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SJ Phase 2a > Liver + friends > Flashcards

Liver + friends Flashcards

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1
Q

Define acute liver failure

A

Rapid decline in hepatic function

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2
Q

Clinical presentation of acute liver failure

A
  1. Jaundice
  2. Abdominal pain
  3. Hepatic encephalopathy (confusion,insomnia)
  4. N+V
  5. Right upper quadrant tenderness
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3
Q

Diagnosis of acute liver failure

A
  1. LFT
    • Hyperbilirubinemia
    • Raised ALT
    • Raised AST
  2. PT/INR (coagulation test)
    • INR>1.5
  3. U&E
  4. Hepatitis screen (ABCE)
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4
Q

Treatment of acute liver failure

A
  1. ITU support
  2. Monitor and correct glucose + electrolytes
  3. Liver transplant
  4. N-acetylcisteine (paracetamol OD)
  5. Viral hepatitis - ACICLOVIR
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5
Q

Clinical presentation of chronic liver failure

A
  1. Oedema
  2. Gynaecomastia
  3. Anorexia
  4. Clubbing
  5. Easy bleeding + bruising
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6
Q

Aetiology of acute liver failure

A
  1. Paracetamol overdose
  2. Alcohol
  3. Viral hepatitis
  4. Drugs
  5. Obstruction
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7
Q

Aetiology of chronic liver failure

A
  1. Alcohol
  2. Viral hepatitis
  3. autoimmune
  4. Metabolic
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8
Q

Define liver cirrhosis

A
  1. Fibrosis and conversion of normal liver architecture
  2. To structurally abnormal nodules (regen nodules)
  3. Final stage of any chronic liver disease
  4. Irreversible
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9
Q

Aetiology of liver cirrhosis

A
  1. Alcohol abuse
  2. Hep B and C
  3. Fatty liver disease
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10
Q

Clinical presentation of liver cirrhosis

A
  1. Palmar erythema
  2. Dupuytren’s contracture
  3. Jaundice
  4. Ascites
  5. Spider naevi
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11
Q

Diagnosis of liver cirrhosis

A
  • serum albumin and PT (INR/PT = high)
    • Platelets
    • Thrombocytopenia
    • U+E
    • Biopsy
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12
Q

Treatment of liver cirrhosis

A
  1. LIVER TRANSPLANT
  2. Ascites = diuretics = SPIRONOLACTONE
  3. Cerebral oedema = MANNITOL
  4. Bleeding = VIT K
  5. Encephalopathy = decrease ammonia = LACTULOSE, ANTIBIOTICS, ENEMA
  6. Hep B - TENOFOVIR
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13
Q

Define ascites

A

Fluid in peritoneal cavity

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14
Q

Aetiology of ascites

A

Cirrhosis

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15
Q

pathophysiology of ascites

A
  1. Peritonitis = more leaky
  2. Raised capillary hydrostatic pressure
  3. Reduced colloid oncotic pressure
  4. Peritoneal lymphatic draining
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16
Q

How do you distinguish between transudate and exudate ascites

A
  1. Transudate = protein<25g/L
  2. Exudate = protein>25g/L
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17
Q

Aetiology of transudate ascites

A
  1. Portal hypertension
  2. Low plasma protein
  3. Heart failure
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18
Q

Aetiology of exudate ascites

A
  1. Peritonitis
  2. Peritoneal malignancy
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19
Q

Clinical presentation of ascites

A
  1. Shifting dullness - fluid = buoyancy -> tympanic sound on front where air filled bowel loops are, when patient lying supine but dullness on flanks
  2. Abdominal disetension
  3. Resp. distress
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20
Q

Diagnosis of ascites

A
  1. Physical examination of abdomen
  2. Diagnostic aspiration (needle for fluid check in abdomen)
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21
Q

Treatment of ascites

A
  1. salt restriction
  2. Diureitcs = FUROSEMIDE
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22
Q

What is SAAG

A
  1. Serum-Ascites Albumin Gradient
  2. Used to determine cause of ascites
  3. SAAG = (serum albumin) - (albumin level of ascitic fluid)
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23
Q

Aetiology of portal vein hypertension

A
  1. Prehepatic = portal vein thrombosis
  2. Intrahepatic = schistosomiasis, cirrhosis
  3. Posthepatic = right side heart failure
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24
Q

Transmission of Hep A

A

Faecal-oral

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25
Epidemiology of Hep A
1. Rare 2. Poor ends
26
Pathophysiology of Hep A
1. Acute infection 2. Usually cleared by host immune system
27
Clinical presentation of Hep A
NON SPECIFIC SYMPTOMS 1. Nausea 2. Anorexia 3. Malaise LIVER SYMPTOMS 1. Jaundice 2. Hepatomegaly 3. Skin rash
28
Diagnosis of Hep A
LFTs 1. Raised ALT (alanine transaminase) 2. Raised bilirubin 3. Serology
29
Treatment of Hep A
Vaccine
30
Transmission of Hep B (HBV)
1. Blood products (IVDU) 2. Sex (MSM) 3. Vertical transmission (across generations)
31
Pathophysiology of Hep B
1. Acute infection infects hepatocyte 2. Cellular response usually suffices 3. Chronic HBV if HbsAg >6months
32
Clinical presentation of Hep B
1. Acute infection symptoms 2. chronic -> cirrhosis symptoms
33
Diagnosis of Hep B
LFTs Serology Ag (Antigen) after 6 months = chronic Hep B
34
Treatment of Hep B
1. Vaccine 2. Antiviral treatment TENOFOVIR
35
Transmission of Hep C
1. Blood/blood products - IVDU 2. More common in UK
36
Pathophysiology of Hep C
1. Acute infection often asymptomatic .˙. can become chronic 2. Chronic -> slow progressive fibrosis over years
37
Clinical presentation of Hep C
Acute = asymptomatic Chronic = chronic liver disease
38
Diagnosis of Hep C
LFTs Serology If Ag after 6m = chronic HCV
39
Treatment of Hep C
Interferon based regimens
40
Transmission of Hep D
Blood borne - Sex - IVDU
41
Pathophysiology of Hep D
1. Requires concurrent HBV infection to replicate 2. Progression to cirrhosis more likely
42
Clinical presentation of Hep D
1. Vaccine 2. Antiviral treatment TENOFOVIR
43
Transmission of Hep E
Faeco-oral transmission (undercooked meat) Common in UK
44
Clinical presentation of Hep E
Asymptomatic
45
Diagnosis of Hep E
Serology
46
Treatment of Hep E
Not required but supportive
47
Define haemochromatosis
1. Multi-system disorder 2. Dysregulated dietary iron absorption 3. Increased iron release from macrophages
48
Aetiology of haemochromatosis
1. Autosomal recessive 2. Secondary iron overload by multiple transfusion
49
Pathophysiology haemochromatosis
Iron accumulates in: - liver - joints - pancreas - heart - skin - gonads
50
Clinical presentation of haemochromatosis
1. Slate grey skin 2. Hypogonadism
51
Diagnosis of haemochromatosis
1. Bloods - Iron - LFTs 2. Liver biopsy
52
Treatment of haemochromatosis
1. Venesection 2. Iron chelation 3. liver transplant
53
Define Wilson's disease
1. Excessive copper 2. Build up in liver and CNS
54
Aetiology of Wilson's disease
1. Autosomal recessive 2. Defective enzyme involved in biliary excretion of excess copper
55
Pathophysiology of Wilson's disease
1. Cu2+ accumulates in liver -> liver symptoms 2. Cu2+ accumulates in basal ganglia -> Parkinson's symptoms 3. Cu2+ accumulates in cornea -> Kayser-Fleischer rings)
56
Clinical presentation of Wilson's disease
1. Parkinson 2. Depression 3. Neurotic behaviour 4. Kayser-Fleischer ring
57
Diagnosis of Wilson's disease
1. 24h urine copper and blood caeruloplasmin 2. Liver biopsy
58
Treatment of Wilson's disease
1. Pencillamine (copper chelation) 2. Liver transplant
59
Define acute pancreatitis
1. Sudden inflammation of pancreas 2. Auto-digestion of the gland 3. reversible
60
Clinical presentation of acute pancreatitis
1. Sever epigastric pain radiating to back 2. N+V 3. Fever and chills 4. Haemodynamic instability 5. Retroperitoneal haemorrhage
61
Aetiology of acute pancreatitis
1. Idiopathic 2. Gallstones 3. Alcohol 4. Trauma 5. Steroids
62
Diagnosis of acute pancreatitis
1. Amylase/lipase 2. LFTs 3. CRP 4. CT
63
Treatment of acute pancreatitis
1. Nil By Mouth (NBM) - bowel rest 2. Aggressive fluid resuss 3. Analgesia 4. Abx (antibiotics) if necrotising pancreatitis
64
Define chronic pancreatitis
1. Long standing inflammation 2. From irreversible damage to pancreas
65
Clinical presentation of chronic pancreatitis
1. Epigastric pain radiating to back 2. N+V 3. Steatorrhea (fatty stool) 4. Weight loss 5. Insulin dependent DM
66
Aetiology of chronic pancreatitis
1. Alcohol 2. CF 3. Cancer 4. Autoimmune
67
Diagnosis of chronic pancreatitis
1. Secretin stimulation test 2. CT, MRI, MRCP
68
Treatment of chronic pancreatitis
1. Creon (pancreatic enzyme replacement therapy) 2. Insulin 3. Opioids 4. Alcohol cessation 5. Surgery
69
Define biliary colic
Temporary blockade of cystic duct by gallstones
70
Clinical presentation of biliary colic
1. RUQ pain after fatty meals 2. Referred shoulder pain 3. N+V
71
Diagnosis of biliary colic
1. USG 2. LFT 3. FBC 4. Lipase
72
Treatment of biliary colic
1. Analgesia 2. Lap. Cholecystectomy
73
Define acute cholecystitis
1. Blockade of cystic duct 2. Leading to build up of bile 3. -> transmural inflammation of gallbladder
74
Clinical presentation of acute cholecystitis
1. RUQ pain after fatty meals 2. Referred shoulder pain 3. N+V 4. Fever 5. Murphy's +ve (inspiratory arrest upon applying pressure to RUQ)
75
Diagnosis of acute cholecystitis
1. FBC 2. CRP 3. LFTs 4. USG (ultrasonography)
76
Treatment of acute cholecystitis
1. Lap cholecystectomy (within 7 days) 2. Fluids + analgesia for surgery
77
Define ascending cholangitis
1. Medical emergency 2. Bacteria ascending through biliary tree 3. -> septicaemia
78
Clinical presentation of cholangitis
1. Charcot's Triad - RUQ pain - Jaundice - Fever + rigors 2. Reynol'd pentad - Charcot's Triad - Confusion - Septic shock
79
Diagnosis of cholangitis
1. Amylase/lipase 2. LFTs 3. CRP 4. FBC 5. CT, USG, MRCP, ERCP
80
Treatment of cholangitis
1. Aggressive fluid resuss 2. IV Abx -> PENICILLIN & AMINOGLYCOSIDES 3. Pressor support 4. ERCP 5. Cholecystectomy when improved
81
Define primary biliary cirrhosis
1. Progressive autoimmune destruction of liver + biliary tree 2. -> fibrosis then cirrhosis

SJ Phase 2a (13 decks)

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