Liver and Friends Flashcards
(37 cards)
What is biliary colic?
A SYMPTOM!
- Pain due to obstruction of the cystic duct or the common bile duct with a gallstone
- Epigastric/RUQ pain, may radiate to R shoulder
What is acute cholecystitis?
Inflammation of the gallbladder as a result of obstruction of the cystic duct with a stone
What are the symptoms and signs of acute cholecystitis?
Symptoms:
- Biliary colic
- N+V
- Fever
Signs:
- Murphy’s sign (pain on inspiration when gallbladder is palpated)
- Local peritonism (tenderness, guarding)
Describe the investigation of acute cholecystitis
Bloods:
- LFTs: raised bilirubin, raised alkaline phosphatase (ALP) and rasied gamma-glutamyltransferase (GGT)
Abdominal US:
- Gallstones
Describe the management of acute cholecystitis
1st line = cholecystectomy
What is ascending cholangitis?
Inflammation/infection of the biliary tree, most commonly due to obstruction of the common bile duct by a gallstone
What are the symptoms and signs of ascending cholangitis?
Symptoms:
- Biliary colic
- N+V
- Fever
Signs:
- Jaundice
- Local peritonism (tenderness and guarding)
- Hypotension
- Confusion
Charcot’s triad = jaundice, biliary colic (RUQ pain), fever
Raynaud’s pentad = Charcot’s triad + hypotension and confusion
Describe the investigations of ascending cholangitis
Bloods:
- LFTs: raised bilirubin, alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT)
Abdominal US:
- Gallstones
Describe the pharmacological and interventional management of ascending cholangitis
Pharmacological:
- Analgesia
- IV Abx: Cefotaxime and Metronidazole
Interventional:
- ERCP (stone removal/stenting)
- Cholecystectomy
Briefly describe the pathophysiology of liver cirrhosis
- Hepatocyte necrosis
- Fibrosis
- Nodule formation
Give some signs of liver cirrhosis
- Hepatomegaly
- Ascites
- Jaundice
- Clubbing
- Leuconychia
- Spider naevi
- Dupuytren’s contracture
What are the causes of liver cirrhosis?
- Alcoholic liver disease
- Viral hepatitis
- Autoimmune, e.g. primary biliary cholangitis
- Metabolic, e.g. hereditary haemochromatosis, Wilson’s disease, alpha 1 antitrypsin deficiency
What is hereditary haemochromatosis?
An inherited condition in which iron levels in the body slowly build up over many years (iron overload) - this damages organs, e.g. heart, pancreas, liver
Describe the investigation of hereditary haemochromatosis
Bloods:
- Serum ferritin levels raised
- Transferrin saturation >45%
Liver biopsy:
- Perl’s stain = blue (iron present)
Describe the management of hereditary haemochromatosis
Conservative:
- Low iron diet
Interventional:
- Venesection (taking blood so that the body uses up its iron stored to make new RBCs)
Which organs does alpha 1 antitrypsin deficiency affect? How does it affect them?
- Lungs, causes emphysema
- Liver, causes cirrhosis and increased risk of hepatocellular carcinoma
Describe the investigation of alpha 1 antitrypsin deficiency
Bloods:
- Serum alpha 1 antitrypsin levels reduced
Liver biopsy:
- Put tissue samples through diastase treatment which should break down glycogen, however A1AD provides resistance to diastase treatment, so glycogen still present
- Use Periodic Acid Shiff (PAS) stain to show glycogen present (stains purple)
Describe the conservative management of A1AD
Smoking cessation
What is Wilson’s disease?
A genetic condition in which the levels of copper in the body are too high, so copper accumulates in organs (e.g. liver, brain) leading to organ damage
Describe a characteristic sign of Wilson’s disease
Kayser-Fleischer rings (dark rings that encircle the iris as a result of excess copper deposition)
Describe the investigation of Wilson’s disease
Urine:
- 24 hr copper excretion raised
Liver biopsy:
- Hepatic copper concentration raised
Describe the management of Wilson’s disease
Conservative:
- Low copper diet
Pharmacological:
- Penicillamine
- Zinc
What is primary biliary cholangitis?
Autoimmune destruction of the interlobar bile ducts, which leads to liver cirrhosis
Describe the investigation of primary biliary cholangitis
Blood tests:
- LFTs: raised bilirubin, raised ALP, low albumin
- Prolonged PT
- Autoantibody screen = anti-mitochondrial antibody (AMA)
