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Medicine Finals: HARD STUFF ONLY > Liver + Friends > Flashcards

Liver + Friends Flashcards

1
Q

How does alcohol withdrawal present?

A

x

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2
Q

How does delirium tremens present?

A

x

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3
Q

How is delirium tremens managed?

A

x

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4
Q

What scoring system can be used to assess the severity liver cirrhosis? What is included in this scoring system?

A 
Child-Pugh classification
A - Albumin
B - Bilirubin
C - Clotting
D - distension (ascites)
E - encephalopathy
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5
Q

What is seen on ultrasound in liver cirrhosis?

A 
Nodular surface of the liver
Corkscrew appearance of the arteries 
Enlarged portal vein.
Ascites
Splenomegaly
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6
Q

How is liver cirrhosis monitored?

A

Ultrasound and alpha feroprotein checked every 6 months

Check that it has not become hepatocellular carcinoma

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7
Q

Why does malnutrition occur in liver disease?

A

Liver cannot store glucose as glycogen as effectively

Reduced production of protein

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8
Q

What autoantibodies are present in autoimmune hepatitis?

A

Type 1 – ANA/anti-smooth muscle

Type 2 – Ant-kidney-liver ribosomes 1

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9
Q

What are drug causes of hepatocellular dysfunction?

A 
Paracetamol
Alcohol
Sodium valproate+Phenytoin
Nitrofurantoin
Amiodarone
Methyldopa
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10
Q

What are drug causes of cholestasis?

A 
COCP
Fluclox
Co-amox
Erythromycin
Sulfonylureas
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11
Q

In which of PBC or PSC can ursodeoxycholic acid improve outcomes?

A

PBC

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12
Q

How is chronic pancreatitis diagnosed?

A

CT = pancreatic calcification

Faecal elactase = Low

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13
Q

How does haemochromatosis present?

A 
Early symptoms – fatigiue, erectile dysfunction, arthralgia
Liver cirrhosis
Diabetes
Joint pain(arthritis)
Dilated cardiomyopathy
Hypogonadotropic hypogonadism 
Bronze skin pigmentation
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14
Q

How does Wilson’s disease present?

A

In children – liver symptoms eg cirrhosis, pruritus, spider naevi, palmar erythema

In young adults – neurological symptoms eg memory problems, psychosis, mood disorders, Parkinsonism, concentration and co-ordination difficulties, speech difficulties, asterixis

Other:
Kayser-Fleischer rings
Blue nails

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15
Q

How is Wilson’s disease diagnosed?

A

First line = 24 hour urine collection for copper

Reduced serum copper
Reduced serum caeruloplasmin

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16
Q

In which of Wilson’s disease or haemochromatosis is there an increased risk of hepatocellular carcinoma?

A

Haemochromatosis

17
Q

What is seen on CT in pancreatic cancer?

A

Double duct sign = dilation of the pancreatic duct and the common bile duct

18
Q

What are signs of appendicitis?

A

Pain which starts at the umbilicus then localises to the RIF
Anorexia
Nausea
Tenderness at McBurney’s point
Tenderness on PR
Rovsing’s sign = tenderness in the R iliac fossa when palpating the L iliac fossa

19
Q

What is seen on blood tests in appendicitis?

A

Neutrophil predominant leukocytosis

20
Q

How does carcinoid syndrome present?

A

Diarrhoea
Flushing
Hypotension
Wheeze

21
Q

What is Budd-Chiari syndrome and how does it present? How can it be diagnosed?

A

Thrombosis of the hepatic vein

TRIAD=
Sudden onset severe abdominal pain
Ascites
Tender hepatomegaly

Diagnosis = Doppler ultrasound

22
Q

What are causes of Budd-Chiari syndrome?

A

Polcythaemia vera
Pregnancy
COCP
Thrombophilia

23
Q

What factors are used to determine severity of acute pancreatitis?

A 
P – paO2 <7.9
A – Aged >55
N - neutrophila (high WCC)
C – calcium (low)
R  - renal function (high urea)
E – enzymes (raised LDH)
A - albumin (low)
S – sugar (HIGH glucose)
24
Q

How can you interpret an ascitic tap?

A

SAAG – serum ascites albumin gradient

SAAG >11 = Liver cirrhosis, heart failure, liver mets, Budd-chiari syndrome

SAAG <11 = Nephrotic syndrome, severe malnutrition

25
Q

What is Maddrey’s discriminant function?

A

Uses prothrombin time and bilirubin levels to determine whether oral prednisolone would help

26
Q

What is Mirizzi’s syndrome?

A

Complication of gallstones
Cause of acute cholecystitis

Gallstone becomes impacted in the distal cystic duct, causing extrinsic compression of the common bile duct

27
Q

Compression of which part of the biliary tree causes jaundice?

A

Common bile duct

Compression of the cystic duct does not cause jaundice

28
Q

What is Rovsing’s sign?

A

In appendicitis - palpation of the left iliac fossa causes pain in the right lilac fossa

29
Q

What is Boas sign?

A

In acute cholesytisis - hyperaesthesia beneath the right scapula

30
Q

When would a TIPS be used for oesophageal varicose?

A

For varices that are resistant to other prophylactic treatments

31
Q

What are complications of PBC?

A

Cirrhosis
Portal hypertension
Hepatocellular carcinoma

32
Q

How does PBC present and what marker is raised?

A

Middle aged female with history of autoimmune disease. Fatigue, pruritus, xanthomata, xanthelasma

Anti-mitochondrial antibodies

33
Q

How does PSC present and what marker is raised? What is seen on MRCP?

A

History of ulcerative colitis. Cholestasis - jaundice, pruritus, RUQ pain.

Raised pANCA

MRCP = beaded appearance

34
Q

What can cause tender, pulsatile hepatomegaly?

A

Right sided heart failure

35
Q

Post-cholecystectomy steatorrhoea - what medication can help with this?

A

Cholestyramine

36
Q

What are complications of pancreatic cancer?

A

Jaundice
Trousseau’s syndrome - thrombophlebitis
DIC
Diabetes

37
Q

What is Courvoisier’s sign?

A

Palpable painless gallbladder with jaundice — likely to be Pancreatic cancer

38
Q

How to manage severe jaundice causeb by unresectable pancreatic cancer?

A

Biliary stenting

39
Q

What is the criteria for liver transplantation in paracetamol induced liver failure?

A

Arterial pH <7.3 24 hours after ingestion

OR
Prolonged PT + Raised Creatinine + Encephalopathy

Medicine Finals: HARD STUFF ONLY (23 decks)

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