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Medicine > Case 3 - Liver disease - Progress Test > Flashcards

Case 3 - Liver disease - Progress Test Flashcards

1
Q

What causes right upper quadrant pain provoked by eating a fatty meal?

A

Biliary colic

gallstone lodged in the bile duct

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2
Q

What causes right upper quadrant pain, Murphy’s sign, fever and raised inflammatory markers?

A

Acute cholecystitis

inflammation / infection of the gallbladder secondary to impacted gallstones

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3
Q

What causes right upper quadrant pain associated with fever and jaundice?

A

Ascending cholangitis

a bacterial infection of the biliary tree, commonly predisposed by gallstones

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4
Q

What causes severe epigastric pain, radiating to the back.

Associated signs include tenderness, ileus and low grade fever

A

Acute pancreatitis

usually due to alcohol or gallstones

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5
Q

What causes epigastric pain worse after eating?

A

Gastric ulcers

may be a history of NSAID use or alcohol excess

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6
Q

What causes epigastric pain that improves after eating?

A

Duodenal ulcers

may be a history of NSAID use or alcohol excess

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7
Q

What causes initially central abdominal pain that moves to the right fossa.

Associated features include: tachycardia, low-grade fever and tenderness in RIF

A

Appendicitis

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8
Q

What causes left lower quadrant pain, which is colicky in nature.

Associated symptoms include diarrhoea (which is sometimes blood), fever, raised inflammatory markers and white cells

A

Acute diverticulitis

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9
Q

What causes central abdominal pain associated with vomiting and tinking bowel signs?

A

Intestinal obstruction

may be history of malignancy or previous operations

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10
Q

What causes a loin to groin pain?

A

Renal colic

pain is often severe but intermittent. Visible or non-visible haematuria may be present

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11
Q

What causes loin pain, fever, rigors and vomiting?

A

Acute pyelonephritis

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12
Q

What causes suprapubic pain in men?

A

Urinary rentention

Caused by obstruction to bladder flow

(often associated with BPH)

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13
Q

What causes right or left iliac fossa pain, with assoicated amenorrhoea?

A

Ectopic pregnancy

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14
Q

What causes central abdominal pain radiating to the back?

A

Ruptured AAA

may be assoicated with shock and have a history of cardiovascular disease

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15
Q

What causes central abdominal pain associated with diarrhoea, rectal bleeding and a metabolic acidosis?

A

Mesenteric ischaemia

Patients often have a history of cardiovascular disease or AF

The metabolic acidosis is caused by dying tissue

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16
Q

What antibodies are assoicated with auto-immune hepatitis?

A

Anti-nuclear antibodies

Smooth muscle antibodies

17
Q

How is auto-immune hepatitis managed?

A

Steroids

Other immuno supressants eg. azathioprine

Liver transplantation

18
Q

What are the most common causes of acute pancreatitis?

A

Alcohol

Gallstones

19
Q

What is the pathophysiology of acute pancreatitis?

A

autodigestion of pancreatic tissue by pancreatic enzymes, leading to necrosis

20
Q

What do investigations into acute pancreatitis show?

A

Raised serum amylase
Raised serum lipase
US - determine if there is gallstones or biliary obstruction

Can also use a contrast CT

21
Q

What scores are used to identify severe cases of acute pancreatitis?

A

Ranson
Glasgow
APACHE II

22
Q

What factors indicate severe pancreatitis?

A 
age > 55 
hypocalcaemia 
hyperglycaemia 
hypoxia 
neutrophilia 
elevated LDH and AST
23
Q

What are the classifications of acute pancreatitis severity?

A

Mild
Moderate
Severe

24
Q

What determines mild acute pancreatitis?

A

No organ failure

No local complications

25
Q

What determines moderately severe acute pancreatitis?

A

No organ failure / organ failure < 48 hrs

Possible local complications

26
Q

What determines severe acute pancreatisis?

A

Persistent organ failure (>48hrs)

Possible local complications

27
Q

How is acute pancreatitis managed?

A 
Fluid resuscitation (large quantities of cryastalloid) 
- Aiming for urine output > 0.5mls/kg/hr

Analgaesia (IV opioids)

Nutrition - enteral nutrition should be offer to patients with moderately severe or severe acute pancreatitis within 72 hrs of presentation

Surgery:

  • If acute pancreatitis due to gallstones - cholecystectomy / ERCP
  • If necrosis + worseing organ function - may require debridement
  • If infected necrosis - radiological drainage / surgical necrosectomy
28
Q

What are complications of acute pancreatitis?

A
  • Peripancreatic fluid collections
  • Pseudocysts
  • Pancreatic necrosis
  • Pancreatic abscess
  • Haemorrhage
  • Acute respiratory distress sydrome
29
Q

What are the causes of chronic pancreatitis?

A
  • 80% alcohol

- 20 % unknown cause

30
Q

What are the features of chronic pancreatitis?

A

Pain typically worse 15 to 30 minutes following a meal

Steatorrhoea (develops 5-20 years after the onset of pain)

DM develops in most patients (generally occurs more than 20 years after the symptoms begin)

31
Q

How is chronic pancreatitis investigated?

A

Abdominal XR / CT: pancreatic calcifications

Faecal elastase may be used to assess exocrine function if imaging is inconclusive

32
Q

How is chronic pancreatitis managed?

A

Pancreatic enzyme supplementation

Analgaesia

Antioxidants (may only help in early disease)

33
Q

What do investigations into alcoholic liver disease show?

A

Gamma-GT raised

AST:ALT > 2 (if >3, strongly suggestive of acute alcoholic hepatitis)

34
Q

How is alcoholic liver disease managed?

A

Glucocorticoids
- used during acute episodes of alcoholic hepatitis

Pentoxyphylline is sometimes used

35
Q

What are the features of non-alcoholic fatty liver disease?

A

Usually asymptomatic
Hepatomegaly
ALT > AST
Increased echogenicity on US

36
Q

How is non-alcoholic fatty liver disease managed?

A
  • Lifestyle changes and weight loss

- Monitoring

37
Q

How is liver cirrhosis investigated?

A

Transient elastography

Upper endoscopy to check for varicies

Liver US (+/- alpha feto protein) every 6 months to check for hepatocellular cancer

38
Q

How is variceal haemorrhage managed?

A

Fluid resusitation prior to endoscopy

Correct clotting: FFP and vitamin K

Terlipressin

Prophylactic antibiotics (quinolones)

Endoscopy + band ligation

Sengstaken-Blakemore tube if uncontrolled haemorrhage

Transjugular intrahepatic portosystemic shunt if all else fails

Medicine (15 decks)

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