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Gastroentrology > 2: Chronic Liver Disease, Focal Liver Lesions, Pancreatic Cancer > Flashcards

2: Chronic Liver Disease, Focal Liver Lesions, Pancreatic Cancer Flashcards

(90 cards)

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1
Q

What is alcoholic liver disease

A

chronic liver disease caused by excess consumption of alcohol

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2
Q

What are the three stages of alcoholic liver disease

A
  1. Alcoholic fatty liver disease
  2. Alcoholic hepatitis
  3. Alcohol-related cirrhosis
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3
Q

What is stage 1 of alcohol liver disease

A

Alcoholic fatty liver disease

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4
Q

Is stage 1 of alcoholic liver disease reversible

A

Yes

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5
Q

what is the most common cause of cirrhosis

A

Hepatitis C

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6
Q

what is the second most common cause of cirrhosis

A

Alcohol Consumption

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7
Q

how does stage 1 alcoholic liver disease present clinically

A

Asymptomatic - Some patients complain of abnormal sensation in upper arm

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8
Q

is stage 1 alcoholic liver disease reversible

A

Yes

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9
Q

how does stage 2 alcoholic liver disease present

A
  • Jaundice
  • Hepatomegaly

Non-specific Sx:

  • Anorexia
  • Weight loss
  • Lethargy
  • Fever
  • Loss of appetite
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10
Q

is stage 2 alcoholic liver disease reversible

A

In mild forms

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11
Q

is stage 3 alcoholic liver disease reversible

A

No

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12
Q

Explain the pathophysiology of alcoholic liver disease

A

AcetylcoA is degraded by alcohol dehydrogenase to produce NADH and G3P.

These encourage triglyceride synthesis in the liver to cause steatohepatitis

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13
Q

What blood-tests are ordered in alcoholic liver disease

A

FBC

LFTs

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14
Q

What will be seen on LFTs in alcoholic liver disease

A
  • Raised AST and ALT

- Raised GGT

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15
Q

Describe AST: ALT ratio in alcoholic liver disease

A

AST: ALT >2

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16
Q

What may be seen on FBC in alcoholic liver disease and why

A

macrocytic anaemia - due to B12 deficiency

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17
Q

What are three possible specialised investigations for alcoholic liver disease

A
  • US
  • Fibroscan
  • Biopsy
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18
Q

When are fibroscans for alcoholic liver disease indicated

A

Male >50Units p/w
Female >50 Units p/w
Diagnosis alcoholic liver disease

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19
Q

when is a liver-biopsy indicated

A

Alcoholic hepatitis severe enough to require prednisolone

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20
Q

what is first-line management of alcoholic liver disease

A

Prednisolone

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21
Q

what is the benefit of prednisolone for alcoholic liver disease

A

Improves short-term (1m) survival

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22
Q

what is the only ultimate treatment for alcoholic liver disease

A

Liver transplant

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23
Q

What does Maddrey’s discriminant function predict

A

Poor prognosis in patients with alcoholic liver disease and who may need prednisolone

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24
Q

What does Lille’s score discriminant function predict

A

Mortality of individuals with alcoholic liver disease not responding to prednisolone

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25
What are two complications of alcoholic liver disease
- Oesophageal varices | - Decompensated cirrhosis
26
What are the four stages of NAFLD
1. Steatosis 2. Steatohepatitis 3. Fibrosis 4. Cirrhosis
27
What is the commonest liver disease in western civilisations
NAFLD
28
What are 4 risk factors for NAFLD
1. Metabolic syndrome 2. T2DM 3. Jejunoileal bypass 4. Sudden weight loss
29
What is metabolic syndrome
Individual needs three of the following 1. HTN 2. Obesity 3. DM 4. Hyperlipidaemia 5. Hypertriglyceridaemia
30
How does NAFLD present initially
Asymptomatic | Fatigue and Malaise
31
How does NAFLD present later on
Hepatomegaly RUQ Pain Jaundice Ascites
32
Explain pathophysiology of NAFLD
Insulin resistance causes liver to enter mode where it stores fat and decreases fatty acid oxidation. This means decrease metabolism of FAs but increased uptake
33
What is it important to exclude as a differential of NAFLD
Alcoholic liver disease
34
What two blood tests are important in NAFLD
LFTs Enhanced Liver Fibrosis (ELF) blood test
35
How will LFTs present in NAFLD
Raised ALT
36
Will ALT or AST be raised more in NAFLD
ALT
37
Explain difference in LFTs between NAFLD and Alcoholic Liver Disease
Alcoholic liver disease. AST is raised more than ALT. Where, AST: ALT ratio >2 NAFLD: ALT is raised more than AST.
38
When is enhanced liver fibrosis (ELF) blood test recommended
If findings of fatty-liver are found incidentally on US
39
What scan is used in NAFLD
Fibroscan (Transient elastography)
40
What scoring system is used for NAFLD
Fibrosis-4 (FIB4)
41
What is first-line management of NAFLD
Lifestyle advice
42
If lifestyle advice is ineffective what may NAFLD be offered
Pioglitazone and vitamin E
43
What is a simple-liver cyst
Epithelial-lined fluid-filled sac in the liver
44
What is thought to cause simple liver cysts
Congenital malformation of bile ducts - with failure to fuse with extra-hepatic ducts
45
How do simple liver cysts present clinically
Asymptomatic
46
Which lobe of the liver are simple cysts more common
Right
47
What is the most important investigation for simple liver cysts
Hepatic USS
48
How are simple liver cysts managed
If more than 4cm they are followed up by US scan. If symptomatic needle-guided aspiration
49
Define polycystic liver disease
Presence of >20 cysts, with each one being at least >1cm
50
What are the two causes of polycystic liver disease
- Autosomal Dominant Polycystic Kidney Disease | - AD polycystic liver disease
51
What is the most common extra-renal manifestation of ADPKD
Polycystic liver disease (10-60% ADPKD patients)
52
How will polycystic liver disease present
Asymptomatic If symptomatic due to compression of structures causing hepatomegaly and RUQ pain Severe disease may present with portal HTN
53
what should be ordered if polycystic liver disease
LFT U+E USS
54
if asymptomatic, how is polycystic liver disease managed
Surveillance
55
if symptomatic, how is polycystic liver disease managed
US-guided needle aspiration of cysts or laparoscopic de-roofing of cysts
56
What does the term pancreatic cancer refer to
Ductal carcinoma of the pancreas
57
What type of cancer are 90% of pancreatic carcinomas
Ductal carcinoma of the pancreas
58
In which age-group are pancreatic carcinomas more prevalent
60-80 years
59
In which ethnicity are pancreatic carcinomas more common
African Americans
60
What are 8 RF for pancreatic carcinoma
- Age - Smoking - DM - Alcohol - Chronic Pancreatitis - HNPCC - BRCA2 - MEN
61
What is the main issue with ductal carcinoma of the pancreas at presentation
90% are unresectable at presentation due to being diffusely spread
62
What are 5 symptoms of pancreatic cancer
- Jaundice - Weight Loss - Steatorrhoea - Abdominal pain radiating to the back - Diabetes mellitus
63
Why does obstructive jaundice occur in pancreatic cancer
Due to cancer occluding the bile duct
64
Explain Courvoisier's law
If an individual is jaundiced and the gallbladder is palpable it is due to pancreatic carcinoma
65
Why does abdominal pain radiating to the back occur in pancreatitis
Due to invasion of the coeliac plexus or secondary pancreatitis
66
Why does steatorrhoea occur in pancreatic cancer
Exocrine dysfunction of the pancreas
67
Why may individuals present with diabetes mellitus in pancreatic cancer
Endocrine dysfunction of the pancreas
68
What is the most common type of pancreatic cancer
ductal adenocarcinoma
69
Where do the majority of ductal adenocarcinomas occur
head of the pancreas (75)
70
As the cancer spreads, where may it directly invade to
Direct invasion: - Spleen - Transverse colon - Adrenal glands
71
Where may pancreatic adenocarcinoma metastasise to
- Lymph nodes - Liver - Lungs - Peritoneum
72
How will FBC present in pancreatic cancer
- Anaemia | - Thrombocytopenia
73
How will LFTs present in pancreatic cancer
- Raised bilirubin | Obstructive picture: raised ALP, raised GGT
74
What tumour marker is used for pancreatic cancer
CA19-9
75
When should CA19-9 be used
Used to monitor response to treatment, opposed to for diagnosis
76
What three blood tests are ordered for pancreatic cancer
FBC LFT CA19-9
77
What are three imaging methods that may be used for pancreatic cancer
AUS CT CAP Endoscopic US
78
What does AUS show
Dilated biliary tree
79
What is CT CAP used for
Staging
80
What is endoscopic US used for
FNA to histologically evaluate the lesion
81
What is first-line management for pancreatic cancer
Whipple's procedure
82
What is Whipple's procedure also referred to as
Pancreatoduodenectomy
83
What type of pancreatic adenocarcinomas is Whipple's procedure indicated for
Head of the pancreas tumours
84
What are three contraindications for Whipple's procedure
Metastases
85
Explain Whipple's procedure
Head of the pancreas, Gall bladder, first and second part of the duodenum, antrum of the stomach and common bile duct are removed. The tail of the pancreas is then attached directly to the jejunum. The common bile duct is also attached directly to the jejunum. The stomach is anastomosed to the jejunum.
86
What blood supply do all organs removed in whipple's share
Gastro-duodenal artery
87
What is offered as an adjuvant to Whipple's procedure
Chemotherapy
88
How are the majority of patients with pancreatic cancer managed
Palliation
89
Explain palliative treatment of pancreatic cancer
- ERCP and stenting - Creon used as enzyme supplement - Gemcitabine - for palliative chemo
90
What is the 5-year survival of pancreatic cancer
< 5%

Gastroentrology (18 decks)

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