Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2a Gastrointestinal system > Liver + biliary > Flashcards

Liver + biliary Flashcards

1
Q

Why do you get poor coagulation function in primary biliary sclerosis, biliary cholangitis, stone in the common bile duct?

A

Cholestasis - the bile salts aren’t released into the intestine and so there is no absorption of fat soluble vitamins (ADEK). Vitamin K is needed to make factors 1972

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What auto-antibody is found in primary sclerosing cholangitis?

A

AMA (Anti-mitochondrial antibody)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the diagnostic finding for alcholic hepatitis?

A

AST:ALT ratio >2:1 (if you see this!!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are AST and ALT

A

aminotransferases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does ALP stand for?

A

Alkaline phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some of the signs you might see in primary biliary cirrhosis?

A

Xanthelasma (yellow fat deposits around eyes), ascites, hepatosplenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid + cholestyramine + vit ADEK supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between Wilson’s disease and haemochromatosis?

A

Wilson’s = copper deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you treat end stage liver disease?

A

Liver Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between primary sclerosing cholangitis and primary biliary cirrhosis?

A

Primary biliary cirrhosis affects intra-hepatic ducts only whilst primary sclerosing cholangitis affects both intra and extra-hepatic bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for primary sclerosing cholangitis?

A

Ursodeoxycholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the function of ursodeoxycholic acid and cholestyramine?

A

Reduces cholestatic itch (chelates bile salts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do iron studies show in haemochromatosis?

A

Decreased TIBC, ^ serum Fe and ferritin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main cause of haemochromatosis?

A

Autosomal recessive mutation to HFE gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for haemochromatosis?

A

Venesection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Does Wilson’s disease affect the basal ganglia? How?

A

Yes - causes Parkinson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the characteristic feature of Wilson’s disease?

A

Brown rings around iris (Kayser-Fleischer ring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give 3 metabolic causes of liver disease (cirrhosis)

A

Alpha1 anti-trypsin deficiency, haemochromatosis, Wilson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What investigations would you do to diagnose Wilson’s disease? What would you see?

A

Liver biopsy (^ copper), DECREASED serum copper, increased urinary 24hr copper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for Wilson’s disease?

A

Penicillamine or zinc (chelate copper)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What two diseases can alpha1 anti-trypsin deficiency cause?

A

COPD (emphysema specifically) and chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the role of alpha1 anti-trypsin?

A

Inhibits neutrophil elastase (+ other proteases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where is alpha1 anti-trypsin produced?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How might someone with alpha1 anti-trypsin deficiency present?

A

Neonatal jaundice

Adults: COPD or liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What would a liver biopsy show in alpha1 anti-trypsin def?

A

Hepatocytes with ^ intracellular globules of alpha1 anti-trypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is budd-Chiari syndrome?

A

A veno-occlusive disease by which there is thrombosis in the hepatic vein causing portal HTN. Most commonly caused by a hypercoaguable state (oral contraceptives, malignancy…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the best markers for demonstrating liver function?

A

PT (coagulopathy) and serum albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why might you get an increase in infection in liver failure/cirrhosis? What might you give them?

A

Decreased production of complement proteins. Influenzae and pneumococcal vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why might you get oedema in liver failure/cirrhosis

A

Reduced albumin production –> decrease in oncotic pressure inside vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why might someone bleed/bruise easily if they have liver cirrhosis?

A

Reduced production of clotting factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the pre-hepatic causes of portal HTN?

A

Veno-occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the hepatic causes of portal HTN?

A

Cirrhosis, alcoholic hepatitis, schistosomiasis, idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the post-hepatic causes of portal HTN?

A

RH F, constrictive pericarditis, Budd chiari

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is normal portal pressure?

A

5-8mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Explain the progression of alcoholic liver disease

A

Fatty liver –> alcoholic hepatitis –> fibrosis –> cirrhosis (non-reversible)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What pressure is portal hypertension characterised by?

A

> 10mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Give 4 complications of liver failure (chronic or acute)

A

^ infections (reduced complement proteins), bleeding/brusing (reduced clotting factor production), oedema and ascites (reduced albumin), osteoporosis, portal HTN + varices, HCC, AKI, malnutrition, hepatic portosystemic encephalopathy

38
Q

What is the tumour serum marker for HCC?

A

Alpha fetoprotein

39
Q

Why might you become malnourished with liver disease?

A

Reduced production of bile - no absorption of fat + fat soluble vitamins

40
Q

Why do those with liver failure/cirrhosis get hepatic porto-systemic encephalopathy?

A

Normally ammonia produced by gut bacteria is broken down in the liver to urea and CO2; however, due to reduced liver function this doesn’t occur and the ammoia bypasses the liver to the brain (ammonia = toxic)

41
Q

What does TIPS stand for and how does it cause hepatic encephalopathy?

A

Transjugular intrahepatic portosystemic shunt. Creates a shunt by which ammonia (produced by gut pathogens) can bypass the liver to the brain

42
Q

What is the characteristic feature around the eyes in primary biliary cirrhosis?

A

Xanthelasma

43
Q

Give 3 causes of ascites that are an exudate

A

Cirrhosis, R HF, Hepatic venous occlusion

44
Q

Give 3 causes of ascites that are a transudate

A

malignancy, nephrotic syndrome, pancreatitis

45
Q

How does cirrhosis, R HF and hepatic venous occlusion cause ascites?

A

They cause portal HTN -> decrease in effective arterial volume –> RAAS –> Na+/H2O retention

46
Q

How do you determine whether someone this a transudate or exudate pleural fluid? Can this be applied to Ascites?

A

LIGHT’s criteria

47
Q

What is the difference between exudate and transudate?

A

Higher LDH (>200) and protein levels (>2.5g/dL) in exudate

48
Q

How does malignancy cause ascites?

A

it causes hypoalbuminaemia –> decreased oncotic pressure

49
Q

What might you ask in a liver/jaundice Hx?

A

Alcohol? Travel? IVDU/tattoos? Blood transfusion pre-90s? Residence of birth?

50
Q

How would you treat ascites?

A

Treat the cause, low salt diet, water retention, k+ sparing diuretic (spironolactone), peritoneocentesis

51
Q

What are the causes of acute liver failure?

A

HAV, HBV, Excessive alcohol, paracetamol OD, idiopathic, drug induced (TB drugs)

52
Q

How does hepatic encephalopathy present?

A

Irritability/change in mood –> drowsiness –> confusion –> coma death

53
Q

How might liver disease result in hyponatraemia?

A

It produces Ang I needed in the RAA system

54
Q

What should you ask in a patient history if they present with acute liver disease?

A

Any drugs started recently?

55
Q

Give an example of a drug that is hepatotoxic

A

TB drugs (rifampicin, isoniazid, pyrazinamide) and paracetamol

56
Q

Why do patients with CLD get a coma/confusion? Give 3 reasons

A

Hepatic encephalopathy (build up of ammonia - as not broken down in the urea cycle by the liver), hypoglycaemia, intracranial event (bleed)

57
Q

What infections are those with CLD most likely to get?

A

SPONTANEOUS BACTERIAL PERITONITIS

58
Q

What is steatosis?

A

Fatty liver

59
Q

What causes a cholestatic itch?

A

Cholestasis - build up of bile in skin

60
Q

What liver tests give an idea of liver function?

A

PT and serum albumin

61
Q

What is the treatment for varices?

A

Endoscopic ligation banding + propranolol

62
Q

How do you treat hepatic encephalopathy?

A

decrease the absorption of ammonia (lactulose) and kill gut bacteria (Abx)

63
Q

What investigations would you do to determine the cause of chronic liver disease (CLD)?

A

Viral serology, serology (auto-Ab’s), biochem (iron/copper studies, alpha 1 -AT levels…), bilirubin, USS/CT, LFTs (ALT/AST, PT, serum albumin)

64
Q

What are the causes of CLD?

A

Alcoholic
Non-alcoholic fatty liver disease
HBV, HCV
Auto-immune (primary sclerosing cholangitis and primary biliary CIRRHOSIS)
Matabolic causes (Wilson’s disease, haemochromatosis, alpha1-AT def.)
Vascular (Budd Chiari)

65
Q

What type of cause for portal HTN is Budd Chiari syndrome?

A

post-hepatic (occlusion of hepatic veins)

66
Q

What are the signs of chronic liver disease?

A

Ascites, oedema, haematemesis (varices), spider naevi, palmar erythema, jaundice, confusion/coma, itching, easy bruising, anorexia (not eating), wasting…

67
Q

What are the causes of acute liver disease?

A

HAV, HBV, EBV, Paracetamol OD, TB drugs, excessive alcohol

68
Q

What is charcot’s triad?

A

Jaundice, fever and RUQ pain

69
Q

What type of cancer is hepatocellular carcinoma?

A

Adenocarcinoma - malignant tumour of glandular epithelium

70
Q

What is charcot’s triad a feature of?

A

Ascending cholangitis

71
Q

What is ascending cholangitis?

A

Infection of the biliary duct

72
Q

Give 3 causes of ascending cholangitis

A

CBD gall stone, benign biliary strictures (primary sclerosing cholangitis, post-surgery/ERCP), cancer of the head of the pancreas

73
Q

What type of jaundice occurs in ascending cholangitis?

A

Obstructive post-hepatic jaundice

74
Q

What bacteria commonly cause ascending cholangitis?

A

E.coli and enterococci

75
Q

What is biliary colic?

A

Pain of the upper abdomen that radiates the the R shoulder, associated with vomiting

76
Q

Why does pain in biliary colic radiate to the R shoulder?

A

Radiation via the phrenic nerve

77
Q

What is the presentation of gallstones?

A

Asymptomatic if in gall bladder

78
Q

What are the complications of gallstones?

A

Acute pancreatitis (common duct), ascending cholangitis, cholecystitis, obstructive jaundice

79
Q

What is acute cholecystitis?

A

Gallstone in the common bile duct causing inflammation of the gallbladder

80
Q

Does acute cholecystitis show jaundice?

A

No

81
Q

What is the presentation of cholecystitis

A

Biliary colic pain which then localises to the RUQ (with associated fever)

82
Q

How would you detect acute cholecystitis? What would this show?

A

Abdominal USS (shows thickenning of the gall bladder wall + presence of gallstones

83
Q

What is the treatment for acute cholecystitis?

A

Cholecystectomy

84
Q

What is the presentation of a stone in the common bile duct?

A

Asymptomatic unless it leads to acute ascending cholangitis

85
Q

Would you treat a stone in a common bile duct or gallstones in the gall bladder?

A

No unless they were symptomatic

86
Q

What does USS show if a stone is in the common bile duct?

A

Dilated CBD + the stone itself

87
Q

What is ascending cholangitis?

A

Bacterial infection of the biliary duct

88
Q

What investigations would you carry out to determine whether someone had ascending cholangitis? What would you see?

A

^ WCC, Blood culture (E. coli or enterococci), USS (dilated CBD, stone, cancer…), ERCP

89
Q

What type of features of jaundice would you see in biliary tract disease?

A

Dark urine + pale stools

90
Q

What is the most useful imaging technique in ascending cholangitis?

A

ERCP (as you can drain the duct)

91
Q

What is the treatment for ascending cholangitis?

A

IV fluids, analgesia, IV Abx, ERCP (biliary drainage + remove stone)

92
Q

What clotting factors does the liver not make?

A

III (tissue factor) and IV (Ca2+)

Phase 2a Gastrointestinal system (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions