Year 3 Flashcards
Why are patients with cirrhosis more likely to bleed?
Decreased absorption of fat soluble vitamins so less clotting factor synthesis, decreased platelets from splenomegaly, gastroenteropathy, increased PTT
What are the features indicated decompensated liver disease?
Increased bilirubin, GI bleed, ascites, hepatic encephalopathy
What is an AFRI?
Ultrasound based scan of the liver used to determine the level of fibrosis
What treatments are there for oesophageal varices?
Band ligation and beta blockers
What are some ways primary biliary cholangitis (PBC) can present?
Fatigue, itching, GI disturbance, abdo pain, jaundice and pale stools, signs of cirrhosis
What is primary biliary cholangitis?
A condition where the immune system attacks small bile ducts, causing obstruction of the ducts leading to cholestasis. This causes liver damage and cirrhosis
Which is the first liver enzyme to be raised in PBC?
ALP
Which auto-antibodies are positive in PBC?
Anti-mitochondrial antibodies
Anti-nuclear antibodies (in 35% of patients)
What treatment is used for PBC?
Ursodeoxycholic acid (reduces intestinal absorption of cholesterol) and colestyramine (bile acid sequestrant)
What is an ERCP?
Where an endoscope inserted through to the bile ducts and inject contrast then X-rays used to identify any strictures
What are the two main types of primary liver cancer?
Hepatocellular carcinoma (80%) Cholangiocarcinoma (20%)
Which liver cancer is associated with primary sclerosing cholangitis?
Cholangiocarcinoma (10% of patients with this cancer had PSC)
What is the main risk factor for hepatocellular carcinoma?
Liver cirrhosis
Why is chemotherapy and radiotherapy not used in treatment of HCC?
HCC is generally considered resistant to chemotherapy and radiotherapy
What are the non-specific symptoms associated with liver cancer?
Weight loss, jaundice, abdominal pain, anorexia, nausea and vomiting, pruritus
What is a Mallory-Weiss tear?
A tear in the lower oesophagus likely caused by violent coughing or vomiting
What can be another cause of black stool other than malaena?
Iron supplements
Does high levels of urea support or contradict a diagnosis of an upper GI bleed?
High levels of urea supports a upper GI bleed
What are common causes of upper GI bleeds?
Ruptured peptic ulcer, varices, M-W tear, oesophagitis, aorta-duodenal fistula, cancer
What are some causes of lower GI bleeding?
Diverticula disease, colitis, anal fissures, IBD, colon cancer, anorectal fissures
If a patient presents like they have a GI bleed but have a high lactate level what could be the diagnosis?
Bowel ischaemia
How would you manage someone with oesophageal variceal bleeding?
Give terlipressin, prophylactic antibiotic therapy, use band ligation, consider TIPS if band ligation not working
How would you manage a patient with gastric variceal bleeding?
Endoscopic injection of N-butyl-2-cyanoacrylate or TIPS if the injection doesn’t control bleeding
What are two major complications of variceal bleeding?
Sepsis, aspiration
