acute v chronic liver disease?

A
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2
Q

What are the acute causes of liver disease?

A

Drugs (paracetamol, herbal, penicillins, thiopurines)
Alcohol
Viruses (Hep A, B & E, CMV, Covid, EBV)
Vascular (hepatic vein thrombosis)
Ischaemic liver disease
Wilsons’s disease

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3
Q

What are the chronic causes of liver disease?

A

Alcohol
Fatty liver disease
AI disease - (AI hepatitis, Primary biliary cirrhosis)
PSC
Viruses - Hep B&C
Congenital - Haemochromatosis, Wilsons, A1AT deficiency

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4
Q

If the liver is damages - what synthetic functions are limited causing Sx?

A

Failure to clear bilirubin -> Jaundice

Failure to produce clotting factors (2,7, 9 & 10) -> coagulopathy & raised INR

Failure to produce protein -> hypoalbuminaemia

Failure to get rid of toxins -> encephalopathy

Ascites

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5
Q

Which viruses that cause hepatitis tend to be self limiting?

A

Hep A, B & E,
CMV
EBV
Covid

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6
Q

Which viruses that cause hepatitis need treatment?

A

B, C & E

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7
Q

In viral hepatitis - what level will ALT usually be?

A

Usually >1000

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8
Q

Which is the only DNA hepatitis virus?

A

Hep B

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9
Q

What is the transmission of Hep E?

A

4 types (1-4)

3 & 4 = zoonotic
Rest = faecal-oral or blood

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10
Q

Which hepatitis is the most common cause of liver failure in pregnancy?

A

Hep E

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11
Q

How can Ps with Hep E present?

A

Mostly asymptomatic
S&S = jaundice, fever, myalgia, vomiting and abdo pain

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12
Q

Which serology can screen for Hep E infection?

A

anti-HEV IgM

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13
Q

What is the trouble of catching Hep E in the immunosuppressed?

A

Can cause chronic hepatitis (cirrhosis does not occur)

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14
Q

What is the most common method of transmission of Hep B?

A

Mother to baby

Also - sex, IVDU

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15
Q

What are the consequences of Hep B infection if untreated?

A

Can cause cirrhosis and hepatocellular cancer

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16
Q

What is the definition of chronic Hep B infection?

A

Hep B +ve for > 6 months

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17
Q

What are the 4 states of hepatitis B infection?

A

Born - and contract Hep B during delivery - have the virus until 25-30 - high viral load but liver doesn’t care = immunotolerant phase. Really high viral load but liver handles it ok.

Liver decides it doesn’t like it and tries to get rid of it - attacks the E antigen which makes it from positive to negative - viral load drops, liver function tests get raised and then normalise = inactive state - low viral load and normal LFTs. Around 30.

Cycle of viral load starts creeping up - liver gets angry - LFTs go up, viral load goes down again - cycle of inflammation and calming causes liver scarring - 10-30 years - develops into cirrhosis. 4 phases.

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18
Q

What are the S&S of acute Hep B infection?

A

Mostly asymptomatic
Many get jaundice and fever
Acute liver failure rare

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19
Q

How can you identify Hep B infection from serology?

A

ALT >1000 in acute
In chronic - ALT may be normal or slightly elevated

Can also look for
Hep B sAg (surface antigen) and sAb (surface antibody)
Hep B eAg (envelope antigen)
Hep B cAb (core AB)

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20
Q

When should you Rx Ps with drugs with Hep B?

A

When they are fibrotic, or HBV DNA >2000 or they have elevated ALT on more than 2 occasion

OR

In 3rd trimester to prevent transmission

OR If immunosuppressed

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21
Q

What does Hep D to a Hep B infection?

A

Makes it more aggressive and increases the risk of liver failure

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21
Q

How is Hep C transmitted?

A

Blood, sex or IVDU.
Vertical transmission low.

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22
Q

How can you confirm active Hep C infection?

A

Presence of Hep C IgC

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23
Q

Without Rx, what is the prognosis of a Hep C infection?

A

30% will progress to cirrhosis in 10-20 years, another 20% over 20-30 years and a further 30% over 30 years. So 90% will develop cirrhosis within 30 years

23
Q

How can you test for EBV?

A

Positive monospot test

24
Q

What is the Rx for CMV?

A

Ganciclovir if severe

25
Q

What is the Rx for HSV 1 & 2?

A

Aciclovir

26
Q

Which drugs can cause hepatitis?

A
27
Q

Which drugs can cause cholestasis?

A
28
Q

Which drugs can cause mixed hepatitis and cholestasis?

A
29
Q

How does alcoholic hepatitis present histologically?

A

Steatohepatitis
Mallory denk bodies
Ballooning degeneration of hepatocytes
Neutrophillic inflammation

30
Q

What is the Rx for alcoholic hepatitis?

A

Steriods
Nutrition
Abstinence

31
Q

What does histology showing lymphoplasmacytic interface hepatitis with rosettes of hepatocytes indicate?

A

AI Hepatitis

32
Q

Which ABs are liked to AI hepatitis?

A

Smooth muscle AB - anti-SMA

Liver kidney microsomal - anti-LKM1

Also - AMA and immunoglobulins which indicate PBC and AI hepatitis

33
Q

What is Rx for AI hepatitis?

A

Steriods
Azathioprine

34
Q

How will Ps with hyperacute, acute and subacute liver failure present?

A

Depends on time from jaundice to hepatic encephalopathy.

Hyperacute = happens less than 1w
Severe coagulopathy (+++), not so much jaundice (+) and raised intracranial HTN
- Paracetamol, Hep A &E

Acute = happens within 1 month (1-4w), less severe coagulopathy (++), more jaundice (++) and same levels of raised intracranial HTN
- Hep B

Subacute - happens over up to 3m (4w-12w), much less severe coagulopathy (+), but severe jaundice (+++), and may or may not have raised intracranial HTN
- Hep D

35
Q

What causes ascites?

A

Leakage of fluid from portal vessels into the peritoneal cavity.

36
Q

Which criteria is used to differentiate between transudate and exudate?

What is used to determine this?

A

Light’s criteria

Uses protein and LDH levels in fluid and blood

37
Q

What type of fluid is found in ascites?

A

Transudate

38
Q

Ascitic fluid can also be found where?

A

It can cross the diaphragm -> pleural effusions

39
Q

What are the clinical signs of decompensated cirrhosis?

A

Ascites
Encephalopathy
Jaundice
GI Bleeding
Renal failure

40
Q

What is the mean survival for 2 years after decompensated cirrhosis?

A

2 years

41
Q

What can cause decompensated cirrhosis?

A

Infection - SBP
Hepatocellular carcinoma
Electrolyte abnormalities
GI bleeding
Natural progression of liver disease - e.g. cont drinking

42
Q

What do raised ferritin and transferritin saturations indicate?

A

High iron levels - Hereditary haemochromatosis

43
Q

What do raised caeruloplasmin and copper indicate?

A

Wilson’s disease

44
Q

What does low levels of α 1 antitrypsin possibly indicate?

A

α 1 antitrypsin deficiency

45
Q

What protein do we test for to exclude hepatocellular carcinoma?

A

AFP - alphafetoprotein

Typically most high in HCC - can get very elevated levels.
Can get less high increases with liver disease, pregnancy, pancreatic or GI cancers.

46
Q

How can you determine whether a disease is causing hepatitis or cholestasis using serology?

A

Look at the ALP and ALT

Disease that causes hepatitis - typically raises ALT
Cholestasis - typically raises ALP

Look at R value

R value = ALT / ULN : ALP / ULN

If >5 = hepatocellular
If <2 = cholestatic
If 2-5 = mixed cause

47
Q

What is transaminitis?

A

Raised ALT levels

48
Q

What percentage of Ps are antibody negative but still have AI hepatitis?

A

20%

49
Q

How is acute liver failure defined?

A

Acute liver injury
- so no underlying chronic liver disease
- Damage - ALT 2-3x ULN
- Impaired function -> jaundice or coagulopathy

and
Hepatic Encephalopathy

50
Q

What normally causes
- Hyperacute liver failure
- Acute liver failure
- Subacute liver failure?

A

Hyperactive = Paracetamol, Hep A & E

Acute = Hep B

Subacute = Hep D

51
Q

What does SBP stand for?

A

Spontaneous bacterial peritonitis

52
Q

Which score is used to assess the progress of chronic liver disease?

A

Child Pugh Score

53
Q

What are the endocrine and exocrine functions of the pancreas?

A

Endocrine = produce insulin and glucagon

Exocrine = produce faecal elastase

54
Q

What are the causes of acute pancreatitis?

A
55
Q

Which drugs can cause acute pancreatitis?

A

Azathioprine
Mesalazines
Thiazide diuretics

56
Q

What can necrotising pancreatitis form?

A

Pseudocysts

A pseudocyst is a fluid-filled sac that forms in the abdomen, typically following an episode of acute pancreatitis or as a complication of chronic pancreatitis. Unlike true cysts, pseudocysts do not have an epithelial lining; instead, they are surrounded by a fibrous or granulation tissue.

57
Q

Why does CF cause pancreatitis?

A

Ducts get block due to thicker fluid in the pancreas (due to Cl channel impairment due to CFTR gene problems).

-> Inflammation = pancreatitis

-> Fibrosis and atrophy

Can cause failure to thrive, steatorrhoea

Year 3 - Medicine (15 decks)

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