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Gastroenterology > Liver > Flashcards

Liver Flashcards

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1
Q

Non Alcoholic Fatty Liver Disease- stages

A

steatosis, steatohepatitis, fibrosis, cirrhosis

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2
Q

At the stage of fibrosis, which cells lay down the fibres

and where are these areas most likely found

A

stellate cells

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3
Q

symptoms

A

often asymptomatic until later stages, jaundice, ascities, hepatomegaly, malaise, fatigue, pain

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4
Q

LFT

A

AST:ALT >2

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5
Q

Diagnosis

A

imaging- USS, CT, MRI diagnosis and staging- biopsy, fat content >5%

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6
Q

mechanisms of alcohol metabolism

A
  1. alcohol dehydrogenase> acetylaldehyde
  2. P450?
  3. cyp2e1
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7
Q

Alcoholic liver disease LFT

and 2 other blood results

A

ALT ^^
AST^
GGT^
ALP^

thrombocytopenia
hypoglycaemia

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8
Q

symptoms of alcoholic fatty liver

A

large, heavy, greasy, tender liver

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9
Q

symptoms of alcoholic hepatitis

A 
loss of appetite
nausea
dirrhoea
hepatomegaly
pain
paravetricular fibrosis
neutrophilic leukocytosis
jaundice
acities
fever
itchy skin
clubbing
oedema
parmar erythema
insomnia
memory loss
black tarry stool if complications
tendancy to bruise more easily
decreased tolerance of drugs and alcohol
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10
Q

complications of alcoholic fatty liver disease

A

Portal hypertension and varices is a complication of cirrhosis, and sometimes alcoholic hepatitis.
Ascities and spontaneous bacterial peritonitis.
Infection.
Liver cancer.
Hepatic encephalopathy

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11
Q

hepatic encephalopathy signs and symptoms

A

agitation, confusion, muscle stiffness, muscle tremors, difficulty speaking, and sometimes coma.

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12
Q

Treating alcoholic liver disease-

A

steatosis/ alcoholic hepatitis, stop alcohol for 2 weeks then drink according to guidelines
Medication- corticosteroids/ pentoxyfelline is sometimes used to reduce inflammation. sometimes, anabolic steroids or ropylthiouracil is used.

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13
Q

Hepatitis A+E similarities

A

Both faeco oral transmission
HAG IgM- active
HAG IgG- recovered

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14
Q

Hepatitis A

A

only acute

IgG means recovered or immunised

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15
Q

Hepatitis E

A

Can cause fulminant liver failure in pregnancy

no vaccination

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16
Q

Hepatitis C

A

Childbirth
Sex
IV drug use
Acute and chronic
3 different tests: enzyme immunoassay- HcG IgG- not protective
Recombinant immunoblot (PCR) - increased specificity, decreased sensitivity= HcV RNA. If decreasing, recovery, if remain same, chronic.

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17
Q

Hepatitis B

A

transmission- sex, childbirth, IV drug use.
Acute or chronic- chronic is 20%
In under 6yrs, chronic is 50%

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18
Q

Fulminant Liver Failure

A

Liver failure and encephalopathy occurring within 2 weeks of patient having a healthy liver/ acute exacerbation of existing disease. Common causes are viral hepatitis, and paracetamol overdose. More than 2 weeks is subacute
Encephalopathic, jaundiced, coagulopathy.

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19
Q

Hepatitis Symptoms

A

fatigue, malaise, fever, jaundice, nausea, hepatomegaly, pain, lymphocytosis

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20
Q

What is pre hepatic jaundice

A

Any jaundice which occurs due to increased rate of haemolysis. The heamolysis increases levels of unconjugated billirubin.

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21
Q

Name 8 causes of pre hepatic jaundice

A 
Sickle cell aneamia
hereditory spherocytosis
Crigler naja syndrome
gilberts syndrome
thallaeseamia
glucose 6 phosphate dehydrogenase deficiency
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22
Q

Name 8 causes of pre hepatic jaundice

A 
Sickle cell aneamia
hereditory spherocytosis
Crigler naja syndrome
gilberts syndrome
thallaeseamia
glucose 6 phosphate dehydrogenase deficiency
haemolytic ureamic syndrome
malaria
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23
Q

What is hepatocellular jaundice

A

Jaundice caused by hepatocellular necrosis, which causes billirubin to build up in blood as it can’t be metabolised

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24
Q

7 causes of hepatocellular jaundice

A 
autoimmune hepatitis
viral hepatitis
alcoholic fatty liver disease
non alcoholic fatty liver disease
liver failure
cirrhosis
drug induced hepatitis
PBC/PSC
Leptospirosis
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25
Post hepatic jaundice
caused by obstruction, conjugated billirubin can't be excreted
26
causes of post hepatic jaundice
``` Gallstones- mirizzi syndrome cholestasis of pregnancy liver flukes pancreatic cancer cholangiocarcinoma pancreatic pseudocysts ```
27
Prehepatic picture jaundice
``` Conjugated:NORMAL unconjugated:INCREASED urine colour:NORMAL stool colour:NORMAL ALP:NORMAL ALT/AST:NORMAL Splenomegaly:PRESENT ```
28
Hepatic picture jaundice
``` Conjugated:INCREASED unconjugated:INCREASED urine colour: DARK stool colour:NORMAL/PALE ALP:INCREASED ALT/AST:INCREASED Splenomegaly:PRESENT ```
29
Post hepatic jaundice
``` Conjugated:INCREASED unconjugated:NORMAL urine colour:DARK stool colour:PALE ALP:INCREASED ALT/AST:INCREASED Splenomegaly:ABSENT ```
30
Causes of Acute pancreatitis
``` Idiopathic Gall stones Ethanol Trauma Scorpion sting Mumps Autoimmune- eg polyarteritis nodosa Steroids Hypercalceamia, Hyperlipideamia, hypothermia ERCP Drugs, eg NSAIDs ```
31
Symptoms of acute pancreatitis
Severe epigastric/ central abdo pain radiating to back with vommitting Sitting forward may ease pain
32
Signs of acute pancreatitis
Jaundice, cullen's sign, grey turner's sign, fever, tacycardia, shock, rigidity, ileus
33
Indicators of severe acute pancreatitis | 3 or more within 48 hrs suggest severe disease needing ICU
``` P- Pa02<8 A- Age >55 N- WBC >15 C- Calcium <2 R- Renal function (urea) >16 A- Albumin <32 S- BM >10 ```
34
Investigations for acute pancreatitis
serum amylase >1000, but not specific for pancreatitis, can be raised in cholyctistitis serum lipase AXR for retroperitoneal fluid and jejunum ileus cRP >150 36hrs post admission means severe disease CXR rules out GI perforation CT/MRI- severity USS for gall stones ERCP if LFTs worsen
35
Management of acute pancreatitis
``` NBM, NG tube IV fluids Oxygen if hypoxic IM pethidine or morphine for analgesia Laparotomy and debridement if suspected pancreatic necrosis, also give IV impipenem ```
36
Chronic pancreatitis causes
chronic alcoholism duct obstruction familial, haemochromatosis, CF, high PTH
37
Chronic pancreatitis symptoms
epigastric pain bor to back, bloating, steatorrhoea, weight loss, brittle diabetes all symptoms relapsing and remitting
38
IVX of chronic pancreatitis
USS and CT show calcification on pancreas which confirms the diagnosis ERCP/MRCP AXR shows speckled calcification
39
RX of chronic pancreatitis
``` CREON analgesia insulin stop alcohol and fatty food pancreatectomy if pain doesnt stop ```
40
Pancreatic carcinoma (usually adenocarcinoma of ductal origin) causes
``` hereditory smoking high sugar intake obesity chronic pancreatitis is premalignant, high red meat intake diabetes ```
41
Pancreatic cancer mainly affects
men over 60
42
Pancreatic cancer symptoms and signs
CANCER AFFECTING HEAD OG PANCREAS OR AoV: painless jaundice, with weight loss may be a palpable abdominal mass `courvoiesier's law- painless jaundice in presence of palpable gall bladder CANCER AFFECTING BODY OR TAIL: abdo pain, weightloss and anorexia diabetes might occur, or symptoms may be nonspecific eg change in bowel habit
43
pancreatic cancer ivx
USS showing dilated bile ducts and mass lesion/ contast spiral CT (more sensiive especially for body and tail). Contrast spiral CT/ MRI is needed for staging ERCP used to treat palliative cases eg for bile duct stenosing in jaundiced patients CA 125 sensitive but not specific, serial measurement used for checking response to treatment
44
Management of pancreatic cancer
MDT approach: especially for pain relief. for palliative, need to relieve obstructive jaundice, gastric outflow, and pain. Surgery chemo, and radiotherapy 5 flurouracil and gemsitabine increase survival rate in severe disease
45
who are more affected by cancer of bile ducts (cholangiocarcinoma)?
elderly PSC patients Chinease liver fluke affected patients
46
presentation of cholangiocarcinoma and imaging
Jaundice secondary to bile duct obstruction, or secondary mets Imaging-USS/ CT/MRI- bile duct stricture/ Hilar mass/multiple metastesis
47
Oesophageal cancer cell types
Squamous cell- usually middle 3rd of oesophagus | Adenocarcinoma- usually lower 3rd
48
Oesophageal cancer causes
Squamous- smoking, and alcohol. sometimes very spicy food/ pickled fish other rf are previous diseases such as achalasia, and coeliac disease adenocarcinoma- Barrett oesophagus (metaplasia). smoking and obesity are also risk factors
49
Oesophageal cancer symptoms
difficulty swallowing, initially solids, then liquids weight loss night sweats fatigue chest pain may be caused by bolus food importation or local infiltration
50
Investigations for oesophageal cancer
OGD and biopsy | Staging by CT chest and abdomen to look for mets
51
Treatment of oesophageal cancer
Surgery if not extended beyond oesophageal wall, and pre operative chemo and radio radio and chemo if unresectable, but no mets if unresectable and metastasised, then chemo, endoscopic stenting to improve oesophageal stricture,
52
H pylori infection
urease producing bacterium. closely associated with gastritis, peptic ulcer disease, gastric cancer, gastric b cell lymphoma. acquired in childhood, associated with poor hygiene, fecal oral
53
ivx for h pylori
1. c13 urea breath test. 2. stool antigen test 3. clo (only during Ogd)
54
rx for h pylori
eradication indicated for all patients with atrophic gastritis, peptic ulcer disease, and b cell lymphoma. also indicated for a 1st degree relative with gastric cancer.
55
gastritis
gastritis is acute or chronic inflammation of the gastric mucosa. causes: h pylori infection, autoimmune gastritis, viruses, duodenal reflux. diagnosis made by biopsy.
56
gastropathy
gastric mucosal damage associated with epithelium cells, and regeneration. causes- NSAIDs, aspirin, cmv, hsv, alcohol. rx- ppi
57
gastric cancer
increased risk as age increases, and in men. h pylori is implicated, causing chronic gastritis in some, causing atrophic gastritis, and premalignant intestinal metaplasia. Other risk factors: smoking, low fruit and veg intake, pernicious anaemia, family history, and after partial gastrectomy.
58
pathology of gastric cancer
adenocarcinomas usually occurring in antrum, and are localised ulcerated lesions, with rolled edges, or diffuse with extensive submucosal spread, giving the picture of Linitus plastic.
59
gastric cancer symptoms
pain similar to peptic ulcer pain. (epigastric). nausea, anorexia and weightless common in advanced disease. Tumours near pylorus causes outflow obstruction, and outflow obstruction, and nausea and near cardia causes dysphagia.
60
gastric lymphoma
MALTOMA- presentation similar to gastric carcinoma. most initiated by h pylori and treatment is usually to eradicate h pylori
61
gastric cancer ivx
gastroscopy and biopsy. ct and laparoscopy to stage.
62
gastric cancer rx
surgery, chemo, palliative chemo.
63
Coeliac
t cell mediated autoimmune condition, where a prolamin (gliadin) intolerance causes subtotal villous atrophy and ulceration. Peaks are infancy and 40-60.
64
coeliac symptoms
``` steatorrhoea weightless aneamia fatigue abdominal pain bloating pathos ulcers angular stomatitis weakness osteomalacia fatigue failure to thrive in kids ```
65
celiac diagnosis
blood- low hb, low b12, low ferritin anti gliadin antibodies tissue transglutaminase anti endomysial antibodies duodenal biopsy at endoscopy- subtotal villous atrophy and intra epithelial infiltration of wbc
66
Complications of coeliac-
aneamia | t cell lymphoma and other malignancies are common.
67
Budd chirari (hepatic vein thrombosis) triad
sudden onset- abdominal pain, tender hepatomegaly, and ascites.
68
Isoniazid therapy causes what
a b6 deficiency causing peripheral neuropathy

Gastroenterology (2 decks)

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