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Phase 2a - Hepatology > Hepatology Conditions A > Flashcards

Hepatology Conditions A Flashcards

1
Q

Liver Failure - Description

A

inability of liver to regenerate or repair

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2
Q

Liver Failure - Causes (12)

A 
toxins
1) paracetamol overdose* (>50%)
2) alcohol
viral
3) hepatitis (esp. B, C)
4) cytomegalovirus 
5) Epstein-Barr virus
metabolic
6) haemochromatosis
7) Wilson’s disease
8) alpha-1-antitrypsin deficiency
other
9) non-alcoholic fatty liver disease
10) hepatocellular carcinoma
11) primary sclerosing cholangitis
12) Budd Chiari syndrome
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3
Q

Liver Failure - Pathophysiology (4)

A

1) hepatocyte destruction
2) nodule destruction
3) fibrosis due to chronic inflammation
4) inability of liver to regenerate or repair

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4
Q

Liver Failure - Symptoms (Paracetamol Overdose) (4)

A

1) asymptomatic (<24 hours)
2) abdominal pain
3) nausea
4) vomiting

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5
Q

Liver Failure - Signs (8)

A

1) jaundice
2) fetor hepaticus (sweet, putrid breath)
3) asterixis
4) ascites
5) bruising
6) clubbing
7) Dupuytren’s contracture
8) signs of hepatic encephalopathy

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6
Q

Liver Failure - Signs (Hepatic Encephalopathy) (10)

A 
grade I
1) altered mood/behaviour
2) sleep disturbance
3) dyspraxia
grade II
4) drowsiness
5) confusion
6) dysarthria
grade III
7) incoherent
8) restless
9) stupor
grade IV
10) coma
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7
Q

Liver Failure - Complications (5)

A

1) hepatic encephalopathy
2) cerebral oedema
3) ascites
4) hypoglycaemia
5) coagulopathy

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8
Q

Liver Failure - Investigations (4/3)

A 
initial
1) blood culture
2) FBC
3) U+E
4) LFT
consider
1) chest x-ray
2) abdomen ultrasound (small liver, underlying cause)
3) liver biopsy*
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9
Q

Liver Failure - Management (0/3/1)

A 
medical
1) treat underlying cause (e.g. n-acetyl-cysteine —> paracetamol overdose)
2) treat complications
3) prophylactic antibiotics
surgery
1) liver transplant
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10
Q

Cholelithiasis - Description

A

gallstones temporarily blocking cystic duct

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11
Q

Cholelithiasis - Risk Factors (5)

A

5Fs

1) fat (obesity)
2) female
3) fertility (more kids = more gallstones)
4) forty (age)
5) family history

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12
Q

Cholelithiasis - Types (3)

A

1) cholesterol (80%)
2) pigment (mainly Ca2+, bilirubin)
3) mixed

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13
Q

Cholelithiasis - Pathophysiology (Cholesterol) (3)

A

1) excess cholesterol
2) cholesterol crystallisation in bile
3) gallstone obstructs cystic duct

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14
Q

Cholelithiasis - Symptoms (5)

A

1) asymptomatic
2) right upper quadrant pain (sudden, crescendo, constant)
3) pain radiates to epigastrium, right shoulder, right subscapular
4) nausea
5) vomiting

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15
Q

Cholelithiasis - Complications (5)

A

1) choledocholithiasis
2) cholecystitis
3) ascending cholangitis
4) acute pancreatitis
5) gallstone ileus

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16
Q

Cholelithiasis - Investigations (3/1)

A

initial
1) FBC (normal)
2) LFT (normal; high ALP, high bilirubin in choledocholithiasis)
3) abdomen ultrasound*
consider
1) endoscopic resonance cholangiopancreatography (unconfirmed by ultrasound)

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17
Q

Cholelithiasis - Management (2/3)

A

medical
1) analgesia (esp. NSAID)
2) ursodeoxycholic acid (cholesterol gallstone)
surgery
1) laparoscopic cholecystectomy*
2) shock wave lithotripsy
3) endoscopic retrograde cholangiopancreatography + sphincterotomy (choledocholithiasis)

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18
Q

Cholecystitis - Description

A

inflammation of gallbladder due to blockage of cystic duct

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19
Q

Cholecystitis - Causes (1)

A

1) cholelithiasis

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20
Q

Cholecystitis - Pathophysiology (6)

A

1) cholelithiasis (gallstone formation in gallbladder)
2) biliary colic (gallstone blocks cystic duct)
3) bile secretion
4) pressure build up in gallbladder
5) damage/infection to gallbladder wall
6) inflammation of gallbladder

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21
Q

Cholecystitis - Symptoms (5)

A

1) right upper quadrant pain (sudden, crescendo, constant)
2) pain radiates to epigastrium, right shoulder, right subscapular
3) fever
4) nausea
5) vomiting

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22
Q

Cholecystitis - Signs (2)

A

1) Murphy’s sign (respiratory arrest when RUQ palpated during deep inspiration)
2) right upper quadrant tenderness

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23
Q

Cholecystitis - Complications (4)

A

1) gallbladder rupture
2) gallstone ileus
3) empyema
4) gangrene

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24
Q

Cholecystitis - Investigations (4/1)

A 
initial
1) FBC (leucocytosis)
2) high CRP + ESR
3) LFT (high ALP, high bilirubin)
4) abdomen ultrasound*
consider
1) endoscopic retrograde cholangiopancreatography (unconfirmed by ultrasound)
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25
Q

Cholecystitis - Management (0/3/2)

A 
medical
1) analgesia (esp. NSAID)
2) IV antibiotics
3) ursodeoxycholic acid (cholesterol gallstone)
surgery
1) laparoscopic cholecystectomy*
2) shockwave lithotripsy
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26
Q

Ascending Cholangitis - Description

A

inflammation of biliary tree due to blockage of common bile duct

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27
Q

Ascending Cholangitis - Causes (2)

A

1) choledocholithiasis (gallstone in common bile duct)

2) bacteria (Klebsiella, Escherichia coli)

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28
Q

Ascending Cholangitis - Pathophysiology (5)

A

1) choledocholithiasis (gallstone in common bile duct)
2) bile secretion
3) pressure build up in biliary tree
4) damage/infections to biliary tree
5) inflammation of biliary tree

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29
Q

Ascending Cholangitis - Symptoms (5)

A

1) right upper quadrant pain (sudden, crescendo, constant)
2) pain radiates to epigastrium, right shoulder, right subscapular
3) fever (inc. rigors)
4) nausea
5) vomiting

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30
Q

Ascending Cholangitis - Signs (Charcot’s Triad) (3)

A

1) right upper quadrant pain
2) fever
3) jaundice

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31
Q

Ascending Cholangitis - Signs (Reynold’s Pentad) (5)

A

shock

1) right upper quadrant pain
2) fever
3) jaundice
4) hypotension
5) altered mental status

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32
Q

Ascending Cholangitis - Complications (4)

A

1) jaundice
2) acute pancreatitis
3) gastrointestinal infection
4) sepsis

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33
Q

Ascending Cholangitis - Investigations (6/0)

A

initial

1) FBC (leucocytosis)
2) high CRP + ESR
3) LFT (high ALP, high bilirubin)
4) abdomen ultrasound
5) blood culture
6) endoscopic retrograde choliangiopancreatography*

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34
Q

Ascending Cholangitis - Management (0/2/3)

A 
medical
1) analgesia (esp. opioids)
2) IV antibiotics
surgery
1) endoscopic retrograde cholangiopancreatography + sphincterotomy (1st line)
2) laparoscopic cholecystectomy*
3) shockwave lithotripsy
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35
Q

Primary Sclerosing Cholangitis - Description

A

chronic inflammation and fibrosis of intrahepatic and extrahepatic bile ducts leading to cholestatic liver disease

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36
Q

Primary Sclerosing Cholangitis - Risk Factors (5)

A

1) 40-50 years old
2) male
3) family history
4) ulcerative colitis
5) autoimmune hepatitis

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37
Q

Primary Sclerosing Cholangitis - Symptoms (5)

A

1) right upper quadrant pain
2) epigastric pain
3) pruritus
4) fatigue
5) weight loss

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38
Q

Primary Sclerosing Cholangitis - Signs (1)

A

1) jaundice

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39
Q

Primary Sclerosing Cholangitis - Complications (5)

A

1) ascending cholangitis
2) jaundice
3) cirrhosis
4) liver failure
5) malignancy (bile duct, gallbladder, liver, colon)

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40
Q

Primary Sclerosing Cholangitis - Investigations (3/1)

A

initial
1) FBC
2) LFT
3) endoscopic retrograde cholangiopancreatography*
consider
1) liver biopsy (fibrous, obliterative cholangitis)

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41
Q

Primary Sclerosing Cholangitis - Management (1/1/1)

A 
conservative
1) annual cancer screening (ultrasound + colonoscopy)
medical
1) cholestyramine (pruritus)
surgery
1) liver transplant*
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42
Q

Acute Pancreatitis - Description

A

acute inflammation of pancreas

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43
Q

Acute Pancreatitis - Causes (3)

A

1) gallstones (60%)
2) alcohol (30%)
3) idiopathic (10%)
esp. gallstones, then heavy alcohol intake

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44
Q

Acute Pancreatitis - Pathophysiology (Gallstones) (5)

A

1) obstruction of pancreatic duct
2) accumulation of pancreatic enzyme-rich fluid
3) premature activation of pancreatic enzymes
4) enzyme mediated autodigestion of pancreas
5) inflammation of pancreas

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45
Q

Acute Pancreatitis - Pathophysiology (Alcohol) (5)

A

1) alcohol alters Ca2+ metabolism
2) increased pancreatic enzyme secretion
3) premature activation of pancreatic enzymes
4) enzyme mediated autodigestion of pancreas
5) inflammation of pancreas

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46
Q

Acute Pancreatitis - Symptoms (4)

A

1) epigastric pain (bores to back)
2) nausea
3) vomiting
4) anorexia

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47
Q

Acute Pancreatitis - Signs (2)

A

1) Grey Turner’s sign (flank bruising)

2) Cullen’s sign (periumbilical bruising)

48
Q

Acute Pancreatitis - Complications (3)

A

1) sepsis
2) acute respiratory distress syndrome
3) acute kidney injury

49
Q

Acute Pancreatitis - Investigations (5/1)

A 
initial
1) FBC (leucocytosis)
2) high CRP + ESR
3) serum amylase (3x upper limit)
4) serum lipase (high)
5) abdomen ultrasound (gallstone)
consider
1) abdomen CT
50
Q

Acute Pancreatitis - Management (3/6/1)

A 
conservative
1) dietary advice (low dietary fat)
2) nutritional support
3) alcohol cessation
medical
1) IV fluids
2) analgesia
3) antiemetic
4) Ca2+ supplement
5) Mg2+ supplement
6) prophylactic antibiotics
surgery
1) cholecystectomy (gallstones)
51
Q

Chronic Pancreatitis - Description

A

chronic inflammation of pancreas

52
Q

Chronic Pancreatitis - Causes (3)

A

1) alcohol (60-70%)
2) smoking
3) autoimmune (esp. coeliac disease)

53
Q

Chronic Pancreatitis - Symptoms (9)

A

1) recurrent epigastric pain (bores to back)
2) pain relieved when sitting forward
3) pain exacerbated by eating/drinking heavily
4) nausea
5) vomiting
6) anorexia
malabsorption
7) weight loss
8) diarrhoea
9) steatorrhoea

54
Q

Chronic Pancreatitis - Signs (1)

A

1) erythema ab igne (reticulated hyperpigemented erythema, dusky grey)

55
Q

Chronic Pancreatitis - Complications (5)

A

1) diabetes mellitus
2) pancreatic exocrine insufficiency
3) pancreatic pseudocysts
4) pancreatic obstruction
5) biliary obstruction

56
Q

Chronic Pancreatitis - Investigations (3/1)

A

initial
1) serum glucose (high)
2) abdomen ultrasound (calcified, dilated pancreatic duct)
3) abdomen CT (calcified, dilated pancreatic duct)
consider
1) endoscopic cholangiopancreatography*

57
Q

Chronic Pancreatitis - Management (4/4/3)

A 
conservative
1) dietary advice (low dietary fat)
2) nutritional support
3) smoking cessation
4) alcohol cessation
medical
1) analgesia (NSAID—>opioid)
2) antiemetic
3) pancreatic enzymes + PPI
4) vitamin ADEK supplements
surgery
1) shockwave lithotripsy
2) pancreatectomy
3) duct drainage
58
Q

Alcoholic Liver Disease - Description

A

chronic liver disease due to excess alcohol

59
Q

Alcoholic Liver Disease - Risk Factors (5)

A

1) >65 years old
2) female
3) hepatitis
4) alcohol (chronic abuse)
5) smoking

60
Q

Alcoholic Liver Disease - Stages (3)

A

1) alcoholic steatosis
2) alcoholic hepatitis
3) alcoholic cirrhosis

61
Q

Alcoholic Liver Disease - Pathophysiology (6)

A

1) alcohol metabolism produces fat in liver
2) hepatocytes become swollen with fat (steatosis)
3) alcohol metabolism produces free radicals in liver
4) free radicals damage hepatocytes (hepatitis)
5) alcohol transforms stellate cells into myofibroblasts
6) myofibroblasts produce collagen causing fibrosis (cirrhosis)

62
Q

Alcoholic Liver Disease - Symptoms (7)

A

1) asymptomatic
2) right upper quadrant pain
3) nausea
4) anorexia
5) weight loss or weight gain
6) fatigue
7) fever

63
Q

Alcoholic Liver Disease - Signs (3)

A

1) hepatomegaly
2) jaundice
3) ascites

64
Q

Alcoholic Liver Disease - Complications (7)

A

1) hepatitis
2) cirrhosis
3) liver failure
4) hepatocellular carcinoma
5) hepatic encephalopathy
6) portal hypertension
7) coagulopathy

65
Q

Alcoholic Liver Disease - Investigations (Steatosis) (2/1)

A 
initial
1) LFT (high AST, high ALT)
2) FBC (macrocytic anaemia)
consider
1) abdomen ultrasound/CT* (fatty infiltration)
66
Q

Alcoholic Liver Disease - Investigations (Hepatitis) (3/1)

A 
initial
1) LFT (high AST, high ALT)
2) FBC (macrocytic anaemia)
3) high CRP + ESR
consider
1) abdomen ultrasound/CT* (fatty infiltration)
67
Q

Alcoholic Liver Disease - Investigations (Cirrhosis) (3/2)

A

initial
1) LFT (high AST, high ALT, AST/ALT>2, low albumin)
2) FBC (macrocytic anaemia)
3) U+E (low Na+)
consider
1) abdomen ultrasound/CT (fatty infiltration)
2) liver biopsy* (confirmation)

68
Q

Alcoholic Liver Disease - Management (6/3/1)

A 
conservative
1) dietary advice (low dietary salt)
2) weight loss
3) smoking cessation
4) alcohol cessation
5) counselling (inc. AA)
6) vaccinations
medical
1) vitamin supplements
2) thiamine (prevents Wernicke’s encephalopathy)
3) corticosteroids
surgery
1) liver transplant
69
Q

Non-Alcoholic Fatty Liver Disease - Description

A

syndrome characterised by histological macrovascular hepatic steatosis (fat swollen hepatocytes)

70
Q

Non-Alcoholic Fatty Liver Disease - Risk Factors (6)

A

1) obesity
2) diabetes mellitus
3) dyslipidaemia
4) hypertension
5) rapid weight loss
6) hepatotoxic drugs (e.g. CCB)

71
Q

Non-Alcoholic Fatty Liver Disease - Symptoms (3)

A

1) right upper quadrant discomfort
2) fatigue
3) malaise

72
Q

Non-Alcoholic Fatty Liver Disease - Signs (4)

A

1) no significant alcohol use
2) hepatomegaly
3) splenomegaly
4) truncal obesity

73
Q

Non-Alcoholic Fatty Liver Disease - Complications (3)

A

1) cirrhosis
2) hepatocellalur carcinoma
3) portal hypertension

74
Q

Non-Alcoholic Fatty Liver Disease - Investigations (4/2)

A 
initial
1) LFT (high AST, high ALT, AST/ALT<1, low ALP, low albumin)
2) FBC (macrocytic anaemia)
3) U+E (low Na+)
4) lipid profile
consider
1) abdomen ultrasound/CT (fatty infiltration)
2) liver biopsy* (confirmation)
75
Q

Non-Alcoholic Fatty Liver Disease - Management (2/1/2)

A 
conservative
1) regular exercise
2) weight loss
medical
1) statin
surgery
1) gastric bypass
2) liver transplant
76
Q

Cirrhosis - Description

A

irreversible end stage of chronic liver disease

77
Q

Cirrhosis - Causes (3)

A

1) alcoholic liver disease
2) non-alcoholic fatty liver disease
3) hepatitis (B, C)

78
Q

Cirrhosis - Pathophysiology (4)

A

1) chronic liver injury
2) hepatocyte necrosis
3) fibrosis
4) irreversible liver damage

79
Q

Cirrhosis - Symptoms (4)

A

1) asymptomatic (early)
2) abdominal pain
3) pruritus
4) melaena

80
Q

Cirrhosis - Signs (Hands) (5)

A

1) leukonychia
2) Terry’s nails
3) clubbing
4) palmar erythema
5) Dupuytren’s contracture

81
Q

Cirrhosis - Signs (Other) (7)

A

1) jaundice
2) spider angioma
3) bruising
4) ankle swelling
5) abdominal distension
6) body hair loss
7) fetor hepticus (sweet, putrid breath)

82
Q

Cirrhosis - Complications (10)

A

1) portal hypertension —> gastro-oesophageal varices
2) ascites (50%)
3) jaundice
4) hepatocellular carcinoma
5) coagulopathy
6) hypoalbuminaemia
7) congestive splenomegaly
8) portosystemic shunt
9) hepatorenal syndrome
10) hepatic encephalopathy

83
Q

Cirrhosis - Investigations (3/2)

A 
initial
1) LFT (high AST, high ALT, AST/ALT>1, low albumin, high PTT)
2) FBC (macrocytic anaemia)
3) U+E (low Na+)
consider
1) abdomen ultrasound/CT
2) liver biopsy* (confirmation)
84
Q

Cirrhosis - Management (3/2/1)

A 
conservative
1) dietary advice (e.g. low dietary salt)
2) alcohol cessation
3) biannual hepatocellular carcinoma screening (ultrasound)
medical
1) treat underlying cause
2) treat complications
surgery
1) liver transplant
85
Q

Portal Hypertension - Description

A

high blood pressure in hepatic portal system

86
Q

Portal Hypertension - Types (3)

A

1) pre-hepatic
2) intra-hepatic (common)
3) post-hepatic (rare)

87
Q

Portal Hypertension - Causes (Pre-Hepatic) (1)

A

1) thrombosis (splenic or hepatic portal vein)

88
Q

Portal Hypertension - Causes (Intra-Hepatic) (3)

A

1) cirrhosis (most common UK)
2) schistosomiasis (most common WW)
3) sarcoidosis

89
Q

Portal Hypertension - Causes (Post-Hepatic) (2)

A

1) Budd Chiari syndrome (thrombosis/tumour in hepatic vein)

2) congestive heart failure

90
Q

Portal Hypertension - Pathophysiology (Cirrhosis) (3)

A

1) fibrosis
2) myofibroblast contraction increases hepatic vascular resistance
3) portal hypertension

91
Q

Portal Hypertension - Symptoms (1)

A

1) asymptomatic

92
Q

Portal Hypertension - Signs (2)

A

1) splenomegaly

2) signs of cirrhosis

93
Q

Portal Hypertension - Complications (2)

A

1) gastro-oesophageal varices

2) haemorrhage —> shock

94
Q

Portal Hypertension - Investigations (2/0)

A

initial

1) hepatic venous pressure gradient
2) abdomen ultrasound

95
Q

Portal Hypertension - Management (0/1/3)

A

medical
1) propranolol (haemorrhage prophylaxis)
surgery
1) endoscopic banding (haemorrhage prophylaxis)
2) transjugular intrahepatic portosystemic shunt (haemorrhage)
3) balloon tamponade (haemorrhage)

96
Q

Gastro-Oesophageal Varices - Description

A

extremely dilated sub-mucosal veins

97
Q

Gastro-Oesophageal Varices - Causes (1)

A

1) portal hypertension

98
Q

Gastro-Oesophageal Varices - Pathophysiology (2)

A

1) portal hypertension

2) extremely dilated sub-mucosal veins

99
Q

Gastro-Oesophageal Varices - Symptoms (3)

A

haemorrhage

1) abdominal pain
2) haematemesis
3) rectal bleeding

100
Q

Gastro-Oesophageal Varices - Signs (4)

A

haemorrhage

1) shock
2) tachycardia
3) hypotension
4) pallor

101
Q

Gastro-Oesophageal Varices - Complications (1)

A

1) haemorrhage —> shock

102
Q

Gastro-Oesophageal Varices - Investigations (4/1)

A 
initial
1) FBC
2) LFT
3) U+E
4) blood typing (potential haemorrhage)
consider
1) oesophagogastroduodenoscopy
103
Q

Gastro-Oesophageal Varices - Management (0/1/3)

A

medical
1) propranolol (haemorrhage prophylaxis)
surgery
1) endoscopic banding (haemorrhage prophylaxis)
2) transjugular intrahepatic portosystemic shunt (haemorrhage)
3) balloon tamponade (haemorrhage)

104
Q

Jaundice - Description

A

increased serum bilirubin causing yellowing of skin, sclera, mucosal

105
Q

Jaundice - Causes (Pre-Hepatic) (2)

A

1) iatrogenic (e.g. paracetamol, rifampicin, steroids)

2) haemolysis (e.g. malaria, thalassaemia, disseminated intravascular coagulopathy)

106
Q

Jaundice - Causes (Intra-Hepatic, Cholestatic) (3)

A

1) hepatitis
2) alcoholic liver disease
3) cirrhosis

107
Q

Jaundice - Causes (Post-Hepatic, Cholestatic) (1)

A

1) ascending cholangitis

108
Q

Jaundice - Symptoms (4)

A

1) right upper quadrant pain
2) pain radiates to right shoulder
3) rigors
4) weight loss

109
Q

Jaundice - Signs (3)

A

1) abdominal swelling
2) pale stool (cholestatic)
3) dark urine (cholestatic)

110
Q

Jaundice - Complications (6)

A

1) liver failure
2) kidney failure
3) pancreatitis
4) biliary cirrhosis
5) cholangitis
6) sepsis

111
Q

Jaundice - Investigations (3/0)

A

initial

1) FBC
2) LFT
3) clotting profile

112
Q

Jaundice - Diagnosis (Pre-Hepatic) (5)

A

1) high unconjugated bilirubin
2) normal conjugated bilirubin
3) normal ALP
4) normal urine
5) normal stool

113
Q

Jaundice - Diagnosis (Intra-Hepatic) (5)

A

1) high unconjugated bilirubin
2) high conjugated bilirubin
3) high ALP
4) dark urine
5) pale stool

114
Q

Jaundice - Diagnosis (Post-Hepatic) (5)

A

1) normal unconjugated bilirubin
2) high conjugated bilirubin
3) high ALP
4) dark urine
5) pale stool

115
Q

Jaundice - Management (2/1/0)

A 
conservative
1) monitor
2) hydration
medical
1) treat underlying cause

Phase 2a - Hepatology (3 decks)

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