Hepatology Conditions A Flashcards
(115 cards)
1
Q
Liver Failure - Description
A
inability of liver to regenerate or repair
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
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
4
Q
Liver Failure - Symptoms (Paracetamol Overdose) (4)
A
1) asymptomatic (<24 hours)
2) abdominal pain
3) nausea
4) vomiting
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
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
7
Q
Liver Failure - Complications (5)
A
1) hepatic encephalopathy
2) cerebral oedema
3) ascites
4) hypoglycaemia
5) coagulopathy
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*
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
10
Q
Cholelithiasis - Description
A
gallstones temporarily blocking cystic duct
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
12
Q
Cholelithiasis - Types (3)
A
1) cholesterol (80%)
2) pigment (mainly Ca2+, bilirubin)
3) mixed
13
Q
Cholelithiasis - Pathophysiology (Cholesterol) (3)
A
1) excess cholesterol
2) cholesterol crystallisation in bile
3) gallstone obstructs cystic duct
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
15
Q
Cholelithiasis - Complications (5)
A
1) choledocholithiasis
2) cholecystitis
3) ascending cholangitis
4) acute pancreatitis
5) gallstone ileus
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)
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)
18
Q
Cholecystitis - Description
A
inflammation of gallbladder due to blockage of cystic duct
19
Q
Cholecystitis - Causes (1)
A
1) cholelithiasis
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
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
22
Q
Cholecystitis - Signs (2)
A
1) Murphy’s sign (respiratory arrest when RUQ palpated during deep inspiration)
2) right upper quadrant tenderness
23
Q
Cholecystitis - Complications (4)
A
1) gallbladder rupture
2) gallstone ileus
3) empyema
4) gangrene
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)
25
Cholecystitis - Management (0/3/2)
```
medical
1) analgesia (esp. NSAID)
2) IV antibiotics
3) ursodeoxycholic acid (cholesterol gallstone)
surgery
1) laparoscopic cholecystectomy*
2) shockwave lithotripsy
```
26
Ascending Cholangitis - Description
inflammation of biliary tree due to blockage of common bile duct
27
Ascending Cholangitis - Causes (2)
1) choledocholithiasis (gallstone in common bile duct)
| 2) bacteria (Klebsiella, Escherichia coli)
28
Ascending Cholangitis - Pathophysiology (5)
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
29
Ascending Cholangitis - Symptoms (5)
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
30
Ascending Cholangitis - Signs (Charcot’s Triad) (3)
1) right upper quadrant pain
2) fever
3) jaundice
31
Ascending Cholangitis - Signs (Reynold’s Pentad) (5)
shock
1) right upper quadrant pain
2) fever
3) jaundice
4) hypotension
5) altered mental status
32
Ascending Cholangitis - Complications (4)
1) jaundice
2) acute pancreatitis
3) gastrointestinal infection
4) sepsis
33
Ascending Cholangitis - Investigations (6/0)
initial
1) FBC (leucocytosis)
2) high CRP + ESR
3) LFT (high ALP, high bilirubin)
4) abdomen ultrasound
5) blood culture
6) endoscopic retrograde choliangiopancreatography*
34
Ascending Cholangitis - Management (0/2/3)
```
medical
1) analgesia (esp. opioids)
2) IV antibiotics
surgery
1) endoscopic retrograde cholangiopancreatography + sphincterotomy (1st line)
2) laparoscopic cholecystectomy*
3) shockwave lithotripsy
```
35
Primary Sclerosing Cholangitis - Description
chronic inflammation and fibrosis of intrahepatic and extrahepatic bile ducts leading to cholestatic liver disease
36
Primary Sclerosing Cholangitis - Risk Factors (5)
1) 40-50 years old
2) male
3) family history
4) ulcerative colitis
5) autoimmune hepatitis
37
Primary Sclerosing Cholangitis - Symptoms (5)
1) right upper quadrant pain
2) epigastric pain
3) pruritus
4) fatigue
5) weight loss
38
Primary Sclerosing Cholangitis - Signs (1)
1) jaundice
39
Primary Sclerosing Cholangitis - Complications (5)
1) ascending cholangitis
2) jaundice
3) cirrhosis
4) liver failure
5) malignancy (bile duct, gallbladder, liver, colon)
40
Primary Sclerosing Cholangitis - Investigations (3/1)
initial
1) FBC
2) LFT
3) endoscopic retrograde cholangiopancreatography*
consider
1) liver biopsy (fibrous, obliterative cholangitis)
41
Primary Sclerosing Cholangitis - Management (1/1/1)
```
conservative
1) annual cancer screening (ultrasound + colonoscopy)
medical
1) cholestyramine (pruritus)
surgery
1) liver transplant*
```
42
Acute Pancreatitis - Description
acute inflammation of pancreas
43
Acute Pancreatitis - Causes (3)
1) gallstones (60%)
2) alcohol (30%)
3) idiopathic (10%)
esp. gallstones, then heavy alcohol intake
44
Acute Pancreatitis - Pathophysiology (Gallstones) (5)
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
45
Acute Pancreatitis - Pathophysiology (Alcohol) (5)
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
46
Acute Pancreatitis - Symptoms (4)
1) epigastric pain (bores to back)
2) nausea
3) vomiting
4) anorexia
47
Acute Pancreatitis - Signs (2)
1) Grey Turner’s sign (flank bruising)
| 2) Cullen’s sign (periumbilical bruising)
48
Acute Pancreatitis - Complications (3)
1) sepsis
2) acute respiratory distress syndrome
3) acute kidney injury
49
Acute Pancreatitis - Investigations (5/1)
```
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
Acute Pancreatitis - Management (3/6/1)
```
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
Chronic Pancreatitis - Description
chronic inflammation of pancreas
52
Chronic Pancreatitis - Causes (3)
1) alcohol (60-70%)
2) smoking
3) autoimmune (esp. coeliac disease)
53
Chronic Pancreatitis - Symptoms (9)
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
Chronic Pancreatitis - Signs (1)
1) erythema ab igne (reticulated hyperpigemented erythema, dusky grey)
55
Chronic Pancreatitis - Complications (5)
1) diabetes mellitus
2) pancreatic exocrine insufficiency
3) pancreatic pseudocysts
4) pancreatic obstruction
5) biliary obstruction
56
Chronic Pancreatitis - Investigations (3/1)
initial
1) serum glucose (high)
2) abdomen ultrasound (calcified, dilated pancreatic duct)
3) abdomen CT (calcified, dilated pancreatic duct)
consider
1) endoscopic cholangiopancreatography*
57
Chronic Pancreatitis - Management (4/4/3)
```
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
Alcoholic Liver Disease - Description
chronic liver disease due to excess alcohol
59
Alcoholic Liver Disease - Risk Factors (5)
1) >65 years old
2) female
3) hepatitis
4) alcohol (chronic abuse)
5) smoking
60
Alcoholic Liver Disease - Stages (3)
1) alcoholic steatosis
2) alcoholic hepatitis
3) alcoholic cirrhosis
61
Alcoholic Liver Disease - Pathophysiology (6)
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
Alcoholic Liver Disease - Symptoms (7)
1) asymptomatic
2) right upper quadrant pain
3) nausea
4) anorexia
5) weight loss or weight gain
6) fatigue
7) fever
63
Alcoholic Liver Disease - Signs (3)
1) hepatomegaly
2) jaundice
3) ascites
64
Alcoholic Liver Disease - Complications (7)
1) hepatitis
2) cirrhosis
3) liver failure
4) hepatocellular carcinoma
5) hepatic encephalopathy
6) portal hypertension
7) coagulopathy
65
Alcoholic Liver Disease - Investigations (Steatosis) (2/1)
```
initial
1) LFT (high AST, high ALT)
2) FBC (macrocytic anaemia)
consider
1) abdomen ultrasound/CT* (fatty infiltration)
```
66
Alcoholic Liver Disease - Investigations (Hepatitis) (3/1)
```
initial
1) LFT (high AST, high ALT)
2) FBC (macrocytic anaemia)
3) high CRP + ESR
consider
1) abdomen ultrasound/CT* (fatty infiltration)
```
67
Alcoholic Liver Disease - Investigations (Cirrhosis) (3/2)
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
Alcoholic Liver Disease - Management (6/3/1)
```
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
Non-Alcoholic Fatty Liver Disease - Description
syndrome characterised by histological macrovascular hepatic steatosis (fat swollen hepatocytes)
70
Non-Alcoholic Fatty Liver Disease - Risk Factors (6)
1) obesity
2) diabetes mellitus
3) dyslipidaemia
4) hypertension
5) rapid weight loss
6) hepatotoxic drugs (e.g. CCB)
71
Non-Alcoholic Fatty Liver Disease - Symptoms (3)
1) right upper quadrant discomfort
2) fatigue
3) malaise
72
Non-Alcoholic Fatty Liver Disease - Signs (4)
1) no significant alcohol use
2) hepatomegaly
3) splenomegaly
4) truncal obesity
73
Non-Alcoholic Fatty Liver Disease - Complications (3)
1) cirrhosis
2) hepatocellalur carcinoma
3) portal hypertension
74
Non-Alcoholic Fatty Liver Disease - Investigations (4/2)
```
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
Non-Alcoholic Fatty Liver Disease - Management (2/1/2)
```
conservative
1) regular exercise
2) weight loss
medical
1) statin
surgery
1) gastric bypass
2) liver transplant
```
76
Cirrhosis - Description
irreversible end stage of chronic liver disease
77
Cirrhosis - Causes (3)
1) alcoholic liver disease
2) non-alcoholic fatty liver disease
3) hepatitis (B, C)
78
Cirrhosis - Pathophysiology (4)
1) chronic liver injury
2) hepatocyte necrosis
3) fibrosis
4) irreversible liver damage
79
Cirrhosis - Symptoms (4)
1) asymptomatic (early)
2) abdominal pain
3) pruritus
4) melaena
80
Cirrhosis - Signs (Hands) (5)
1) leukonychia
2) Terry’s nails
3) clubbing
4) palmar erythema
5) Dupuytren’s contracture
81
Cirrhosis - Signs (Other) (7)
1) jaundice
2) spider angioma
3) bruising
4) ankle swelling
5) abdominal distension
6) body hair loss
7) fetor hepticus (sweet, putrid breath)
82
Cirrhosis - Complications (10)
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
Cirrhosis - Investigations (3/2)
```
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
Cirrhosis - Management (3/2/1)
```
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
Portal Hypertension - Description
high blood pressure in hepatic portal system
86
Portal Hypertension - Types (3)
1) pre-hepatic
2) intra-hepatic (common)
3) post-hepatic (rare)
87
Portal Hypertension - Causes (Pre-Hepatic) (1)
1) thrombosis (splenic or hepatic portal vein)
88
Portal Hypertension - Causes (Intra-Hepatic) (3)
1) cirrhosis (most common UK)
2) schistosomiasis (most common WW)
3) sarcoidosis
89
Portal Hypertension - Causes (Post-Hepatic) (2)
1) Budd Chiari syndrome (thrombosis/tumour in hepatic vein)
| 2) congestive heart failure
90
Portal Hypertension - Pathophysiology (Cirrhosis) (3)
1) fibrosis
2) myofibroblast contraction increases hepatic vascular resistance
3) portal hypertension
91
Portal Hypertension - Symptoms (1)
1) asymptomatic
92
Portal Hypertension - Signs (2)
1) splenomegaly
| 2) signs of cirrhosis
93
Portal Hypertension - Complications (2)
1) gastro-oesophageal varices
| 2) haemorrhage —> shock
94
Portal Hypertension - Investigations (2/0)
initial
1) hepatic venous pressure gradient
2) abdomen ultrasound
95
Portal Hypertension - Management (0/1/3)
medical
1) propranolol (haemorrhage prophylaxis)
surgery
1) endoscopic banding (haemorrhage prophylaxis)
2) transjugular intrahepatic portosystemic shunt (haemorrhage)
3) balloon tamponade (haemorrhage)
96
Gastro-Oesophageal Varices - Description
extremely dilated sub-mucosal veins
97
Gastro-Oesophageal Varices - Causes (1)
1) portal hypertension
98
Gastro-Oesophageal Varices - Pathophysiology (2)
1) portal hypertension
| 2) extremely dilated sub-mucosal veins
99
Gastro-Oesophageal Varices - Symptoms (3)
haemorrhage
1) abdominal pain
2) haematemesis
3) rectal bleeding
100
Gastro-Oesophageal Varices - Signs (4)
haemorrhage
1) shock
2) tachycardia
3) hypotension
4) pallor
101
Gastro-Oesophageal Varices - Complications (1)
1) haemorrhage —> shock
102
Gastro-Oesophageal Varices - Investigations (4/1)
```
initial
1) FBC
2) LFT
3) U+E
4) blood typing (potential haemorrhage)
consider
1) oesophagogastroduodenoscopy
```
103
Gastro-Oesophageal Varices - Management (0/1/3)
medical
1) propranolol (haemorrhage prophylaxis)
surgery
1) endoscopic banding (haemorrhage prophylaxis)
2) transjugular intrahepatic portosystemic shunt (haemorrhage)
3) balloon tamponade (haemorrhage)
104
Jaundice - Description
increased serum bilirubin causing yellowing of skin, sclera, mucosal
105
Jaundice - Causes (Pre-Hepatic) (2)
1) iatrogenic (e.g. paracetamol, rifampicin, steroids)
| 2) haemolysis (e.g. malaria, thalassaemia, disseminated intravascular coagulopathy)
106
Jaundice - Causes (Intra-Hepatic, Cholestatic) (3)
1) hepatitis
2) alcoholic liver disease
3) cirrhosis
107
Jaundice - Causes (Post-Hepatic, Cholestatic) (1)
1) ascending cholangitis
108
Jaundice - Symptoms (4)
1) right upper quadrant pain
2) pain radiates to right shoulder
3) rigors
4) weight loss
109
Jaundice - Signs (3)
1) abdominal swelling
2) pale stool (cholestatic)
3) dark urine (cholestatic)
110
Jaundice - Complications (6)
1) liver failure
2) kidney failure
3) pancreatitis
4) biliary cirrhosis
5) cholangitis
6) sepsis
111
Jaundice - Investigations (3/0)
initial
1) FBC
2) LFT
3) clotting profile
112
Jaundice - Diagnosis (Pre-Hepatic) (5)
1) high unconjugated bilirubin
2) normal conjugated bilirubin
3) normal ALP
4) normal urine
5) normal stool
113
Jaundice - Diagnosis (Intra-Hepatic) (5)
1) high unconjugated bilirubin
2) high conjugated bilirubin
3) high ALP
4) dark urine
5) pale stool
114
Jaundice - Diagnosis (Post-Hepatic) (5)
1) normal unconjugated bilirubin
2) high conjugated bilirubin
3) high ALP
4) dark urine
5) pale stool
115
Jaundice - Management (2/1/0)
```
conservative
1) monitor
2) hydration
medical
1) treat underlying cause
```
