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Phase 2a - Hepatology > Hepatology Lectures > Flashcards

Hepatology Lectures Flashcards

1
Q

Describe the changes in blood pressure in the hepatic portal system. (3)

A

1) normal - 5-8mmHg
2) gastro-oesophageal varices - >10mmHg
3) major haemorrhage - >12mmHg

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2
Q

List 5 things measured in a liver function test (LFT) blood test

A

1) PTT
2) AST
3) ALT
4) albumin
5) bilirubin

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3
Q

List 2 reasons why hepatocytes are susceptible to injury and infection.

A

1) receive low oxygenated blood

2) process infective agents

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4
Q

What is the main type of bilirubin that in pre-hepatic jaundice?

A

Unconjugated bilirubin.

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5
Q

What is the main type of bilirubin that in cholestatic (hepatic or post-hepatic) jaundice?

A

Conjugated bilirubin.

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6
Q

List the 2 types of cholestatic jaundice.

A

1) intrahepatic

2) posthepatic

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7
Q

What differentiates intrahepatic jaundice from posthepatic jaundice?

A

High unconjugated bilirubin in intrahepatic jaundice, normal unconjugated bilirubin in posthepatic jaundice.

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8
Q

What is the most common cause of acute viral hepatitis?

A

Hepatitis A.

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9
Q

Where is hepatitis A endemic? (2)

A

1) Africa

2) South America

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10
Q

What is fulminant hepatitis?

A

Rapid liver inflammation that can cause acute liver failure.

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11
Q

What is the icteric stage of hepatitis?

A

Once jaundice has presented.

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12
Q

Where is hepatitis E common?

A

Indochina.

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13
Q

Where is hepatitis B endemic? (3)

A

1) Far East
2) Africa
3) Mediterranean

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14
Q

What does hepatitis D require for assembly?

A

Hepatitis B.

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15
Q

Where is hepatitis D common? (2)

A

1) Eastern Europe

2) Northern Africa

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16
Q

Describe hepatitis D co-infection. (3)

A

1) infected with HBV and HDV simultaneously
2) clinically indistinguishable from acute icteric HBV infection
3) confirmed by anti-HDV IgM and anti-HBV IgM

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17
Q

Describe hepatitis D superinfection. (3)

A

1) chronic HBV infected with HDV
2) increased risk of fulminant hepatitis
3) only indicated by high AST and high ALT

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18
Q

Where is hepatitis C very incident and why?

A

Egypt. Failed public health initiative.

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19
Q

What type of food is associated with hepatitis A?

A

Shellfish.

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20
Q

Describe the pathophysiology of hepatic encephalopathy. (8)

A

1) liver failure
2) build up of nitrogenous waste (e.g. ammonia)
3) ammonia crosses blood brain barrier
4) ammonia is neurotoxic (halts Krebs cycle —> irreparable cell damage)
5) astrocytes attempt to clear ammonia (conversion of glutamate to glutamine)
6) excess glutamine causes an osmotic imbalance
7) influx of fluid into cells
8) cerebral oedema

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21
Q

List 3 grade I hepatic encephalopathy symptoms.

A

1) altered mood/behaviour
2) sleep disturbances
3) dyspraxia

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22
Q

List 3 grade II hepatic encephalopathy symptoms.

A

1) increasing drowsiness
2) confusion
3) slurred speech

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23
Q

List 3 grade III hepatic encephalopathy symptoms.

A

1) incoherent
2) restless
3) stupor

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24
Q

What is the grade IV hepatic encephalopathy symptoms.

A

Coma.

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25
Q

What is biggest cause of liver failure in the UK?

A

Paracetamol overdose (>50%).

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26
Q

What percentage of acute hepatitis B progress to chronic hepatitis?

A

10%.

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27
Q

What percentage of acute hepatitis C progress to chronic hepatitis?

A

90%.

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28
Q

Describe biliary colic pain. (6)

A

1) sudden onset
2) dull
3) constant
4) crescendo
5) right upper quadrant
6) radiated to epigastrium, right shoulder and right subscapular

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29
Q

List 2 factors that affect the onset of biliary colic.

A

1) excessive fatty food

2) time (mid-evening —> early hours)

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30
Q

What differentiates biliary colic from acute cholecystitis?

A

Inflammation.

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31
Q

What is Mirizzi’s syndrome? (3)

A

1) gallstone becomes impacted in gallbladder or cystic duct
2) compression of common hepatic duct or common bile duct
3) jaundice

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32
Q

What percentage of acute pancreatitis are severe and what is the mortality?

A

10% of cases (40-80% mortality).

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33
Q

What is systemic inflammatory response syndrome (SIRS)? (4)

A 
Pro-inflammatory state.
Any two from:
1) tachycardia (>90bpm)
2) tachypnoea (>20bpm)
3) pyrexia (>38C)
4) high white cell count
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34
Q

Where does autoimmune chronic pancreatitis have a high prevalence?

A

Japan.

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35
Q

List 3 factors that indicate cholestatic jaundice?

A

1) dark urine
2) pale stool
3) itching

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36
Q

What is Wernicke-Korsakoff encephalopathy? (3)

A

1) alcohol withdrawal
2) ataxia, confusion, nystagmus
3) lasts up to a week

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37
Q

List 5 organs that accumulate iron during haemochromatosis and the associated pathology.

A

1) liver* - cirrhosis
2) pancreas - diabetes mellitus
3) pituitary gland - hypogonadism
4) heart - dilated cardiomyopathy, arrhythmias…
5) joints - arthralgia

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38
Q

What is the most common single gene disorder in Caucasians?

A

Hereditary haemochromatosis.

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39
Q

Why is hereditary haemochromatosis less common in females than males?

A

Menstrual blood loss is protective.

40
Q

Describe the change in total body iron content in symptomatic haemochromatosis patients. (2)

A

1) 20-40g symptomatic patients

2) 3-4g normal people

41
Q

What age do haemochromatosis patients generally present?

A

50s.

42
Q

When is deferoxamine used to treat haemochromatosis?

A

When patient is intolerant to venesection due to cardiac pathology.

43
Q

How does deferoxamine treat haemochromatosis?

A

Cheating agent that binds to iron preventing its absorption.

44
Q

Describe how venesection treats haemochromatosis. (4)

A

1) regular removal of blood
2) decreases RBCs
3) excess iron used to make new RBCs
4) decreases iron concentration

45
Q

List 4 foods that should be avoided with haemochromatosis.

A

1) tea
2) coffee
3) fruit
4) red meat

46
Q

List 2 organs where copper accumulates in Wilson’s disease.

A

1) liver

2) basal ganglia

47
Q

What practice is associated with Wilson’s disease?

A

Consanguinity.

48
Q

What do children with Wilson’s disease generally present with?

A

Liver disease.

49
Q

What do young adults with Wilson’s disease generally present with?

A

Neuropsychiatric symptoms.

50
Q

List 4 side effects of penicillamine (Wilson’s disease).

A

1) skin rashes
2) low white cell count
3) renal damage
4) haematuria

51
Q

What do children with alpha-1-anti-trypsin deficiency generally present with?

A

Liver disease.

52
Q

What do adults with alpha-1-anti-trypsin deficiency generally present with?

A

Respiratory problems (emphysema).

53
Q

What percentage of alpha-1-anti-trypsin deficient patients develop respiratory problems?

A

75%.

54
Q

What is the commonest cause of liver tumours?

A

Metastases (90%).

55
Q

What is the 5 year survival rate of hepatocellular carcinoma?

A

<5%.

56
Q

Where is hepatocellular carcinoma common?

A

China.

57
Q

List 2 causes of primary liver cancers.

A

1) hepatocellular carcinoma (90%)

2) cholangiocarcinoma (10%)

58
Q

What is the most common benign liver tumour?

A

Haemangioma.

59
Q

List 3 common tumour locations that metastasise to the liver.

A

1) gastrointestinal tract (via hepatic portal vein)
2) breast
3) bronchus (lung)

60
Q

What is the prognosis of cholangiocarcinoma?

A

5 months.

61
Q

What percentage of cholangiocarcinomas are inoperable?

A

70%

62
Q

What percentage of operated cholangiocarcinomas recur?

A

76%.

63
Q

What is the 5 year survival of pancreatic adenocarcinoma?

A

3%.

64
Q

List 3 sites of pancreatic adenocarcinoma and their prevalence.

A

1) head of pancreas - 60%
2) body of pancreas - 25%
3) tail of pancreas - 15%

65
Q

Why is the prognosis of pancreatic adenocarcinoma poor?

A

Usually presents late stage.

66
Q

List the 3 main causes of ascites.

A

1) cirrhosis (80%)
2) cancer (10%)
3) congestive cardiac failure (3%)

67
Q

List 3 features of parietal peritoneum.

A

1) covers abdominal wall
2) somatic innervation
3) well localised sensation

68
Q

List 3 features of visceral peritoneum.

A

1) covers organs
2) autonomic innervation
3) poorly localised sensation

69
Q

When does peritonitis present?

A

Sudden onset when peritoneum perforates.

70
Q

What is the mortality of peritonitis?

A

15%.

71
Q

List 6 reasons people with peritonitis die.

A

1) sepsis
2) multi-organ failure
3) cardiovascular event (MI, stroke)
4) respiratory complications (pneumonia, pulmonary embolus)
5) surgical complications
6) frailty

72
Q

List the 4 types of hernia.

A

1) reducible
2) irreducible - obstructed
3) irreducible - incarcerated
4) irreducible - strangulated

73
Q

Define Dupuytren’s contracture.

A

Permanently flexed finger/s.

74
Q

Define fetor hepaticus.

A

Extreme bad breath, a sign of end stage liver failure.

75
Q

Define asterixis.

A

Liver flap, hand tremor when wrist is extended.

76
Q

Define cholelithiasis.

A

Presence of gallstones in gallbladder.

77
Q

Define Murphy’s sign.

A

Pain on taking a deep breath when examiner places two finger on right upper quadrant.

78
Q

Define choledocholithiasis.

A

Presence of gallstones in common bile duct.

79
Q

Define Grey Turner’s sign.

A

Flank bruising.

80
Q

Define Cullen’s sign.

A

Periumbilical bruising.

81
Q

Define steatorrhea.

A

Fatty stool.

82
Q

Define hepatic steatosis.

A

Fatty liver.

83
Q

Define spider angioma.

A

Enlarged blood vessels near the skin surface that contain a red spot with radiating reddish extensions.

84
Q

Define congestive splenomegaly.

A

Spleen enlargement due to portal hypertension.

85
Q

Define fulminant hepatitis.

A

Acute liver failure.

86
Q

Define Kayser-Fleischer rings.

A

Dark rings that surround the iris due to copper deposition.

87
Q

List Charcot’s triad. (3)

A

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

88
Q

List Reynolds’ pentad. (5)

A

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

89
Q

Define endoscopic banding.

A

Rubber bands used to treat haemorrhaging varices without surgery.

90
Q

Define transjugular intrahepatic portosystemic shunt.

A

Artificial passage created from hepatic portal vein to portal vein to treat portal hypertension.

91
Q

Define venesection.

A

Removal of blood, used to treat haemochromatosis.

92
Q

Define haemobilia.

A

Bleeding of/into biliary tree.

93
Q

Define gallstone ileus.

A

Gallstone blocking bowel (esp. terminal ileum).

94
Q

Describe gallstone ileus formation. (3)

A

1) gallstone erodes gallstone wall
2) cholecystoenteric fistula forms
3) gallstone blocks bowel (esp. terminal ileum)

95
Q

Define choledocholithiasis.

A

Gallstone temporarily blocking common bile duct.

96
Q

List 4 hernias that rare in children.

A

1) direct inguinal hernia
2) femoral hernia
3) sliding hiatus hernia
4) rolling hiatus hernia

Phase 2a - Hepatology (3 decks)

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