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past questions > liver and friends > Flashcards

liver and friends Flashcards

1
Q

list the 11 causes of pancreatitis

A

IGETSMASHED is the mnemonic to learn for this.
* Idiopathic
* Gallstones
* Ethanol (alcohol)
* Trauma
* Steroids
* Mumps / Malignancy
* Autoimmune
* Scorpion venom/spider bite
* Hyperlipidaemia, hypothermia, hypercalcaemia
* ERCP
* Drugs

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2
Q

pathophysiology of hepatitis?

A
  • liver injury ->
  • activation of inflammatory response ->
  • infiltration of inflammatory cells and liver cell necrosis ->
  • chronic inflammation can lead to progressive fibrosis and cirrhosis ->
  • chronic liver disease
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3
Q

treatment for ruptured appendix?

A

appendectomy then IV antibiotics

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4
Q

what are 2 signs of Wilson’s disease?

A
  • Kayser-Fleischer rings: Build-up of copper in the iris
  • Neurological signs: build-up of copper in the CNS
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5
Q

5 clinical features of primary biliary cholangitis?

A
  • MOST COMMON: Pruritus +- jaundice
  • Hepatosplenomegaly
  • Xanthelasma
  • Raised serum ALP or autoantibodies
  • Steatorrhea / Malabsorption of fat-soluble vitamins
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6
Q

treatment for paracetamol overdose?

A

if within 1hr of consumption: activated charcoal, if not: N-acetyl-cysteine

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7
Q

blood test results for ruptured oesophageal varices?

A
  • Anaemia, (Low ferritin, Low Hb).
  • Raised bilirubin.
  • Low albumin.
  • Raised ALT, AST and ALP.
  • High creatinine.
  • Increased prothrombin time.
  • (Possibly viral serology shows hepatitis infection)
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8
Q

2 conditions that can cause bronze skin pigmentation?

A

Haemochromatosis
Addison’s disease

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9
Q

5 risk factors for acute cholecystitis?

A

female, fat, fertility, forty, flatulent

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10
Q

what is Murphy’s sign?

A

pain occurring on inspiration while palpating right subcostal area, occurs in acute cholecystitis

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11
Q

give 2 signs that appear on the abdomen as colour changes during acute pancreatitis

A

Cullen’s sign, grey turner sign

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12
Q

what is the first line investigation of acute pancreatitis?

A

serum amylase test

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13
Q

what is the first line treatment for autoimmune hepatitis?

A

prednisolone

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14
Q

gram-positive bacterium that is coag pos?

A

staphylococcus aureus

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15
Q

pathophysiology of primary sclerosing cholangitis?

A

inherited abnormality of immunoregulation leading to T lymphocyte mediated attack on bile duct epithelial cells

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16
Q

presentations of primary sclerosing cholangitis?

A

insidious onset, jaundice, pruritus, fatigue, +- IBS

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17
Q

what condition is associated with primary sclerosing cholangitis?

A

cholangiocarcinoma

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18
Q

first line drug given for alcohol withdrawal?

A

chlordiazepoxide

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19
Q

most common cause of liver cirrhosis?

A

hepatitis C

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20
Q

what causes median arcuate ligament syndrome?

A

compression of the coeliac artery

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21
Q

give 4 signs of chronic liver disease

A
  • Palmar erythema
  • Clubbing
  • Dupuytren’s contracture
  • Spider naevi
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22
Q

what test is diagnostic of primary biliary sclerosis?

A

blood test for anti-mitochondrial antibodies

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23
Q

what does obstructive dyspnoea and liver disease presenting with cholestatic jaundice suggest?

A

alpha antitrypsin deficiency

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24
Q

What’s the mechanism of action of N-acetyl cysteine?

A

Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds

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25
Q

what can cause chronic pancreatitis?

A

alcohol misuse, ERCP

26
Q

What’s the first investigation you would perform when diagnosing haemochromatosis?

A

blood test for ferritin levels

27
Q

Which form of viral hepatitis is a notifiable disease and to whom should it be reported?

A

hep A, Consultant in Communicable Disease Control OR Public Health England OR local Health Protection Team

28
Q

Upon a blood test it is found that a patient has Hepatitis B. What was present in the blood to diagnose this?

A

HBsAg OR AntiHB antibody

29
Q

Why is Hepatitis D only able to cause disease in those with Hepatitis B?

A

Incomplete RNA virus – needs Hep B to be able to assemble

30
Q

Name 3 management protocols for acute Hepatitis B

A

avoid alcohol, vaccinate contacts, monitor liver function

31
Q

what is the function of the gallbladder?

A

store and concentrates bile needed for food digestion

32
Q

what are most gallstones made from?

A

cholesterol

33
Q

how can gallstones cause vit K deficiency?

A

An obstruction of the bile duct would cause reduced secretion of bile into the small intestine. This would cause reduced absorption of fat and thus the fat soluble vitamins

34
Q

A possible complication of gallstones is a gallstone ileus, what is this?

A

impaction of a gallstone within the small intestine

35
Q

what are the possible treatments for gallstones?

A

surgery to remove gallbladder and medication to dissolve gallstones

36
Q

Name the three stages in alcoholic liver disease

A

Alcoholic fatty liver, Alcoholic hepatitis, Alcoholic cirrhosis

37
Q

Give 3 complications of liver cirrhosis

A

Hepatocellular carcinoma, Oesophageal varices, Portal hypertension

38
Q

Explain why liver failure leads to ascites

A
  • Low albumin produced - Oncotic pressure lower than hydrostatic pressure, fluid leaks into abdominal cavity
  • Portal hypertension - Hydrostatic pressure greater than oncotic, fluid leaks into abdominal cavity
39
Q

Name 2 first line drugs a patient might be prescribed to treat chronic hepatitis.

A
  • SC pegylated interferon-alpha 2A/B
  • oral ribavirin
40
Q

Why can a vaccine for hepatitis C not be developed?

A

rapid mutations so envelope proteins change rapidly

41
Q

Name 2 ways the spread of hepatitis C can be prevented.

A

screen blood products, protection when handling body fluids

42
Q

give 4 main functions of the liver

A
  • Glucose metabolism
  • Fat metabolism
  • Detoxification + excretion of: bilirubin/ ammonia/ drugs/ hormones/ pollutants
  • Protein synthesis: albumin/ clotting factors
  • Defence against infection
43
Q

Give 3 differential diagnoses of a Biliary Colic

A
  • IBS
  • carcinoma on right side of colon
  • renal colic
  • pancreatitis
44
Q

What are the 2 types of Biliary Colic?

A

cholesterol, bile pigment

45
Q

antimicrobial antibodies are found in which condition typically?

A

primary biliary cholangitis

46
Q

what kind of jaundice would present in malaria?

A

pre-hepatic

47
Q

give 3 causes of chronic pancreatitis

A

chronic alcohol use, smoking, autoimmune, haemochromatosis

48
Q

name 2 tests can be done to confirm chronic pancreatitis

A

faecal elactase, abdo US/CT to show pancreatic calcifications

49
Q

state 3 medical treatments used for chronic pancreatitis

A

insulin therapy if DM has developed, analgesia (e.g. tramadol), pancreatic enzyme replacement therapy

50
Q

state 3 potential complications of chronic pancreatitis

A

DM, biliary obstruction, splenic vein thrombosis, steatorrhoea, pancreatic carcinoma

51
Q

when are ALT and AST be raised?

A

liver damage e.g. alcoholic hepatitis, cirrhosis

52
Q

what does HBsAg indicate?

A

surface antigen - active infection / just been vaccinated

53
Q

what does HBeAg indicate?

A

E antigen - marker of viral replication, implies high infectivity

54
Q

what does HBcAb indicate?

A

core antibody - past or current infection

55
Q

what does HBsAb indicate?

A

surface antibody - vaccination or past / current infection

56
Q

what is secreted by a hepatocellular carcinoma?

A

alpha-fetoprotein

57
Q

Which of the following is the gold standard investigation for portal hypertension?

A

hepatic venous pressure gradient

58
Q

Where is an adenocarcinoma of the pancreas most likely to originate from?

A

head of the pancreas

59
Q

chromosome for Haemochromatosis?

A

6

60
Q

chromosome for Wilson’s disease?

A

13

61
Q

chromosome for A1AT?

A

14

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