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GI > Liver bits > Flashcards

Liver bits Flashcards

1
Q

What is jaundice?

A

Yellow discolouration of skin and sclera due to bilirubin accumulation
Seen >34-68 micmol/L

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2
Q

Pre-hepatic jaundice symptoms?

A

Unconjugated bilirubin
Normal stool
Normal urine

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3
Q

Causes of pre-hepatic jaundice?

A 
Gilbert's syndrome
Crigler-Najjar syndrome
Haemolysis
Malaria
Drug induced
Haemolytic uraemic syndrome
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4
Q

What is Gilbert’s syndrome?

A

Defect in promotor sequence for enzyme UGT which conjugates bilirubin - reduced level of enzyme results in an increase in unconjugated bilirubin

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5
Q

What is Crigler-Najjar syndrome?

A

Defect in UGT protein resulting in either a inactive protein (type 1) or a less efficient protein (type 2)

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6
Q

Examples of hereditary haemolytic anaemias?

A 
Sickle cell
Thalassemia
Spherocytosis
G6PD deficiency
Pyruvate kinase deficiency
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7
Q

Autoimmune causes of haemolytic anaemia?

A

SLE
Rheumatoid arthritis
Scleroderma
Non-Hodgkin’s lymphoma Chronic lymphocytic leukaemia

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8
Q

Causes of acquired anaemia?

A 
Blood transfusion
Cytomegalovirus
Mononucleosis
Toxoplasmosis
Leishmaniasis
DIC
TTP
HUS
Drug mediated
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9
Q

What is paroxysmal nocturnal haemoglobinuria?

A

Rare, acquired, potentially life-threatening

Characterised by an acquired membrane defect and complement-induced intravascular haemolytic anaemia

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10
Q

What is foot strike haemolysis?

A

Haemolysis in the heel of runners due to impact when running

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11
Q

What is Wilson’s disease?

A

Autosomal recessive

Excessive copper deposition in hepatocytes and brain cells

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12
Q

Hall mark of Wilson’s disease?

A

Kayser-Fleischer rings

Low serum caeruloplasmin

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13
Q

What is pseudo-jaundice?

A

Yellow pigmentation of the skin due to increased beta-carotene levels in the blood

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14
Q

Drugs that cause haemolysis?

A 
Cephalosporins
Levodopa
Levofloxacin
Nitrofurantoin
NSAIDs
Phenazopyridine
Quinidine
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15
Q

Intrahepatic causes of jaundice?

A 
Viral hepatitis
Alcoholic hepatitis
Autoimmune hepatitis
Drug induced hepatitis
Decompensated cirrhosis
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16
Q

Causes of infectious hepatitis?

A 
Hep A-E
Leptospirosis
Brucellosis
Coxiella burnetii
Glandular fever
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17
Q

Causes of drug induced hepatitis?

A 
Antibiotics
Phenytoin
Carbamazepine
Lamotrigine
NSAIDs
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18
Q

What is kernicterus?

A

Affects infants
A complication of excess bilirubin
Affects basal ganglia, hippocampus, geniculate bodies, cranial nerve nuclei and cerebellum

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19
Q

How does acute bilirubin toxicity present?

A

Hypotonia followed by hypertonia

Opisthotonus - hyperextension of spine

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20
Q

What is acute liver failure?

A

rapid decline in hepatic function characterised by jaundice, coagulopathy and hepatic encephalopathy

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21
Q

Complications of acute liver failure?

A 
Infection
Renal failure
Hypoglycaemia
Acidosis
Shock
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22
Q

Causes of acute liver failure?

A 
Paracetamol toxicity
Idiosyncratic drug-induced liver injury
Acute hep A or hep B
Autoimmune hepatitis
Shock liver
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23
Q

How much paracetamol for toxicity?

A

250mg/kg

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24
Q

Pathophys of paracetamol toxicity?

A

Metabolism produces NAPQI, in overdose glutathione stores become depleted which inactivates NAPQI
NAPQI causes necrosis of liver and kidney tubules

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25
Q

Management of paracetamol toxicity?

A

Acetylcysteine - within 8 hours
Supportive care
Activating charcoal
Onsansetron

26
Q

How does acetylcysteine work?

A

Increased level of glutathione

Give within 8 hours for maximal effect but can give for up to 24 hours

27
Q

Autoimmune hepatitis?

A 
Antinuclear antibody
Anti-smooth muscle antibody
Anti-mitochondrial antibody (PBC)
Anti-phospholipid antibody
Anti-liver-kidney microsomal-1
28
Q

Presentation of liver problems?

A 
Fatigue, myalgia
Nausea
Jaundice
Weight loss
Oedema
Hepatomegaly
Ascites
Spiderangiomata
Encephalopathy
29
Q

Hep A?

A

Acute infection
Most common
Faecal-oral route

30
Q

Hep B?

A

Acute + chronic infection

Blood/body fluid transmission

31
Q

What testing for HepB resistance?

A

HBsAg

32
Q

Hep C?

A

Chronic infection
Blood transmission
Some vertical + sexual transmission

33
Q

Hep D?

A

Defective virus
Requires presence of hep B
Co-infection
Most commonly acute

34
Q

Hep E?

A

Prevalent in developing world
Enteral transmission
Acute infection

35
Q

Other infectious causes of hepatitis?

A 
Cytomegalovirus
Epstein-Barr
Herpes simplex virus
HIV
TB
Sepsis
36
Q

What is acute on chronic liver failure?

A

Acute decompensation of chronic liver disease
Organ failures
High short-term mortality
Triggered by infection or sepsis

37
Q

Grade I hepatic encephalopathy?

A

Sleep reversal
Confusion
Shortened attention span
Impaired computations

38
Q

Grade II hepatic encephalopathy?

A

Lethargy
Poor memory
Personality change
Asterixis

39
Q

Grade III hepatic encephalopathy?

A 
Somnolence 
Confusion
Disorientation
Hyper-reflexia
Nystagmus
Clonus
Rigidity
40
Q

Grade IV hepatic encephalopathy?

A

Stupor

Coma

41
Q

Risk factors for hepatic encephalopathy?

A 
Chronic alcohol abuse
Female
>40
Poor nutritional status
Chronic hepatitis B
Narcotic use
42
Q

What is fulminant hepatic failure?

A

Severe hepatic failure in which encephalopathy develops in under two weeks in a patient with a previously normal liver

43
Q

Management of acute liver failure?

A

Correct electrolyte imbalance
Avoid sudden head movements
Ventilation techniques
Treat any infection

44
Q

List features of chronic liver disease?

A 
Spider angioma
Jaundice
Palmar erythema
Gynecomastia
Ascites
Encephalopathy
Asterixis
Clubbing
Atrophic testes
Loss of body hair
Amenorrhoea
Portal hypertension
45
Q

What is portal hypertension?

A 
Hepatic-renal pressure gradient resulting in formation of collateral distended vessels
Oesophageal varices
Anorectal varices
Splenomegaly
Ascites
Caput madusae
46
Q

Stages leading to cirrhosis

A

Normal liver —> hepatic steatosis —> steatohepatitis —> cirrhosis

47
Q

Causes of non-alcoholic fatty liver disease?

A

Obesity
Abnormal glucose tolerance
Dyslipidema

48
Q

Risk factors for fatty liver disease?

A 
Alcohol excess
Metabolic syndrome
Polycystic ovary syndrome
Rapid weight loss
Refeeeding syndrome
Hep B, C, HIV
Medication
Lipid and glucose disorders
49
Q

Investigations for chronic liver disease?

A 
LFTs
FBC
Lipid profile
Viral studies
Autoimmune studies 
Liver biopsy 
Ultrasound
CT scan
50
Q

Cirrhosis presentation?

A 
Fatigue
Anorexia
Nausea
Weight loss
Oedema
Ascites
Easy bruising
Poor concentration and memory
Bleeding varices
Spontaneous bacterial peritonitis
51
Q

What does child Pugh classification measure?

A

Severity of cirrhosis

52
Q

What factors are measured?

A 
Bilirubin
Serum albumin
International normalised ratio
Ascites
Hepatic encephalopathy
53
Q

Causes of ascites?

A 
Cirrhosis
Malignancy
Heart failure
Nephrotic syndrome
TB
Pancreatitis
54
Q

What malignancies can cause ascites?

A 
Colorectal
Pancreatic
Gastric
Primary hepatocellular
Mets in liver
Ovarian
Lymphoma
55
Q

What is Megs’ syndrome

A

Rare complication of ovarian cancer that produces ascites

56
Q

Symptoms of ascites?

A 
Abdominal distension
Weight gain
Discomfort
Nausea
Appetite suppression
Increasing dyspnoea
57
Q

Management of mild/moderate ascites?

A

Low sodium diet
Spironolactone
Furosemide

58
Q

Management of grade 3 ascites?

A 
Paracentesis
<5L synthetic plasma expanders 
>5L albumin
Low sodium diet
Diuretic therapy
59
Q

Chronic ascites management?

A

Transjugular intrahepatic portosystemic shunt

60
Q

Complications of ascites?

A

Hyponatremia
Spontaneous bacterial peritonitis
Hepatorenal syndrome

61
Q

What is spontaneous bacterial peritonitis?

A 
Infection of the peritoneum caused by E Coli, streptococci, enterococci
20% mortality rate
Fever
Mild abdominal pain
Vomiting
Confusion
62
Q

What is hepatorenal syndrome?

A 
Cirrhosis with ascites
Creatinine >1.5mg/dL
No shock or hypovolemia
No nephrotoxic drugs
Absence of parenchymal renal disease

GI (9 decks)

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