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Year 3 > Case 3 - Liver, Biliary And Pancreatic Disease > Flashcards

Case 3 - Liver, Biliary And Pancreatic Disease Flashcards

1
Q

Describe the fate of bilirubin in the human body

A

Broken down RBCs release bilirubin
Bilirubin becomes conjugated in the liver
Conjugated bilirubin is secreted in bile into the intestine
Bacteria in the intestine deconjugate bilirubin and convert it into urobilinogen (reabsorbed and secreted in urine) or stercobilin (excreted in feces)

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2
Q

What is conjugated hyperbilirubinaemia?

A

Increase levels of conjugated bilirubin in the body due to a reduced secreted of conjugated bilirubin into the bile.

Classically gives a picture of dark urine and pale stools

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3
Q

What is kernicterus?

How is it treated?

A

Brain damage that can happen in newborns with jaundice. It happens due to a build up of unconjugated bilirubin in the brain which can be toxic and lead to encephalopathy

Treated with phototherapy or exchange transfusion

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4
Q

How can you use LFTS to tell the difference between intrahepatic jaundice or obstructive jaundice?

A

Intrahepatic Jaundie - Raised ALT/AST and ALP

Obstructive jaundice - Rise in ALT/AST but significant rise in ALP

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5
Q

What are delirium tremens?

A

An acute confusional state which results when someone who drinks excessively suddenly stops drinking - can lead to seizures and death

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6
Q

How do you treat delirium tremens?

A

Give a benzodiazepines

Lorazepam
Or
Chlordiazepoxide 10-30mg 4 times a day

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7
Q

How can the appearance of stool and urine help differentiate between the difference types of jaundice?

A

Pre hepatic jaundice - normal stool and urine colour
Intrahepatic jaundice - normal stool colour, dark urine
Post hepatic jaundice - pale stool, dark urine (also itchy skin)

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8
Q

In what type of jaundice would you see pruritus (itching of the skin)?

A

Obstructive jaundice (post hepatic jaundice)

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9
Q

What is Gilbert’s Syndrome?

A

A genetic disorder that cause the liver to have problems removing bilirubin from the blood

So you have slightly higher than normal levels of bilirubin in the blood, causing episodes of jaundice.

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10
Q

What is Mirizzi Syndrome?

A

Where a gallstone impacted at the gallbladder neck/hartmann’s pouch/cystic duct, causing inflammation resulting in obstruction or erosion of the common bile duct

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11
Q

What is Crigler-Najjar syndrome?

A

Jaundice apparent at birth or infancy which can lead to kernicterus

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12
Q

Why are patients with Crohns disease more likely to develop gall stones?

A

Bile salts are absorbed in the terminal ileum. When this process is impaired as it is in crohns then the patient may develop gall stones

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13
Q

What liver disease can pruritus indicate in the third trimester of pregnancy?

A

Intrahepatic choleastasis of pregnancy

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14
Q

When is the peak incidence of symptoms, seizures and delirium tremens following alcohol withdrawal?

A

Symptoms e.g, tremor, sweating, tachycardia, anxiety- 6-12 hours
Seizures - 36 hours
Delirium tremens - 48-72 hours

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15
Q

What is the screening test for harmful alcohol drinking and dependance?

A

AUDIT
AUDIT-C
FAST

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16
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol excess

17
Q

What are the typical symptoms of chronic pancreatitis?

A

Abdominal pain - typically worse following meals
Steatorrhoea - described as floating/smelly feaces
Diabetes mellitus

18
Q

What drugs can cause acute pancreatitis?

A

Azathioprine, mesalazine, diadanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

19
Q

What does the H stand for in the acronym IGETSMASHED?

A

Hyperriglyceridaemia, hyperchylomicronaemia, hypercalcaemia, hypothermia

20
Q

What is the modified Glasgow Score?

A 
A score to help predict the severity of pancreatitis. Use the acronym PANCREAS to help remember:
P - Pa02 (<8kPa)
A - Age (>55 years)
N - Neutrophillia (WBC >15X10^9)
C - Calcium (<2mmol/L)
R - Renal function (urea >16mmol/L)
E - Enzymes (LDH >600 ; AST >200)
A - Albumin (<32g/L)
S - Sugar (Blood glucose >10mmol/L)

A score of 3 or more indicates severe pancreatitis

21
Q

Which is the best imaging investigation to diagnose chronic pancreatitis?

A

CT pancreas with intravenous contrast

22
Q

Which is the most sensitive blood test for the diagnosis of acute pancreatitis?

A

Lipase

Amylase may with both false positive and negative results

23
Q

Which hepatitis virus has a high mortality rate in pregnant women?

A

Hepatitis E

24
Q

Which hepatitis viruses increase the risk of hepatocellular cancer?

A

Hepatitis B and C

25
Q

Which hepatitis virus can cause chronic hepatitis?

A

Hepatitis B and C

26
Q

Which hepatitis virus can cause polyartertis nodosa (inflammation of blood vessels)?

A

Hepatitis B

27
Q

Which hepatitis viruses can cause cryoglobulinemia?

A

Hepatitis B and C

28
Q

What are the common signs and symptoms seen in liver cirrhosis?

A 
Spider naevi 
Palmar Erythema 
Hepatomegaly 
Splenomegaly 
Ascites 
Abnormal collateral veins in the abdomen
29
Q

What causes hepatic encephalopathy?

A

Acute liver failure

Decompensated liver cirrhosis

30
Q

What is the pathophysiology of hepatic encephalopathy?

A

Liver fails, releases nitrogenous waste (NH3) into circulation
This passes to the brain
Brain astrocytes clear it, involves process of conversion of glutamate to glutamine
Excess glutamine causes osmotic imbalance and a shift of fluid into brain cells

31
Q

What can cause decompensation in liver disease?

A 
Infection 
Upper GI bleed
Excessive alcohol 
Hypoglycaemia 
Drugs - opiates, diuretics
32
Q

What are the two types of ascites and how would you differentiate between the two?

A

Differentiate by doing ascitic tap

Exudate (peritoneal disease) - serum ascites albumin gradient <1.1g/dL
Transudate (portal hypertension) - serum ascites albumin gradient >1.1g/dL

33
Q

How would you treat hepatitic encephalopathy?

A

Lactulose (laxative) - 30ml Oral

Aim for 2-3 loose stools per day

34
Q

What are the different causes of obstructive jaundice?

A

Intaluminal - gallstones
Mural causes - cholangiocarcinoma, scelerosing cholangitis
Extrinsic causes - Cancer of head of pancreas

35
Q

What is the CAGE questionnaire for alcohol dependence?

A

Have you ever felt you should CUT down
ANGERED by suggestions that you cut down
Felt GUILTY about drinking
Have you ever used alcohol as an EYE opener in the morning

2 or more positive suggests alcohol abuse/addiction

36
Q

What are the differentials for alcohol withdrawal symptoms?

A 
Opiate use
Hypoglycaemia 
Head injury 
Sepsis
Hepatic encephalopathy
37
Q

What would >500 white cells per mm3 on an ascitic tap suggest?

A

Spontaneous bacterial peritonitis

Year 3 (24 decks)

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