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Flashcards in Liver and Friends Deck (51)
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1

Which Hepatitis virus is a DNA virus, rather than RNA?

Hepatitis B Virus (HBV)

2

Which Hepatitis viruses transmit via faeco-oral transmission?

HAV, HEV

fAEcal

3

Which Hepatitis viruses transmit via blood-blood transmission?

HBV, HCV, HDV

4

Who is at risk of contracting HDV? What is the management of HDV?

Person with HBV.

Can only get HDV WITH HBV.

Management: Pegasys: pegylated interferon-a 48wks

5

Acute HBV will show which antibody?

Past-exposure/ current HBV will show which Antibody?

Acute <6months - Anti-HBV IgM

Past-exposure - Anti-HBV IgG

6

Which Hepatitis Virus has no vaccine?

Hepatitis C - can be re-infected

7

Which Hepatitis Virus are you more likely to get if young?

Hepatitis A

8

Which Hepatitis Viruses give you a greater risk of developing Chronic Liver Disease/ Hepatocellular carcinoma?

Blood-Blood transmission viruses

HBV, HCV, HDV

9

Pt presents with Jaundice, fever and RUQ abdominal pain. They describe pale stools and you notice pruritus.

Likely diagnosis? Investigations?
Management

Acute Cholangitis

1L Transabdominal US

GOLD: ERCP + Biopsy
(Endoscopic retrograde cholangiopancreatography)

Mx: ABx, ERCRP Drainage + Decompression

10

Pt presents with RUQ Pain which started 9 hours ago, and a positive Murphy's sign.

Investigation, Management?

Acute Cholecystitis

GOLD: Abdominal US

Mx: Early Laparascopic Cholecystectomy (w/in 1 wk)

11

Define Biliary Colic

Steady severe abdominal pain (intensity >5) in the right upper quadrant, lasting 15-30 minutes

12

Management of gallstones

Asymptomatic: conservative

Asymptomatic but stone in common bile duct: clearance + laparoscopic cholecystectomy

Symptomatic: Cholecystectomy

13

A 50yr old F comes in with RUQ pain, fatigue, pruritus. She complains of a dry mouth and teary eyes. Palpation reveals hepatomegaly.

Investigations, likely diagnosis, management?

PBC-specific Autoantibody - AMA (Antimitochondrial Antibodies)

Primary Biliary Cholangitis

Mx: Ursodeoxycholic Acid - bile acid analogue + Prednisolone

14

What drug is used to treat cholestatic pruritus?

Cholestyramine

15

Pt presents with epigastric stabbing pain radiating to their back. Pain is relieved when moving forward. Theyre feverish and vomiting.

Likely diagnosis? Investigations
Causes? Mx?

Acute Pancreatitis

Causes: GET SMASHED
- gallstones
- Alcohol binge
- scorpion venom

Investigations: Elevated serum lipase/ amylase

IV Fluid Resus w/ crytalloids

16

Signs of severe haemorrhagic pancreatitis?

Cullen's sign: blue colour around umbilicus

Grey-Turner's sign: blue colour around flank

17

Pt presents with dull epigastric pain radiating to their back and steatorrhoea. Pain is worse after a fatty meal, and is relieved when sitting forward.

They are jaundice and you notice skin nodules.

Likely diagnosis? Investigations?

Chronic pancreatitis

Inv: Elevated BG

GOLD: CT abdomen - calcifications, enlargements, duct dilation

Mx: Alcohol abstinence, diet. Analgesia, insulin, pancreatic enzyme replacement.

Coeliac plexus block, pancreatectomy

18

Most common complication of acute liver failure

Infection

19

Management of Liver Failure

Underlying

Encephalopathy - IV Lactulose + Mannitol

Coagulopathy - VitK, fresh frozen plasma

Peritonitis - broad Abx

20

How do we determine if someone should have a liver transplant in the context of paracetamol overdose?

King's College Hospital Criteria for Liver Transplant

- arterial pH OR

prothrombin time
+ creatinine
+ Grade III/ IV encephalopathy

21

Pt presents with hepatic encephalopathy, bleeds readily and is jaundiced. They're nauseous and tired. You notice ascites.

Likely diagnosis? Tx?

Liver Failure
(Acute <26wks. Chronic if Hx cirrhosis)

Lactulose + Mannitol

VitK + Plasma

22

Management of Alcoholic Liver Disease.

Management of withdrawals

Abstinence + Oxazepam

Withdrawals: Chlordiazepoxide, Acamprostate, Naltrexone

23

Management of Non-Alcoholic Liver Disease

VitE + Orlistat + Insulin-sensitizer

Lifestyle

24

How do we assess the severity of someone's alcoholism?

AUDIT + SADQ Questionnaire

25

Pt presents with dark urine, jaundice and pale stools. Their ALP is markedly raised.

Likely diagnosis

Gallstones - obstructive cause of jaundice

ALP is upregulated in response to cholestasis

26

Isolated raised ALP indicates...

Where is ALP concentrated?

Isolated raised ALP indicates Bone pathology: tumour, vitD deficiency, fracture

ALP is concentrated in:
- liver
- BILE DUCT
- Bone tissue

ALP is upregulated in response to cholestasis :, is a good marker

27

Where is ALT concentrated?

ALT is concentrated in HEPATOCYTES :. is a good marker for hepatocellular injury:
- hepatitis

28

A marked raise in ALT and mild raise in ALP indicates...

Hepatocellular injury, eg Hepatitis

= Hepatic jaundice

29

A marked raise in ALP and mild raise in ALT indicates...

Cholelithiasis

= Post-hepatic jaundice

30

Pt is jaundiced, however their ALT and ALP levels are normal.

Likely cause? What will their urine and stools look like?

= Pre-hepatic cause of jaundice

- GILBERT's SYNDROME (impaired conjugation of bilirubin)

- HAEMOLYTIC ANAEMIA (haemolysis = more bilirubin)

Unconjugated Bilirubin is water insoluble, so:
- Normal urine colour

Pre-hepatic pathology, so fat absorption unaffected:
- Normal stool colour