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Liver and GI Flashcards

1
Q

signs of compensated liver disease

A

yellow sclera, spider naevi, gynacomastia, liver large or small, splenomegaly, clubbing, duputryens, scratch marks, pigmented ulcers

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2
Q

signs of decompensated liver disease

A

disorientated, drowsy, coma, hepatic flap, dilated abdo veins, oedema

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3
Q

What is jaundice?

A

skin/sclerae yellow discolouration due to raised bilirubin

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4
Q

which enzyme converts unconjugated bilirubin –> conjugated bilirubin?

A

glucuronyl transferase

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5
Q

Congenital cause of jaundice?

A

Gilbert’s syndrome

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6
Q

how does gilbert’s syndrome present? which gene is mutated?

A

asymptomatic incidental finding of raised unconjugated bilirubin.

Mutation in glucuronyl transferase (less of the bilirubin is conjugated.)

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7
Q

What clinical picture does cholestatic jaundice give?

A

pale stools, dark urine (bilirubin conjugated)

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8
Q

Intrahepatic causes of cholestatic jaundice?

A

hepatitis, drugs, alcohol, cirrhosis, neoplastic infiltrations

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9
Q

Extrahepatic causes of cholestatic jaundice?

A

duct stones, bile duct/pancreatic cancer, stricture, sclerosing cholangitis

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10
Q

How do you determine location of problem with LFTs?

A

Raised AST = intrahepatic

Raised ALP = extrahepatic

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11
Q

Ix of cholestatic jaundice?

A

LFTs, US of the biliary tree, hep A and B markers, prothrombin time

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12
Q

What is hepatitis?

A

liver cell necrosis and inflammatory cell infiltration

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13
Q

Causes of hepatitis?

A

viral - A,B, C, EBV, CMV, yellow fever
Drugs - paracetamol
Alcohol
Other - wilson’s disease, haemochromatosis

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14
Q

Features of Hep A?

A

spread faeco-orally via contaminated shellfish/water

- jaundice, N&V, anorexia, hepatomegaly

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15
Q

Ix for hepatitis viral infections?

A

LFTs, HEP antibodies, ESR, bilirubin levels

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16
Q

How are hep B and C spread?

A

blood/blood products/sex

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17
Q

Prophylaxis against hep B and C?

A

avoid needle sharing/prostitutes, counselling patients, immunisation

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18
Q

features of fulminant liver failure

A

reduced attention, liver flap, disorientated in time, confused and coma

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19
Q

Features of autoimmune hepatitis?

A

anorexia, malaise, nausea, fatigue, palma erythema, spider naevi, hepatosplenomegaly, jaundice

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20
Q

Mx of autoimmune hepatitis?

A

prednisolone, immunosuppressants

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21
Q

What is non-alcoholic fatty liver disease?

A

same liver biopsy findings as those drinking lots, but in absence of heavy drinking

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22
Q

what diseases are affected by NAFLD?

A

obesity, T2DM, hyperlipidaemia

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23
Q

What do you see on an US of NAFLD?

A

hyperchoic texture/bright liver and fatty infiltratione

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24
Q

What is cirrhosis?

A

necrosis of liver cells followed by fibrosis and nodule formation. Result = impaired liver cell function and distortion of liver architecture

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25
Name the 2 histology types of cirrhosis? + their causes
MICRONODULAR - uniform small 3mm nodules in diameter. Cause = alcohol/biliary tract dis MACRONODULAR - variable nodule size and normal acini inbetween. Follows viral hepatitis
26
Ix for cirrhosis?
LFTs/FBC/prothrombin time/albumin/UEs/aFP/US liver and portal veins, endoscopy for varices, DXA for osteoporosis
27
Mx of cirrhosis?
correct the underlying cause. Immunisations. Liver transplant. screen HCC - aFP and US 6 monthly
28
Name 3 complications of cirrhosis?
portal HTN, variceal haemorrhage, ascites
29
which veins meet to form the portal vein?
splenic vein and superior mesenteric
30
Features of portal vein HTN?
GI oesophageal bleeding, ascites, hepatic encepalopathy
31
How do you manage an active variceal haemorrhage?
1. resuscitate the patient 2. urgent gastroscopy --> band ligation 3. Terlipressin (reduces portal blood flow) 4. Somatostatin infusion 5. balloon tamponade 6. surgical ligation of barices
32
Transudate causes of ascites?
portal HTN, cardiac failure, cirrhosis
33
Exudate causes of ascites?
pacreatitis, nephrotic syndrome, peritoneal TB
34
Ascites features?
flank fullness, shifting dullness, pleural effusion, peripheral oedema, tense ascites
35
Ascites Ix?
aspirate the ascitic fluid - albumin, neutrophil count, gram stain and culture, cytologym amylase
36
Mx of ascites?
measure UEs and K levels | spironolactone/furosemide
37
Common bacteria which causes spontaenous bacterial peritonitis?
E.Coli
38
Which toxic substance causes portosystemic encepalopathy?
Ammonia
39
Features of portosystemic encepalopathy?
drowsy and coma, increased tone and reflexes | patient irritable and slow/confused
40
Mx of portosystemic encepalopathy?
lactulose, Abx, maintain Kcals
41
What is primary biliary cirrhosis?
progressive destruction of intrahepatic bile ducts due to abnormal immunoregulation --> causes cholestasis and cirrhosis
42
What antibodies are there in primary biliary cirrhosis? What does the biopsy show?
AMA ABs | loss of bile ducts/lymphocyte infiltration/granuloma formation
43
Mx of primary biliary cirrhosis?
lifeling Ursodeoxycholic acid
44
What is hereditary haemochromatosis?
excessive iron deposition in organs --> fibrosis --> organ failure. It is due to increased iron absorption from the upper small intestine
45
Features of hereditary haemochromatosis?
``` Liver - hepatomegaly/lethargy Pancreas - DM Heart - Cardiomegaly Pituitary - reduced libido, impotence Joints - arthralgia Skin - increased pigment ```
46
Ix findings in haemochromatosis?
LFTs often normal, increased serum iron, reduced TIBC, genotyping HFE
47
What is wilsons disease?
mutation which causes reduced Cu secretion into bile. Cu accumulates in the liver = liver failure and cirrhosis. It also causes parkinson's/dementia in the basal ganglia and kayser fleischer rings in the cornea.
48
Ix findings for wilson's disease?
low serum Cu, increased urinary Cu secretion
49
Mx of wilson's disease?
Penicillame
50
What is the histology of alcohol hepatitis?
steatosis, ballooned hepatocytes, MALLORY BODIES (surrounded by neutrophils and fibrous/foamy degeneration of hepatocytes)
51
what is primary sclerosing cholangitis?
progressive fibrosis of intra and extra hepatic ducts --> cirrhosis. 75% of patients have UC
52
Mx of primary sclerosing cholangitis?
ursodeoxycholic acid
53
What is Budd-Chiari syndrome?
occluded hepatic vein obstructing venous outflow from the liver and causes staiss --> hypoxic damage and necrosis of hepatocytes
54
What organism commonly causes a liver abscess?
E.Coli
55
Features of a liver abscess?
fever, lethargy, weight loss, abdo pain, enlarged and tender lvier, right chest effusion
56
RF for HCC?
Hep B/C, androgenic steroids, aflatoxin, COCP? male
57
Features of HCC
weight loss, anorexia, ascites, abdo pain
58
name the 2 types of gallstones
cholesterol, pigment
59
Describe biliary pain?
exam = normal severe constant upper abdo pain (subsides after hours) pain can radiate to the right shoulder associated with vomiting
60
Gallstone RF?
increasing age, female, family history, rapid weight loss, ileal disease, diet high in animal fat
61
What do the LFTs show with gallstones?
raised ALP and raised bilirubin (conjugated)
62
Mx for gallstones?
analgesia, elective cholecystectomy
63
What is acute cholecystitis?
impaction of a stone in cystic duct/gall bladder neck
64
Features of acute cholecystitis?
initial features similar to biliary colic | LEADS TO - severe localised pain, associated fever, muscle guarding, Murphy's pain (pain worse on inspiration)
65
Ix for acute cholecystitis?
WCC raised, serum LFTs mildly abnormal | abdo US - gallstone and distended gallbladder
66
Mx of acute cholecystitis?
NBM, IV fluids, IV cefotaxime, cholecystectomy
67
what is acute cholangitis?
infection of biliary tree, often due to obstructed CBD by gallstones
68
features of acute cholangitis?
CHARCOT TRIAD - fever, jaundice, RUQ pain
69
Pathogenesis of acute pancreatitis?
increased intracellular Ca, causing activation of intracellular proteases and release of pancreatic enzymes which results in acinar cell injury/necrosis --> inflammatory cells recruited
70
Features of acute pancreatitis?
epigastric pain radiating to back, associated nausea and vomiting. Abdo tenderness, guarding, rigidity coma, multiorgan failure
71
Signs of acute pancreatitis on the abdomen?
cullens - ecchymoses around umbilicus | grey turner sign - ecchymoses around the flank area
72
Causes of acute pancreatitis?
gallstones, alcohol, post surgery/ERCP/pancreatic tumours/trauma
73
Ix for acute pancreatitis?
Bloods - increased amylase/lipase (also do FBC/CRP/UE/LFT/Ca) Radiology - CXR, Abdo US (shows inflamed pancreas and fluid collections)
74
what is the scoring criteria for acute pancreatitis?
glasgow scoring criteria
75
Mx for acute pancreatitis?
``` HDU if necessary IV fluids correct metabolic abnormalities LMWH supplmentary O2 sliding scale insulin ```
76
Complications of acute pancreatitis?
hyperglycaemia, hypocalcaemia, renal failure, shock
77
What is chronic pancreatitis?
inappropriate activation of enzymes within pancreas leading to plugs within duct lumen --> forms nidus for calcification. Duct blockage causes ductal HTN and pancreatic damage
78
name causes of chronic pancreatitis?
alcohol, autoimmune, CF
79
Features of chronic pancreatitis?
epigastric abdo pain which radiates to back + weight loss | diabetes/steatorrhea - due to endocrine and exocrine insufficiency
80
Ix of chronic pancreatitis?
XR - pancreatic calcification US/CT - duct dilation/fluid collection BG - increased if there is DM
81
Features of pancreatic cancer?
painless jaundice and weight loss scratch marks distended gallbladder central abdo mass
82
Ix for pancreatic cancer?
US/CT, ERCP (palliative stent), CA19-9

Finals (21 decks)

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