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Hepatobiliary Flashcards

(74 cards)

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1
Q

What do raised ALT and AST indicate?

A

Non-specific evidence of liver injury

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2
Q

What does raised LDH indicate?

A

non-specific

could be liver injury, cardiac failure, leukaemia, lymphoma

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3
Q

What does raised GGT indicate?

A

Alcoholic liver injury

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4
Q

What does raised Alk Phos indicate?

A

Biliary obstruction

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5
Q

2 types of bilirubin?

A 
Unconjugated Bilirubin (indirect)
Conjugated Bilirubin (direct)
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6
Q

Where is bilirubin conjugated?

A

In the liver

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7
Q

3 types of jaundice?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

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8
Q

Pre-hepatic causes of jaundice?

A

Haemolysis

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9
Q

How to calculate unconjugated (indirect) bilirubin?

A

Total bilirubin - Conjugated (direct) bilirubin

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10
Q

Intra-hepatic causes of jaundice?

A 
Liver disease (cirrhosis, alcoholic, fatty liver disease, pregnancy)
Intra-hepatic bile duct loss (PBC)
Intra-hepatic bile duct obstruction (mets, cirrhosis, hepatitis)
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11
Q

Post-hepatic causes of jaundice?

A 
Obstruction of extra-hepatic bile ducts:
Gallstones
benign strictures
extrahepatic cholangiocarcinoma
carcinoma head of pancreas
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12
Q

Conjugated bilirubin in the urine manifests as?

A

Pale stools and dark urine

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13
Q

Causes of acute liver injury?

A

alcohol, drugs (paracetamol), viral (Hep A and B), ascending cholangitis due to gallstones, acute fatty liver of pregnancy, Weil’s disease

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14
Q

What is Weil’s disease?

A

bacterial infection also known as leptospirosis

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15
Q

Causes of chronic liver disease?

A

chronic hepatitis, cirrhosis, iron overload (haemochromatosis)

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16
Q

Chronic hepatitis definition?

A

clinical and biochemical evidence of hepatitis lasting more than 6 months

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17
Q

Causes of chronic hepatitis?

A

Viral (Hep B + C), drugs, alcohol, fatty liver disease (NAFLD -> NASH), autoimmune, Wilson’s disease

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18
Q

What does autoimmune hepatitis look like on biopsy?

A

Portal lymphocytes with prominent plasma cells

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19
Q

Why is it important to diagnose autoimmune hepatitis?

A

Rapid progression to cirrhosis may be stopped with steroid use

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20
Q

What is the most common cause of liver cirrhosis?

A

Alcohol

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21
Q

Features of acute alcoholic hepatitis?

A

risk of death or progression to cirrhosis

acute inflammation, hepatocyte necrosis and Mallory’s hyaline

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22
Q

When is Mallory’s hyaline seen on biopsy?

A

In acute alcoholic hepatitis

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23
Q

Risk factors for NAFLD & NASH?

A

obesity, hyperlipidaemia and T2DM

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24
Q

What is hemosiderosis?

A

Deposition of iron in the liver as hemosiderin, turning it brown

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25
Causes of hemosiderosis?
Multiple blood transfusions Alcohol Primary hereditary haemochromatosis
26
What gene mutations cause haemochromatosis?
C282Y + H63D in the HFE gene
27
What pattern of inheritance is Haemochromatosis?
Autosomal Recessive
28
What happens in Wilson's Disease?
Copper is deposited in the liver and the basal ganglia of the brain
29
Symptoms of Wilson's Disease?
chronic hepatitis leading to cirrhosis progressive neurological disability Kayser-Fleischer Rings in the eyes
30
Diagnosis of Wilson's Disease?
low serum caeruloplasmin | inc. copper in liver biopsy
31
Treatment of Wilson's Disease?
chelating agent penicillamine
32
What can cause both cirrhosis and emphysema?
Alpha 1 antitrypsin deficiency
33
Causes of liver cirrhosis?
Alcohol, Hep B, Hep C, Haemochromatosis, Autoimmune, Biliary Obstruction, NASH, Wilson's Disease, alpha 1 antitrypsin deficiency
34
Complications of cirrhosis?
liver failure, portal hypertension, hepatocellular carcinoma
35
Liver failure definition?
red. synthesis of albumin, clotting factors | failure to eliminate hormones, nitrogenous wastes
36
Liver failure consequences?
``` systemic oedema bruising and bleeding ascites encephalopathy renal failure ```
37
Why does encephalopathy occur in liver failure?
Failure to eliminate nitrogenous wastes
38
Failure of the liver to eliminate steroid hormones results in?
Secondary hyperaldosteronism | Hyper-oestrogenism (spider naevi, gynaecomastia)
39
Commonest sites that mets to the liver?
Colon, pancreas, lung and breast
40
What is the commonest primary tumour of the liver?
Hepatocellular Carcinoma
41
What does hepatocellular carcinoma secrete in the blood?
Alpha fetoprotein
42
Alpha fetoprotein in the blood indicates?
Hepatocellular Carcinoma
43
Where is hepatocellular carcinoma really common?
Africa and China
44
Where does a cholangiocarcinoma arise?
Within the liver or within the extrahepatic bile ducts
45
Transmission of Hepatitis A?
close personal contact contaminated food/water blood exposure (rare)
46
What is acute infection of Hep A diagnosed by?
Detection of HAV-IgM in serum by EIA
47
What is past infection/immunity of Hep A detected by?
Detection of HAV-IgG in serum by EIA
48
Which viral hepatitis can you not have without another?
Can't have Hep D without B
49
Which hepatitis does not become chronic?
Hepatitis A
50
Which viral hepatitis have no vaccine?
Hep C | Hep E
51
Which hepatitis are largely transmissed by blood to blood contact or sexual transmission?
Hep B + Hep D | Hep C
52
What are the 6 'F's of ascites?
flatus, fluid, faeces, foetus, fat, filthy big tumour
53
Types of peritonitis?
Primary (spontaneous bacterial) | Secondary
54
Symptoms of spontaneous bacterial peritonitis?
ascites, fever, abdominal pain, altered mental state
55
Diagnosis of spontaneous bacterial peritonitis?
positive ascitic bacterial fluid culture | leukocyte count >250 in ascitic fluid
56
What causes secondary peritonitis?
spillage of organisms from GI or GU tracts into the peritoneal cavity trauma, appendix perforation, perforated ulcer, carcinoma, diverticulitis, ulcerative colitis, cholecystitis, infection
57
Secondary Peritonitis Symptoms?
``` initially symptoms of primary cause abdo pain (moderate aggrevated by movement, then severe) vomiting fever unable to pass flatus ```
58
Causative organisms of secondary peritonitis?
``` E coli, enterococci, clostridium, Bacteroides Antibiotic resistant (especially in healthcare setting) ```
59
Risk factors for liver abscesses?
DM, underlying hepatobiliary or pancreatic disease, liver transplant
60
Liver abscess presentation?
Fever (90%) Abdominal symptoms (50-75%) nausea, vomiting, anorexia, malaise, weight loss
61
Liver abscess microbiology?
Streptococcus, E coli, Staph aureus, Candida (immunocompromised), Klebsiella (Asia), Amebiasis (especially in pts with travel history)
62
What causes amebiasis?
Entamoeba Histolytica
63
Treatment of amebiasis?
Metronidazole
64
Complications of acute pancreatitis?
Pancreatic necrosis Pseudocyst formation Extra-pancreatic infection (20%)
65
How much of cholecystitis is acalculous?
Approx. 10% Usually in critically ill patients Associated with high mortality and morbidity
66
Diagnosis of cholecystitis?
Murphy's Sign Ultrasound MRCP CT
67
Complications of cholecystitis?
``` Gallbladder gangrene (20%) Fistula Gallstone ileus Emphysematous Cholecystitis Recurrence Sepsis ```
68
What is emphysematous cholecystitis?
Infection and inflammation of the gallbladder wall with air-creating pathogens (e.g., E coli, clostridium) surgical emergency
69
What is acute/ascending cholangitis?
clinical syndrome characterised by Charcot's triad that develops as a result of stasis or infection in the biliary tract
70
Causative organisms of cholangitis?
E coli Klebsiella Enterobacter
71
Diagnosis of cholangitis?
``` fever/chills lab evidence of inflammatory response jaundice abnormal LFTs biliary dilation on imaging ```
72
Clinical features of diverticulitis?
``` abdominal pain in LLQ nausea and vomiting tender mass change in bowel habit urinary symptoms peritoneal guarding, rigidity, rebound tenderness ```
73
Diverticulitis Complications?
Abscess Obstruction Fistula Perforation
74
Diagnosis of diverticulitis?
CT scan with contrast

Pathology (13 decks)

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