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Phase 2a Ru > Liver + Friends > Flashcards

Liver + Friends Flashcards

1
Q

What are the functions of the liver

A

Oestrogen level regulation
Albumin
Clotting factors
Storage (VITS, Fe, Metabolism of carbs, Immunity, Detoxification, Bilirubin metabolism

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2
Q

How do bilirubin, albumin and prothrombin time change with liver damage

A

Bilirubin and prothrombin time increase
Albumin decreases

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3
Q

What does an AST:ALT ratio of 2:1 suggest

A

Alcoholic liver disease

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4
Q

What does an AST:ALT ratio of 4.5:1 suggest

A

Wilson’s or hyperthyroid

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5
Q

What does an AST:ALT ratio of <0.9:1 suggest

A

None alcoholic fatty liver disease

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6
Q

Where are ALT and AST found other than the liver

A

Heart, kidney and muscles

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7
Q

What is GGT

A

Gamma-glutamyl transferase, an enzyme found mostly in liver

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8
Q

What does a raised GGT suggest

A

Alcoholic liver disease (helps differentiate raised ALP as an hepatic/ bony cause)

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9
Q

What is ALP

A

Alkaline phosphate

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10
Q

What does a raised ALP suggest

A

Biliary tree specific damage and bone pathology

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11
Q

What is liver failure

A

When the liver loses regeneration/ repair ability

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12
Q

What is acute liver failure

A

Liver injury accompanied with hepatic encephalopathy, jaundice, coagulopathy and ascites.
In patients with previously normal liver

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13
Q

What is fulminant liver failure

A

Rare syndrome of massic hepatocyte necrosis

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14
Q

What do you see histologically in fulminant liver failure

A

Multiacinar necrosis

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15
Q

What are the three types of fulminant liver failure

A

Hyperacute:- HE within 7 days of jaundice
Acute:- HE within 8-28 days of jaundice
Subacute:- HE within 5-26 weeks of jaundice

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16
Q

What is the main cause of fulminant liver failure

A

Paracetamol overdose

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17
Q

What is acute on chronic liver failure

A

Abrupt decline in patient with chronic liver symptoms

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18
Q

What is chronic liver failure

A

Patient with progressive history of liver disease
e.g. Hepatitis- fibrosis- compensated cirrhosis- decompensated cirrhosis
6+ months

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19
Q

What are causes of liver failure

A

Viral (Hep A,B,E CMV EBV)
Autoimmun hep
Drugs:- Paracetamol, alcohol, ecstasy
Metabolic:- Wilsons, haemochromatosis
Budd Chiari
Hepatocellular carcinoma

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20
Q

What are the signs/ symptoms of liver failure

A

Jaundice, coagulopathy, Hepatic encephalopathy
Spider naevi
Fetor hepaticus (rotten egg/ garlic breath)
Caput medusae (distended epigastric veins)
Duputryens contracture

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21
Q

What is the West Haven Criteria

A

For grading Hepatic encephalopathy
1:- Altered mood, sleep issues
2:- lethargy, mild confusion, asterixis (hands flapping when wrist is extended)
3:- Marked confusion, somnolent
4:- Comatose (state of coma)

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22
Q

What investigations do you carry out in suspected liver failure

A

LFTs (increased NH3, decreased glucose)
EEG to grade HE
Ultrasound to check Budd Chiari
Microbiology to rule out infection (blood culture, urine culture, ascitic tap)

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23
Q

What is the treatment for acute liver failure

A

Administer to ITU ABCDE,
Fluid, Analgesia
Treat underlying causes + complications

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24
Q

How do you treat the complications of liver failure

A

Increased ICP:- IV mannitol
HE:- Lactulose
Ascites:- Diuretics (spironolactone)
Haemorrhage:- Vitamin K

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25
Q

How does lactulose treat Hepatic encephalopathy

A

Increases NH3 excretion

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26
Q

What is the most common cause of chronic liver failure

A

Alcoholic liver disease

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27
Q

Other than ALD what are causes of chronic liver failure

A

Non-alcoholic fatty liver disease
Viral Hep B C/D
Metabolic, Budd Chiari, drugs, autoimmune, PBC + PSC)

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28
Q

What are risk factors for chronic liver failure

A

Alcohol, obesity, T2DM, drugs, Inherited metabolic disease/ existing autoimmunity

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29
Q

What is the Child-Pugh Score

A

Assesses the prognosis and extent of treatment required in chronic liver disease

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30
Q

What is decompensated cirrohis a massive risk factor for

A

Hepatocellular carcinoma

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31
Q

What is the MELD socre

A

Model for end-stage liver disease, stratifies severity of ESLD for transplant planning

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32
Q

What are the signs/ symptoms of chronc liver failure

A

Jaundice, ascites, HE, Portal Htn, oesophageal varices, caput musase, spider naveri, palmer erythema, gynecomastia, clubbing, fetor hepaticus, dupytrens contracture

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33
Q

What are the classes in the Child Pugh score

A

A:- 100% 1Y survival
B:- 80% 1Y survival
C:- 45% 1Y survival

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34
Q

What is the gold standard test for chronic liver failure

A

Liver biopsy

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35
Q

What is the treatment for chronic liver failure

A

Prevent progression, lifestyle modification
Consider liver transplant
Manage complications

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36
Q

How do you manage the complications of chronic lier failure

A

HE:- Lachilose
Ascities:- diruetics

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37
Q

What is the grams and mls of 1 unit of alcohol

A

8g and 10ml

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38
Q

What is the progression of alcoholic liver disease

A

Steatosis (fatty liver undamaged), alcoholic hepatitis (w/ mallory bodies), alcoholic cirrhosis

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39
Q

Name two alcohol dependency questionnaires

A

CAGE, Audit

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40
Q

What are the CAGE quations

A

should you Cut down
are people Annoyed by your drinking
feel Guilty about your drinking
do you drink in the morning (Eye opening)

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41
Q

What do LFTs show in ALD

A

LFTs:- Increased bilirubin, decreased albumin, increased pro thrombin time, increased GGT
AST:ALT >2

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42
Q

What anaemia do you often see with ALD

A

Macrocytic non megaloblastic anemia

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43
Q

Why do you do a biopsy in ALD

A

Confirm extent of cirrhosis or simply hepatitis

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44
Q

What do you see on a biopsy of ALD

A

Inflammation, necrosis, Mallory cytoplasmic inclusions bodies

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45
Q

How do you treat delirium tremours from alcohol withdrawal

A

Diazepam

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46
Q

What are pharmological options for treatment for ALD

A

Steroids short term
B1 + folate supplements

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47
Q

How long must a patient abstain prior to a liver transplant for ALD

A

3+ months

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48
Q

What are the complications of ALD

A

Pancreatitis
HE
Ascites
HCC
Malory West tear
Wernicke korsakoff syndrome

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49
Q

What is Werinicke Korsakoff syndrome

A

Combined b1 deficincey and alcohol withdrawal symptoms

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50
Q

What are symptoms of Werincke korsakoff syndrome

A

Ataxia, nystagmus, encephalopathy

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51
Q

What is the treatment for Wernicke Korsakoff syndrome

A

IV Thiamine

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52
Q

What are the risk factors for non-alcoholic fatty liver disease

A

Obesity, Htn, hyperlipidaemia, T2DM, Fhx, endocrine disorders, drugs (NSAIDS, amiodarone)

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53
Q

What is the progression of non-alcoholic fatty liver disease

A

Hypostatises, non alcoholic steatohepatitis, fibrosis, cirrhosis

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54
Q

Symptons of NAFLD

A

Typically asymptomatic
If v. severe, presents with signs of liver failure

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55
Q

What is the 1st line test for NFLAD

A

US abdomen

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56
Q

What does FBC show in NFLAD

A

Thrombocytopenia, hyperglycemia

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57
Q

How can you assess the risk of fibrosis

A

With a non-invasive scoring system
FIB-4 (fibrosis 4 score)

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58
Q

What is the treatment for NFLAD

A

Lose weight, control risk factors, Vitamin E

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59
Q

Which of the viral hepatitis can be chronic

A

Hep C and Hep B

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60
Q

Which of the Viral hepatitis are RNA and which DNA

A

Hep A+C+E+D; RNA

Hep B; DNA

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61
Q

What are the causes of acute pancreatitis

A

I GET SMASHED
Idiopathic
Gallstones 50+% of all acute cases
Ethanol 80% of all chronic cases
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom/ spider bite
Hypercalcemia/ hyperlipidemia
ERCP
Drugs (NSAIDS, ACEi)

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62
Q

What country has a high prevalence of Autoimmune Pancreatitis

A

Japan

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63
Q

What serum antibody is present in autoimmune pancreatitis

A

IgG4

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64
Q

What is the treatment for autoimmune pancreatitis

A

Oral prednisolone for 4-6 weeks

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65
Q

How do gallstones cause pancreatitis

A

Gallstones abstract pancreatic secretions which accumulate enzymes. The host defence is soon overwhelmed which then leads to auto digestion. Inflammation and enzymes leak into blood

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66
Q

What prevents autodigestion of the pancreas (host defence)

A

A1AT, pancreatic secretory transport inhibitors

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67
Q

What are the signs/ symptoms of acute pancreatitis

A

Sudden severe epigastric pain radiating to back
Jaundice, pyrexic, steatorrhoea, grey turner sign and Cullen sign.

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68
Q

What is Grey Turner sign

A

Flank bleeding/ bruisng

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69
Q

What is Cullen sign

A

Periumbiliacal bleeding/ discolouration

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70
Q

What is the gold standard investigation for acute pancreatitis

A

Serum amylase/ Lipase

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71
Q

Other than acute pancreatitis, what can increase serum amylase/ lipase.

A

Gastroduodenal perforation.
CXR to exclude

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72
Q

What is required to diagnose someone with acute pancreatitis

A

2 of
Characteristic symptoms
High amylase/ lipase
Radiological evidence

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73
Q

What scoring system can be used to assess the severity of acute pancreatitis within 24hr

A

APACHE2

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74
Q

What scoring system can be used to predict a severe attack in acute pancreatitis after 48hr

A

Glasgow score

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75
Q

What is the treatment for acute pancreatitis

A

NIL by mouth
IV fluid
Analgesia (IV morphine)
Catherterise
Abx prophylaxis

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76
Q

What is a complication of acute pancreatis

A

Systemic inflammatory response syndrome (SIRS)
2 or more of
Tachycardia
Tachypnoea
Pyrexia
Increased WCC

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77
Q

What is chronic pancreatitis

A

3+ months of pancreatic deterioration, irreversible pancreatic inflammation + fibrosis

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78
Q

What are the causes of chronic pancreatitis

A

Alcohol (MC)
CKD, Trauma, recurrent acute pancreatitis

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79
Q

What are the symptoms of chronic pancreatitis

A

Epigastric pain that radiates to back, exacerbated by alcohol

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80
Q

What are the exocrine and endocrine Sx of chronic pancreatitis

A

Steatorrhea and endocrine dysfuntion

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81
Q

What are the serum levels of amylase/ lipase in severe chronic pancreatitis

A

Not raised, none left to leak out

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82
Q

What is fecal elastase

A

An enzyme that breaks down proteins produced by the pancreas

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83
Q

Why would you do an US + CCT to investigate chronic pancreatitis

A

To detect pancreatic calcification + dilated pancreatic duct (diagnostic)

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84
Q

How to treat chronic pancreatitis

A

Stop alcohol
NSAIDS for analgesia
Pancreatic supplements (enzymes + Insulin)

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85
Q

What can cause pre-hepatic portal Htn

A

Portal Vein thrombosis

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86
Q

What can cause intrahepatic portal Htn

A

Cirrhosis (MC IN UK)
Schistomiasis

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87
Q

What are causes for post hepatic portal Htn

A

Budd Chiari
RHS heart failure
Constrictive pericarditis

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88
Q

How does cirrhosis cause portal Htn

A

Increases the resistance of flow and then splanchnic dilation and compensatory increased cardio output. This results in fluid overload in the portal vein.

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89
Q

What is usual portal pressure

A

5-8mmHg

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90
Q

How does portal Htn cause oesophageal varices

A

Blood shunting to gastroesophageal veins @ the cardia + lower oesophagus

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91
Q

What % of patients with portal Htn develop oesophageal varices

A

90%

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92
Q

What % of people with oesophageal varices due to portal Htn have a rupture

A

33%

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93
Q

What is a differential diagnosis for oesophageal varices rupture

A

Mallory west tear

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94
Q

How do you diagnose oesophageal varices

A

Oesophagaealgastroduoendoscopy

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95
Q

What is first-line treatment for ruptured oesophageal varices

A

Resus until haemodynamically stable
(consider bloood transfusion)

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96
Q

What is the treatment to stop bleeding oesophageal varices

A

IV Terupressin
Variceal banding
Transjugular intrahepatic portosystemic shunt (TiPPS) :- decreases portal pressure by diverting blood to other veins.

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97
Q

What is a side effect of TiPPS

A

Hepatic encepholopathy due to not properly filtered blood

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98
Q

How do you prevent bleeds in oesophageal varices

A

Non-selective beta-blocker:- propranolol + nitrates
Repeat variceal banding
Last resort:- liver transplant

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99
Q

What is most common cause of fulminant liver failure

A

Paracetamol overdose 50%

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100
Q

How much paracetamol needs to be ingested for an overdose

A

> 75mg/kg

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101
Q

What are the symptoms of a paracetamol overdose

A

Severe RUQ pain, severe N+ V

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102
Q

What is the treatment for a paracetamol overdose

A

Activated charcoal within 1hr of paracetamol ingestion + N-acetyl-cysteine

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103
Q

What % of paracetamol usually undergoes phase 1 conjugation and what % phase 2

A

10% phase 1
90% phase 2

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104
Q

What is ascites

A

Accumulated free fluid in abdo cavity

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105
Q

What are causes of ascities

A

Local inflammation:- peritonitis abdo cancer
Low protein:- nephrotic syndrome, hypoalbuminemia
Flow stasis:- cirrhosis, budd chiari, congestive heart failure, constrictive pericardiatis

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106
Q

What are the signs/ symtpoms of ascities

A

Abdo distention
Shifting dullness
May have jaundice + pruritus

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107
Q

What is the treatment for ascites

A

Treat underlying cause
Diuretic to increase Na+ excretion (SPIRONOLACTONE)
Paracentesis
Liver transplant

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108
Q

How is Hep A spread

A

Faeco-oral

109
Q

Which of the viral hepatitis are a picoRNA virus

A

Hep A

110
Q

Where is Hep A endemic

A

Africa

111
Q

What are risk factors for Hep A

A

Overcrowding, poor sanitation, shellfish, travel

112
Q

How is Hep A excreted

A

In the bile

113
Q

How long is the incubation period for Hep A

A

2 weeks

114
Q

What are the initial symptoms of Hep A (1-2 weeks)

A

Malaise, N+V, fever

115
Q

What are the symptoms you experience with Hep A after the initial ones

A

Jaundice, dark urine, pale stools, hepatosplenomegaly

115
Q

What are the symptoms you experience with Hep A after the initial ones

A

Jaundice, dark urine, pale stools, hepatosplenomegaly

116
Q

What do blood tests show in Hep A (not lft)

A

Raised ESR, leukopenia

117
Q

What do LFTs show in Hep A

A

Raised bilirubin

118
Q

What do HAV IgM antibodies mean

A

Acute infection of Hep A

119
Q

What is the treatment for Hep A

A

Usually, resolve by itself in 1-3 months
Vaccine available
100% immune after infection

120
Q

Which of the viral hepatitis are RNA

A

A, C, E, D

121
Q

Which of the viral hepatitisis are blood borne

A

Hep C+ B

122
Q

Which of the viral Hep has the biggest association with IVDU

A

Hep C

123
Q

Other than IVDU, how else can Hep C be transmitted

A

Vertical, sexual transmission

124
Q

Initial symptoms of hep C infection

A

Often asymptomatic, sometimes influenza-like symptoms

125
Q

What does a later presentation of Hep C show

A

Chronic liver signs + hepatosplenomegaly

126
Q

What do serology tests show in Hep C

A

HCV RNA= Current infection (calculate viral load)
HCV Ab= presents within 4-6 weeks of infection

127
Q

What is the treatment for Hep C

A

Direct acting Antivirals (DAA)
Oral ribavirin + N55Ai/ N55Bi (needed for viral replication)

128
Q

What % of Hep C infections progress to chronic liver failure

A

30%

129
Q

How is Hep E transmitted

A

Faeco-oral spread
Water, dogs, pigs
Associated with undercooked pork

130
Q

What is the treatment/ progression for Hep E

A

Self-limiting
Can cause chronic diseases in immunosuppressed
Fulminant liver 10-20% in prego
100% immune after infection

131
Q

What hep is Hep D dependent on and why

A

HBV as it is incomplete and requires HBV for assembly. Manifests as co-infection; IgM HDV+ IgM HBV

132
Q

What is treatment/ diagnosis/ risk factors for HDV

A

Same as HBV
Shellfish travel
Malaise, N+V
Jaundice, dark urine

133
Q

What do you see on histology in all Hepatitis

A

Interface Necrosis (Piecemeal necrosis)

134
Q

Which Hepatitis should you notify Public Health about

A

All viral

135
Q

What are the risk factors for autoimmune hepatitis

A

Female, other AU disease, viral hep, HLADR3 or DRA

136
Q

Who does type 1 autoimmune hepatitis affect

A

Adult females (80%) of cases

137
Q

What does type 2 autoimmune hepatitis affect

A

Young females

138
Q

What antibodies are present present in Type 1 AU Hep

A

ANA (antinuclear antibody):- found in many AU disease but very specific for T1 AU hep
ASMA (Anti smooth muscle Ab)

139
Q

What antibodies are associated with Type 2 Autoimmune pancereatitis

A

ALC-1 (anti liver cytosol)
ALKM-1 (antiliver-kidney microsomal)

140
Q

What % of patients with AU Hep are asymptomatic

A

25%

141
Q

What are the signs/ symptoms of AU Hep

A

Jaundice, fever, hepatosplenomegaly
lupus-like rash

142
Q

What is the treatment for AU Hep

A

Corticosteroids (prednisolone) + azathioprine
Hep A+B vaccine
Last resort transplant

143
Q

What type of virsu is Hep B

A

HepaDNAvirus

144
Q

How is hep B transmitted

A

Needles, sexual, vertical, horizontal

145
Q

What are risk factors for HBV

A

IVDU, MSM, dialysis patients, healthcare workers

146
Q

What are the signs/ symptoms of Hep B

A

Similar to Hep A
1-2 weeks, malaise, N+V, fever
then jaundice, dark urine, pale stools, hepatosplenomegaly, hives/ urticaria, joint pain

147
Q

What do HBVs Ag show and how long present

A

Infected or carrier, 1-6 months

148
Q

What do HBs AB show

A

Immunity, present after 6 months

149
Q

What do HBc Ag

A

Exposed to Hep B at some point

150
Q

What do HBc IgM show

A

Show active infection

151
Q

What do HBc IgG show

A

Chronic infection, carrier, cleared

152
Q

What do HBeAg show

A

Marker of patient infectiousness

153
Q

What do HBeAB show

A

chronically infected or if cleared infection

154
Q

What is the treatment for chronic Hep B

A

Sub Cutaneous pegylated interferon alpha 2a
(also can be used in chronic Hep C

155
Q

Most common type of primary liver cancer

A

Heptocellular carcinoma

156
Q

RF for heptocellular carcinoma

A

Chronic hepatitis virus C+B
Cirrhosis from ALD. NAFLD/ haemochromatosis

157
Q

Where does hepatocellular carcinoma met too and by what type of spread

A

Lymph nodes, bones, lungs via haematogenous spread (hepatic/ portal veins)

158
Q

Sx of hepatocellular carcinoma

A

Decompensated liver failure; Jaundice, ascites, HE
Cancer signs
Irregular hepatomegaly

159
Q

What is 1st line imaging for hepatocellular carcinoma

A

Ultrasound

160
Q

GS imagine for HCC

A

CT

161
Q

Why is biopsy avoided in HCC

A

Prevents seeding of tumour elsewhere

162
Q

What vaccine can protect against HCC

A

HBV

163
Q

Tx of HCC

A

Surgical resection of tumour
Liver transplant if decompensated cirrhosis

164
Q

What are most common primary sites for a secondary liver cancer

A

GIT, Lungs, Breast

165
Q

What type of carcinoma is a cholangiocarcinoma typically

A

Adenocarcinoma

166
Q

RF for cholangiocarcinoma

A

Parasitic flukeworms, biliary cysts, IBD, PSC

167
Q

What is Courvoisier sign

A

Painless palpable gallbladder with jaundice

168
Q

Sx of cholangiocarcinoma

A

Abdo pain, jaundice, weight loss, pruritis, fevers
Late constellation of Sx tumour is slow growing

169
Q

1st line investigation in cholangiocarcinoma

A

Abdo Ultrasound + CT

170
Q

GS investigation for cholangiocarcinoma

A

Endoscopic retrograde cholangiopancreatography
Can stent strictures + obtain a sample

171
Q

Name 2 types of benign primary liver tumour

A

Haemangioma
Hepatic adenoma

172
Q

What does a haemangioma present with

A

Strawberry mark on the skin in infants

173
Q

Does pancreatic cancer usually affect the endocrine or exocrine pancreas

A

Exocrine 99%

174
Q

What section of pancreas typically affected in pancreatic cancer

A

Head

175
Q

RF for pancreatic cancer

A

Male, 60+, smoking, alcohol, DM, fH, chronic pancreatitis, genetic depostion

176
Q

Sx of pancreatic cancer affecting the head

A

Courvoisier sign
Pale stool+ dark urine+ jaundice

177
Q

Sx of pancreatic cancer affecting body + tail

A

Epigastric pain radiating to back relieved by sitting forward

178
Q

GS investigation for pancreatic cancer

A

CT

179
Q

What tumour marker is present in pancreatic cancer and can be used to monitor disease progression

A

CA19-9 (carbohydrate antigen)

180
Q

Other than Courvoisier’s sign, what other sign is present in pancreatic cancer

A

Trousseaus sign of malignancy; Migratory thrombophlebitis (when blood vessels inflamed with an associated blood clot in different locations over time)

181
Q

What are gallstones commonly made up of

A

Cholesteral

182
Q

RF for gallstones

A

Fat, Female, Forty, Fertile (prego/ many children), fair, fH, T2DM, NAFLD

183
Q

What are Sx of gallstone blockage

A

RUQ biliary colic (constant severe pain for around 30 mins)
Worse after eating meals

184
Q

Sx of Cholecystitis

A

RUQ pain + fever, tender gall bladder
Referred pain to top of right shoulder due to the phrenic nerve
Murphy sign

185
Q

What is Murphys sign

A

Press on gall bladder and ask patient to inhale
They’ll wince and stop inhaling due to pain

186
Q

Sx of ascending cholangitis

A

CHarcots triad
RUQ pain, fever, jaundice (obstructive; dark urine + pale stool)

187
Q

What is Retnolds pentad

A

Charcots triad + altered mental state+ hypotension

188
Q

1st line investigstion for gallstones

A

Abdo Ultrasound

189
Q

Treatment for gallstones

A

NSAIDs for mild pain
Elective laparoscopic cholecystectomy
Less fatty diet`

190
Q

What is a strong NSAID

A

Diclofenac

191
Q

Investigations in cholecystitis

A

FBC; Leukocytosis
LFT; normal
Abdo US; thickened GB wall

192
Q

Investigations in ascending cholangitis

A

FBC; Leukocytosis+ neutrophils
LFT; High conjugated hyperbilirubinemia
Abdo US; CBD dilation + gallstones
Magnetic resonance cholangiopancreatography

193
Q

1st and GS investigation in ascending cholangitis

A

1st; Abdo US
GS; Magnetic resonance cholangiopancreatography

194
Q

Treatment for cholangitis

A

Surgery within 1 week; Laparoscopic cholecystectomy
Till then, IV fluid, analgesia

195
Q

Treatment for ascending cholangitis

A

Endoscopic retrograde cholangiopancreatography

Then laparoscopic once stable to prevent a recurrence

196
Q

What is primary biliary cirrhosis

A

An autoimmune condition in which the small bile ducts within the liver are targeted causes a blockage to the outflow of bile (cholestasis)

197
Q

What are the intralobular ducts also known as

A

Canals of Hering

198
Q

RF for primary biliary cirrhosis

A

Female, 40-50, other autoimmune, smoking

199
Q

How would you describe the inflammation in primary biliary cirrhosis

A

Chronic autoimmune granulomatous

200
Q

Sx of PBC

A

Often asymptomatic
Pruritis + fatigue earliest then jaundice then hepatomegaly + xanthelasma

201
Q

Complications of PBC

A

Cirrhosis; Malabsoroptin of fats + ADEK
Stearrohoea, osteomalacia

fibrosis, portal htn, infection

202
Q

What do LFTs show in PBC

A

Raised ALP, conjugated bilirubin
Low albumin

203
Q

What antibody is mostly specific to PBC

A

Anti-mitochondrial antibodies
Anti-nuclear antibodies are also present

204
Q

What is first live imaging in PBC

A

Ultrasound

205
Q

What do you see on liver biopsy in PBC

A

Portal tract infiltrate(lymphocyte+ plasma cell)

206
Q

What is first line treatment in PBC

A

Ursodeoxycholic acid; (bile acid analogue) reduces intestinal absorption of cholesterol (improves Sx)

207
Q

Treatment for PBC

A

Ursodeoxycholic acid
ADEK sups

208
Q

RF for primary sclerosing cholangitis

A

Male, 30-40, Ulcerative colitis, fH

209
Q

Why is primary sclerosing cholangitis an ‘atypical’ autoimmune disease

A

Affects men more than women

210
Q

Sx of PSC

A

Pruitis + fatigue, jaundice, Charcot’s triad if CBD involved, hepatosplenomegaly, IBD

211
Q

What do serology tests show in PSC

A

HBVaAG/HCVAb -ve
ANA -ve
anti tTG -ve
pANCA +ve in 33-88%

212
Q

What is GS imaging for PSC

A

Magnetic resonance cholangiopancreatography

213
Q

Do you give ursodeoxycholic acid in PSC

A

No

214
Q

What can be given to help with pruritis

A

Colestyramine

215
Q

Describe breakdown of RBC

A

SPLEEN; Hb into Haem+ Globin
Haem into Iron + Biliverdin
Biliverdin into unconj bilirubin by
biliverdin reductase
TRANSPORT IN BLOOD BOUND TO ALBUMIN

LIVER; Conj Bilirubin

VIA CBD INTO SI

SI; converted into urobilinogen by colonic flora
90% to stercobilin makes faeces brown
5% to urobilin makes wee yellow

216
Q

Why do you get pale stool and dark urine in obstructive jaundice

A

As high kevels of conj bilirubin in blood but less in the intestine

217
Q

Causes of pre-hepatic jaundice

A

Haemolytic anaemia
Sickle cell
G6PD def
Autoimmune haemolytic
Thalassemia
Malaria

218
Q

Causes of intrahepatic jaundice

A

HCC
ALD/ NAFLD
Hepatitis
Gilbert syndrome

219
Q

Causes of post hepatic jaundice

A

Choledocholathis
Pancreatic cancer
Mirizzi syndrome
Drug-induced cholestasis
PBC+ PSC

220
Q

What is Mirizzi syndrome

A

Gallstone stuck in GB kneck can compress CBD + cause obstruction

221
Q

What are primary causes of peritonitis

A

Ascites
Spontaneous bacterial peritonitis MC

222
Q

Most common organisms causing peritonitis

A

E. coli, Klebsiella, Staph aureus

223
Q

Sx of peritonitis

A

Sudden onset severe abdo pain then collapse + septic shock
Rigidity helps pain
Poorly localised

224
Q

What investigations do you do in peritonitis

A

Ascitic tap shows neutrophilia
MC+S
Exclude pregnancy (-ve Beta-hCG)
Erect CXR shows air under the diaphragm; indicating a perforated colon

225
Q

Treatment for peritonitis

A

ABCDE
Treat underlying cause; IV fluid + Abx
Surgery peritoneal lavage

226
Q

Complications fo peritonitis

A

Septicemia, Pelvic abscess

227
Q

What inheritance is haemochromatosis

A

Autosomal recessive

228
Q

What gene is affected and on what chromsome is it on in haemochromatosis

A

Human Haemochromatosis protein (HFE)
Chromosome 6

229
Q

Pathology of haemochromatosis

A

Excess iron uptake by transferrin 1 and decreased hepcidin synthesis
Fe accumulation + fibrosis of organs

230
Q

What organs are affected in haemochromatosis

A

Liver, pancreas, kidney, Heart, skin, anterior pituitary

231
Q

Sx of haemochromatosis

A

Fatigue, joint pain, hypogonadism, slate grey skin, liver cirrhosis, osteoporosis, heart failure

232
Q

What are Sx of gross Fe overload

A

Bronze statue skin,
Hepatomegaly
T1DM
Hair loss
Joint pain
Chronic tiredness

233
Q

What do Fe studies show in haemochromatosis

A

High serum fe
High transferrin saturation
High ferritin
Low total iron binding capacity

234
Q

What stain do you use with a liver biopsy to assess liver damage in haemochromatosis

A

Perls stain

235
Q

What is 1st line treatment for haemochromatosis

A

Venesection

236
Q

What is the treatment if venesection is contraindicated in haemochromatosis

A

Desferrioxamine (chelation therapy)

237
Q

What is the inheritance pattern of Wilson’s disease

A

Autosomal receive

238
Q

What gene is affected in Wilson’s disease

A

ATP7B gene on chromosome 13

239
Q

Pathology of Wilsons disease

A

Impaired Cu biliary excretion leading to lots of Copper accumulation in liver and CNS (basal ganglia)

240
Q

Sx of Wilsons disease

A

Jaundice
Parkinsonism/ memory issues
Kayser Fleischer Rings; Cu deposits in cornea (greenish brown ringed appearance)

241
Q

Is serum copper high or low in Wilsons disease

A

Low serum copper as more deposited in tissue

242
Q

GS investigation for Wilsons disease

A

Liver biopsy

243
Q

1st line treatment for Wilsons disease

A

D-Penicillinamwe (Cu chelation lifelong)

244
Q

What dietary changes should you make in Wilson’s disease

A

Avoid shellfish and muschroom

245
Q

What gene is affected in A1AT deficency

A

Serpina-1 gene/
Protease inhibitor gene

246
Q

What can A1AT deficency cause in the liver

A

Becomes fibrotic, cirrhosis + HCC risk

247
Q

How would you describe chest in A1AT deficiency

A

Barrel chest
Hyper inflated lungs

248
Q

What do you see on CT in A1AT deficiency

A

Panacinar emphysema

249
Q

How much paracetamol ingested to be an overdose

A

> 75mg/kg

250
Q

Sx of paracetamol overdose

A

Acute severe RUQ pain, severe N+V

251
Q

Explain pathology of Paracetamol overdose

A

Normal
90% phase 2 conjugation and excreted
10% phase 1 conj (CYP450) into NAPQ1 whic is toxic. Then phase 2 conj and excreted

In overdose phase 2 saturated so shunts more down phase 1 leading to glutathione depletion and accumulation of toxic NAPQ1 in liver

252
Q

What is the treatment for paracetamol overdose

A

Activated charcoal within 1hr
N-Acetyl-cysteine (increases available glutathione)

253
Q

What is Gilberts syndrome

A

Deficient or abnormal glucuronosyltransferase
So high levels of unconjugated bilirubin

254
Q

What inheritance pattern is Gilberts syndrome

A

Autosomal recessive

255
Q

RF for gilberts

A

T1DM, male

256
Q

Sx of gilberts syndrome

A

Painless jaundice at young age

257
Q

Examples of irreducible hernias

A

Obstructed
Strangulated
Incarcerated

258
Q

What are 2 types of hiatal hernia

A

Rolling; LES stays in abdo, fundus rolls into abdo
Sliding; LES into abdo MC

259
Q

Sx of Hiatal hernia

A

GORD
Dysphagia

260
Q

GS investigation for hiatal hernia

A

Barium swallow

261
Q

What is a femoral hernia

A

Bowel through the femoral cord

262
Q

Femoral hernia more common in male or female

A

Female

263
Q

Why are femoral hernias very likely to strangulate

A

Rigid femoral canal border

264
Q

Sign of femoral hernia

A

Swelling in upper thigh pointing down

265
Q

What is an ingunal hernia

A

Spermatic cord herniates through inguinal canal

266
Q

Inguinal hernia more common in male or female

A

Male

267
Q

RF for ingunal hernia

A

History of heavy lifting/ abdo pressure

268
Q

Sx of ingunal hernia

A

Painful swelling in groin points along the groin margin

Phase 2a Ru (10 decks)

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