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Gen Med and Surg - C.U > Hepatology > Flashcards

Hepatology Flashcards

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1
Q

Steatosis =

A

infiltration of liver cells with fat

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2
Q

What pathologies can alcoholism lead to in the liver

A

Steatosis, fibrosis and cirrhosis

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3
Q

CAGE questionnaire

A

Do you feel you should cut down?
Do you feel annoyed when people criticize your drinking?
Do you feel guilty?
Do you ever have an eye opener?

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4
Q

Investigations in liver cirrhosis

A 
LFT - esp GGT 
Albumin (decreased) 
coagulation 
FBC - increased MCV 
Platelets reduced 
U&Es 
IgA increased 
Increased cholestrol 
USS - liver 
Biopsy, if needed for extent of damage
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5
Q

clinical features of Wernicke’s encephalopathy

A

Confusion
Opthalmoplegia
ataxia

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6
Q

Oral thiamine should be given to?

A

Harmful or dependent drinkers

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7
Q

Blood tests for hepatocellular integrity

A

ALT/ AST
LSH - raised in liver mets and obstructive jaundice
GGT
Iron / ferritin - raised in liver disease

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8
Q

Jaundice can be divided into 3 forms

A

Pre hepatic
Intrahepatic
Post hepatic

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9
Q

Prehepatic jaundice is due to?

A

Haemolysis

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10
Q

Intraheptatic jaundice due to?

A

hepatocellular damage

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11
Q

In which type of jaundice is there bilrubinuria?

A

Intra and post

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12
Q

Post hepatic jaundice is due to?

A

Cholestasis

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13
Q

Disorders of excretion blood tests (cholestasis)

A

Bilirubin
ALP
Copper raised
Cholestrol

(all increased in cholestasis)

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14
Q

Tests for the synthetic function of the liver

A

Coagulation - prothrombin time and INR
liver screen
albumin

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15
Q

Which clotting factors are produced by the liver?

A

1,2,5,7,11 and 13

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16
Q

what tests are done in a liver screen?

A 
Viral hepatitis 
CMV and EBV 
Autoantibodies
Ig 
Ferritin 
Copper

USS of the liver

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17
Q

Imagining + option for the liver

A 
USS 
CT 
MRI 
Angiography - vascular supply 
Nuclear medicine 
Liver biopsy
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18
Q

Define acute liver failure

A

Acute liver injury (reduction in hepatic function <6m due to hepatocellular death)
Causes increased INR and hepatic encephalopathy

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19
Q

3 main causes of acute liver failure

A

Infections
Drugs
Malignancy

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20
Q

Examples of infections causing acute liver failure

A

Hep A, B, E
Immunocompromised - EBV / CMV
Foreign travel - dengue fever

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21
Q

Drugs causing acute liver failure

A

Paracetamol
Cocaine
Iron overdose

Amoxicillin 
Rifampicin 
Isoniazid 
Phenytoin 
Valproate
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22
Q

“Other” causes of acute liver failure

A

AI
Wilsons
Ischaemia
Pregnancy related - acute fatty liver / HELLP

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23
Q

Important questions in acute liver failure hx

A 
Recent new medication 
Travel hx 
Unprotected sexual contact 
IVUDs 
Prodromal illness
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24
Q

Blood investigations in acute liver failure

A 
FBCs
U&amp;Es 
LFTs 
Albumin 
Coagulation 
Copper 
Glucose 
ABG 
Hepatitis screen 
Toxicology 
Auto antibodies 
Group and save 
Blood culture
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25
Imaging in acute liver failure
USS | CT
26
Immediate treatment in acute liver failure
``` ABC IV access and fluid resuscitation N-acetylcysteine IV Vitamin support Discuss with local transplant centre Transfer to ICU if required ``` Monitor INR - 6 hrly Urine output and creatinine
27
Commonest mode of death in acute liver failure
Sepsis
28
Hepatic encephalopathy mainly due to the build up of?
Ammonia
29
Define fulimant hepatic failure
Sudden onset liver failure with hepatic encephalopathy within 2 weeks in a person with no underlying liver pathology
30
Precipitating event for hepatic encephalopathy
``` Infection GI bleed - high protein abs Dehydration Alcohol binge Metabolic disarray TIPS ```
31
Microbiology in hepatic encephalopathy
Blood cultures Ascites tap Urine dip
32
Imaging in hepatic encephalopathy
USS | CT
33
TIPS =
transjugular intrahepatic portosystemic shunt
34
How to acutely treat hepatic encephalopathy
ABC Fluids Antibiotics Treat the cause
35
Bloods in hepatic encephalopathy
``` FBC U&E LFT Coag CRP ABG Glucose Arterial ammonia ```
36
How to work out units
% x ml / 1000 x no. of days
37
Main cause of primary liver cancer
Hepatocellular carcinoma (75%) and cholangiocarcinoma
38
Two important diagnostic tests in liver cancer
Abdo CT and alpha feto protein
39
Main risk factor in cholangiocarcinoma
Primary sclerosing cholangitis is the main risk factor
40
Markers elevated in cholangiocarcinoma
CA 19-9, CEA and CA 125 are often elevated
41
Autoantibodies in autoimmune hepatitis
anti-smooth and ANA
42
Other autoimmune diseases linked to autoimmune hepatitis
SLE thyroid disease pernicious anaemia
43
Invasive test in autoimmune hepatitis
liver biopsy
44
1st line management for autoimmune hepatitis
prednisolone
45
Primary biliary cirrhosis is?
autoimmune distruction of the lobular ducts
46
primary sclerosing cholangitis is?
chronic liver disease leading due to fibrosis and inflammation leading to cholestasis and cirrhosis.
47
primary sclerosing cholangitis associated with which group of conditions?
IBD
48
autoantibodies found in primary sclerosing cholangitis?
p-ANCA
49
cancer linked to primary sclerosing cholangitis?
cholangiocarcinoma
50
Decompensated cirrhosis is?
Cirrhosis with development of one of... ASCITES BLEEDING Conscious level - decreased
51
Causes of cirrhosis
``` Alcohol Hepatitis Genetic e.g. Wilsons Drugs e.g. Methotrexate Autoimmune ```
52
Hand signs of cirrhosis
clubbing leuconychia dupuytren's contracture palmar erythema
53
Face / neck signs of cirrhosis
jaundice | Raised JVP
54
Chest signs of cirrhosis
Spier naevi | gynacomastia
55
Abdo signs of cirrhosis
spleno / hepatomegaly ascites caput meduse
56
Imaging for cirrhosis
US CT MRCP/ ERCP
57
Conservative treatment for cirrhosis
alcohol abstinence | nutrition
58
peripheral signs of liver disease
brusing - poor clotting malnourished oedmea
59
Causes of portal hypertension Prehepatic Hepatic Post-hepatic
Splenic / portal / mesenteric vein thrombosis Extrinsic compression Cirrhosis Hepatitis Cardiac failure Hepatic vein thrombosis
60
Shunting of blood from the portal to systemic system leads to?
hepatic encephalopathy
61
Clinical features of portal hypertension
Ascites Bleeding Decreased conscious level
62
Imaging used to diagnose hepatic / portal vein thrombosis
US
63
Medical management in portal hypertension
anti-coag for thrombosis beta blockers TIPS
64
Surgical management in portal hypertension
shunt
65
Complications of portal hypertension
varices ascites splenomegaly
66
Presentation of ruptured varices
Haemodynamically unstable Haematemesis Melaena May be signs of chronic liver disease e.g. jaundice, ascites, encephalopathy
67
Blood tests in ruptured varices (medical emergency)
``` ABG FBC LFTS UandEs Clotting Group and save - order ```
68
What should be given in an upper GI bleed due to liver decompensation
Vit K Platelets Broad spectrum AN
69
1st line intervention in varices rupture
Endoscopy and banding
70
Those with cirrhotic livers should be screened for what?
OGD for development of varices
71
Those with cirrhotic livers should be screened for what?
OGD for development of varices
72
Transudate protein content
<25g/L
73
Exudate protein content
>25g/L
74
Best guide as to whether ascites due to portal hypertension
SAAG - Serum ascitic albumin gradient <11g/L
75
Causes of transudate ascites
Liver failure | Renal failure
76
Causes of exudate ascites
Infection Malignancy Pancreatitis
77
On examination in ascities
swelling full flanks shifting dullness
78
Fluid aspirate meaning Normal Bilirubin Infection Malignancy
Straw coloured Orange Turbid Blood
79
Conservative treatment in ascites
monitor fluid input and output | reduce sodium input
80
Medical treatment for ascites
diuretics
81
Invasive treatment for ascites
Drain the fluid | TIPS
82
Serious complication of ascites
Spontaneous bacterial peritonitis
83
Causative organisms of spontaneous bacterial peritonitis
E.Coli Klebsiella Streptococcus
84
Main investigation to diagnose spontaneous bacterial peritonitis
Gram stain and cell count of ascitic tap
85
Medical treatment for spontaneous bacterial peritonitis
IV 5 day AB - Cefotaxime or Tazocin
86
First line in hepatic encephalopathy
latculose - lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
87
Gilberts syndrome
Genetic syndrome of mild unconjugated hyperbilirubinaemia Liver function is otherwise normal
88
Causes of liver damage / decompensation
Pre heptatic - haemolytic anaemia e.g. sickle cell or autoimmune - Gilberts syndrome Hepatic - Hepatitis - infective / autoimmune - Alcohol - Fatty liver disease - Haemochromatosis / Wilsons - Primary biliary sclerosis Post / systemic - Gall bladder disease - Pancreatic cancer - Congestive heart failure
89
Associated symptoms with hepatomegaly
``` Nausea Puritis Abdo distention Weight loss Pyrexia Jaundic Dark urine / pale stool ```
90
FM Q in patient with hepatomegaly
Sickle cell Carcinoma Autoimmune disease
91
Social Q in patient with hepatomegaly
Travel hx Alcohol consumption Tattoos / needles / risky sexual behaviour
92
Causes of hepatomegaly - massive
Massive “MR HAM” ``` metastases right heart failure hepatocellular cancer alcoholic liver disease myeloproliferative disorders ```
93
Causes of hepatomegaly - moderate
Moderate same as massive + “HIFI” haematological disease iron (haemachromatosis) fatty liver infiltration
94
Causes of hepatomegaly - mild
hepatitis biliary obstruction HIV

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