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Phase 2a - conditions > Liver and friends > Flashcards

Liver and friends Flashcards

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1
Q

What are the risk factors for gallstones?

A

Fat
Female
Forty
Fertile

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2
Q

What are the constituents of gall stones?

A

Cholesterol stones - 85%
Pigment stones
Mixed

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3
Q

What are the possible complications of gallstones?

A

Biliary colic
Acute choleecystitis
Ascending cholangitis
Gallstone ileus

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4
Q

What is biliary colic?

A

Pain associated with temporary obstruction of the cystic or common bile duct.

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5
Q

What are the symptoms of biliary colic?

A 
RUQ pain 
Radiates to the back/shoulder (phrenic nerve)
Nausea 
Vomiting 
Worse after fatty meals
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6
Q

What investigations should be carried out to identify gallstones?

A

Ultrasound of abdomen
LFTs - to check for liver/bile pathology
Blood tests - often show raised ESR/CRP

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7
Q

What is acute cholecystitis?

A

Gallstone becomes lodged in the neck of the gallbladder, outflow is obstructed and inflammation occurs.

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8
Q

What are the symptoms of acute cholecystitis?

A

Biliary colic
Vomiting
Fever
Local peritonism

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9
Q

What is the difference between biliary colic and acute cholecystitis?

A

Acute cholecystitis has an inflammatory component - fever, peritonism, raised WCC.

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10
Q

What is a specific sign for gallbladder inflammation?

A

Murphy’s sign - laying two finger over RUQ, pain is experienced when the patient breathes in. (only positive is same does not occur in the LUQ).

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11
Q

What is the treatment for biliary colic?

A

Analgesia
Fluids
Laprascropic cholecystectomy (if gallstone cannot be passed)

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12
Q

What is the treatment for acute cholecystitis?

A

Analgesia
Antibiotics
Laparoscopic cholecystectomy

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13
Q

What is ascending cholangitis?

A

Gallstone blocking the common bile duct and causing infection and inflammation.

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14
Q

What are the symptoms of cholangitis?

A

Charcot’s triad - fever, RUQ pain, jaundice

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15
Q

What is a specific sign for ascending cholangitis?

A

Rigors

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16
Q

What does an FBC show in cholangitis?

A

raised ESR and CRP

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17
Q

What do LFTs show in cholangitis?

A

raised AST and ALT

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18
Q

What enzymes can be used as markers of liver injury?

A

Alanine transaminase

Aspartate transaminase

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19
Q

How to treat cholangitis?

A

IV antibiotics

Stone removal

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20
Q

What is gallstone ileus?

A

When a gallstone erodes through the gallbadder into the duodenum - can then cause obstruction in the terminal ileum.

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21
Q

What are two autoimmune conditions of the biliary tract?

A

Primary biliary cholangitis

Primary sclerosing cholangitis

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22
Q

What is the nature of primary biliary cholangitis?

A

Autoimmune mediated inflammation of the interlobar bile ducts - non continuously.

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23
Q

What is the nature of primary sclerosing cholangitis?

A

Autoimmune mediated inflammation of the interlobar and extrahepatic bile ducts.

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24
Q

What autoantibody is present in primary biliary cholangitis?

A

AMA - diagnostic feature

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25
What are the associations of primary sclerosing cholangitis?
other autoimmune conditions - IBD.
26
What are the S+S of the autoimmune cholangitis conditions?
Lethargy Pruritus Jaundice If late - liver failure
27
What are the symptoms of acute hepatitis?
Asymptomatic Malaise Myalgia RUQ pain
28
What are the signs of acute hepatitis?
Jaundice Tender hepatomegaly Raised AST and ALT and bilirubin
29
What are the causes of acute hepatitis?
Hepatitis A, B (+/- D), C and E | Alcohol, drugs, toxins
30
What are the symptoms of chronic hepatitis?
Asymptomatic Malaise Myalgia Swollen RUQ
31
What are the signs of chronic hepatitis?
Clubbing Jaundice Ascites Coagulopathy
32
What are the causes of chronic hepatitis?
``` Hepatitis B (+/- D), C and E Alcohol, drugs, toxins. ```
33
What is the genetic material in hepatitis A?
RNA
34
How is hepatitis A spread?
Faeco-orally
35
What are the risk factors for hepatitis A?
Travel, household contact, IVDU
36
What are the clinical features of hep A?
Acute only | 100% immunity post infection
37
How do you diagnose infection by hepatitis?
Initial rise in anti-hepatitis 'A' virus IgM | Then anti-hepatitis 'A' virus IgG remains post infection as a marker of previous infection.
38
What is the management for hepatitis A?
vaccination available | Supportive treatment - self limiting condition.
39
What is the genetic material in hepatitis B?
DNA
40
How is hepatitis B spread?
Blood-borne
41
What are the risk factors for contracting hepatitis B?
mother-child, iatrogenic, IVDU
42
What are the clinical features of hepatitis B?
Acute and chronic (1-5%) forms
43
What can be used to treat chronic hepatitis B?
pegylated interferon - alpha 2a.
44
What is the genetic material of Hepatitis C?
RNA
45
How is hepatitis C transmitted?
Blood-bourne
46
What are the risk factors for hepatitis C?
90% history of IVDU
47
What are the clinical features of hepatitis C?
Acute (30%) or chronic (70%) 50% of cases are undiagnosed Previous infection does not give immunity
48
What is the consequence of chronic hepatitis C?
cirrhosis and liver failure
49
How is chronic hepatitis C treated?
Anti-virals
50
What is the genetic material of hepatitis D?
RNA
51
What is the clinical features of hepatitis D?
It cannot arise on its own. Will only present in combination with Hepatitis B.
52
What is Hep D spread?
Blood bourne
53
What is the genetic material of Hepatitis E?
RNA
54
How is hepatitis E transmitted?
faeco-oral spread
55
What are the clinical features of hepatitis E?
95% asymptomatic | Usually acute, can be chronic in immunosuppressed.
56
What are risk factors for hepatitis E?
Contaminated food and water - UK undercooked pork.
57
What is the progression of liver damage from alcohol?
Inflammation - steatosis - fibrosis - cirrhosis
58
How does alcohol damage the liver?
Conversion of ethanol - acetaldehyde uses NAD+ which leads to less fat oxidation. Acetaldehyde directly damages the hepatocytes.
59
What is the consequence of alcohol damage to the liver?
Liver failure
60
What are the causes of liver cirrhosis?
Alcohol abuse Hepatitis B or C Genetic disorders Non-alcoholic steatohepatitis
61
What are the signs of chronic liver disease?
``` Oedema Ascites Spider naevi Easy bruising Jaundice Prirutus Encephalopathy (CNS changes due to toxins) Infections Hypoglycaemia ```
62
What are the symptoms fo chronic liver disease?
Malaise Fever Anorexia
63
What is the cause of oedema and ascites in liver failure?
Failure of production of albumin - hypoalbuminaemia - low oncotic pressure of blood - fluid not drawn back in.
64
What is the cause of spider naevi?
Change in oestrogen metabolism causes dilation of blood vessels.
65
Why is there easy bruising in liver failure?
Clotting factors not produced
66
What are the results of blood tests in chronic liver failure?
LFTs - raised bilirubin, AST, ALT, GGT | Low albumin
67
What other investigations should be carried out in liver failure?
Ultrasound | Biopsy
68
How to treat chronic liver failure?
If alcohol induced - stop alcohol! Avoid NSAIDs, sedatives, opiates Treat cause Liver transplant
69
Is cirrhosis reversible?
NO
70
What are the causes of portal hypertension?
pre-hepatic - thrombosis hepatic - cirrhosis, fibrosis post hepatic - RHF, constrictive pericarditis
71
What is the effect of portal hypertension?
Results in varices (swollen veins) in teh oesophagus/stomach/rectum. Can also cause ascites.
72
What is the risk with varices?
Variceal bleeding - presents as a GI bleed.
73
What is the pathogenesis of oesophagel varices?
Progressive liver fibrosis/cirrhosis - portal hypertension - splanchnic vasodilation - increased CO - formation of collaterals between portal and systemic (ie. lower oesophagus) - pressure increases - eventual bleed.
74
What is non-alcoholic fatty liver disease?
An accumulation of fat in the liver that can lead to fibrosis and cirrhosis.
75
What are the risk factors of NAFLD?
Obesity Hypertension Diabetes Hyperlipidaemia
76
What lifestyle advice should be offered in NAFLD?
Weight loss Exercise Healthier diet - Mediterranean
77
What is no-alcoholic steatohepatitis?
Liver inflammation caused by fat deposition.
78
What is a possible complication of NASH?
Increases the risk of hepatocellular carcinoma.
79
What are three inherited metabolic causes of liver disease?
Wilson's disease Hereditory haemochromatosis Alpha-1-antitrypsin deficiency
80
What is Wilson's disease?
Excess copper in the liver and CNS
81
What is the presentation of Wilson's disease?
Liver - heaptitis | CNS - tremor, dysartria, involuntary movements
82
What is a sign of Wilson's disease?
Kayser-Fleischer ring (copper deposition in the cornea)
83
What is hereditory haemochromatosis?
Excess iron in various organs.
84
What is the presentation of hereditory haemochromatosis?
Bronze pigmentation Hepatomegaly Diabetes Pseudogout
85
What is alpha-1-antitrypsin deficiency?
Accumulation of alpha-1-antitrypsin in hepatocytes and a lack of it in the serum. Causing a lack of protease inhibition in alveoli - alveolar damage.
86
What is the physiology of bilirubin metabolism?
RBC breakdown releases unconjugated bilirubin - this is conjugated by the liver - released into the small intestine in bile - stercobilinogen excreted in faeces (brown) - urobilinogen reabsorped and excreted by kidneys (yellow).
87
What are the causes of pre-hepatic jaundice?
Haemolytic anaemia
88
What are the results of tests for pre-hepatic jaundice?
High unconjugated bilirubin | Normal otherwise.
89
What are the causes of hepatic jaundice?
ALD Hepatitis Drugs Autoimmune conditions
90
What are the results of tests for hepatic jaundice?
High unconjugated and low conjugated | Dark urine and pale stools
91
What are the causes of post-hepatic jaundice?
Gallstones | Stricture
92
What are the results of tests for post hepatic jaundice?
High unconjugated and high conjugated | Dark urine and pale stools
93
What is ascites?
Abnormal accumulation of fluid in the peritoneal cavity.
94
What are the three mechanisms of ascites formation?
Reduced blood outflow (ie. portal hypertension) Leaky membrane Decreased oncotic pressure (ie. hypoalbuminaemia)
95
What is the presentation of ascites?
``` Swollen stomach Tense Prominent veins Pain/discomfort Sign - shifting dullness due to fluid movement within. ```
96
What is an exudate fluid?
High protein fluid. low serum to ascites albumin gradient.
97
What is the cause of an exudate fluid ascites?
Membrane problem. | Malignancy, sepsis, TB
98
What is a transudate fluid?
Low protein fluid. High serum to ascites albumin gradient.
99
What is the cause of a transudate fluid ascites?
Reduced outflow or decreased oncotic pressure. Cirrhosis, cardiac failure.
100
How do you treat ascites?
Low sodium diet Diuretics FLuid restriction If that does not work - drain
101
What is the risk with ascites?
Spontaneous bacterial peritonitis (cloudy from the drain)
102
What is the toxic intermediate in paracetamol overdose?
NAPQI
103
What is the antidote for paracetamol overdose?
N-acetyl-cysteine (activated charcoal)
104
What is the most common tumour of the liver?
Secondary metastatic tumours.
105
Where may the secondary tumours of the liver originate from?
Stomach Breast Colon
106
What is the most common primary liver tumour?
Hepatocellular carcinoma
107
What are the symptoms of liver tumours?
``` Fever Malaise Anorexia Weight loss RUQ pain Jaundice/ascites - late presentations ```
108
Risk factors for hepatocellular carcinoma?
Hepatitis B virus Hepatitis C virus Cirrhosis NAFLD
109
What is a cancer of the biliary tree called?
Cholangiocarcinoma
110
What is the most common benign tumour of the liver?
Hemangioma

Phase 2a - conditions (11 decks)

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