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1st/2nd Year Revision > Liver/Pancreas Conditions > Flashcards

Liver/Pancreas Conditions Flashcards

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1
Q

What is liver cirrhosis?

A

Irreversible liver damage

Loss of normal hepatic architecture

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2
Q

What are the causes of liver cirrhosis?

A 
Chronic alcohol abuse
Chronic HBV/HCV infection
Non-alcoholic fatty liver disease
Genetic disorders - eg Wilson's, alpha anti-1 antitrypsin deficiency
Primary biliary cholangitis
Primary sclerosis cholangitis
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3
Q

What are the symptoms of liver cirrhosis?

A 
Related to cause
Lethargy
Splenomegaly
Jaundice
Leukonychia
Spider naevi
Gynaecomastia
Clubbing
Ascites
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4
Q

What investigations would be done if liver cirrhosis was suspected?

A 
LFT, FBC, U&Es
Albumin
Coagulation
Ultrasound
Ascites tap - if ascites
Liver biopsy
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5
Q

How is liver cirrhosis treated?

A 
Aimed at underlying cause
Good nutrition
Laxatives avoid hepatic encephalopathy
Vitamin K to correct clotting
Antibiotics
Liver transplant
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6
Q

What are the complications of liver cirrhosis?

A 
Malnutrition
Hepatic encephalopathy
Ascites/oedema
Vitamin deficiency
Hepatorenal carcinoma
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7
Q

What is the stepwise progression of alcohol related disease?

A

Alcohol related fatty liver - temporary, resolves in 2 weeks if no alcohol
Alcoholic hepatitis - inflammation
Cirrhosis - permanent

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8
Q

What are the symptoms of alcoholism?

A 
Jaundice
Hepatomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising
Ascites
Caput medusae
Asterixis
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9
Q

How is alcoholism investigated?

A 
CAGE
Increased GGT (and other LFTs)
Increased MCV, prothrombin time
Decreased albumin
Ultrasound
Liver biopsy
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10
Q

How is alcoholism managed?

A

Stop drinking
Nutrition
Vitamin replacement
Transplant

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11
Q

What are the complications of alcoholism?

A

Alcohol withdrawal
Delirium tremors
Wernicke’s-Korsakoff syndrome

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12
Q

What is the pathology of liver failure?

A

Acute necrotising hepatitis leads to cell destruction

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13
Q

What are the 3 types of liver failure?

A

Hyper-acute - encephalopathy within 1 week
Acute - within 2-4 weeks
Sub-acute - within 4-8 weeks

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14
Q

What are the causes of liver failure?

A 
Viral hepatitis
Infections
Drugs - paracetamol
Toxins
Alcohol
Malignancy
Fatty liver disease
Primary biliary cholangitis
Primary sclerosing cholangitis
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15
Q

What are the symptoms of liver failure?

A 
Jaundice
Hepatic encephalopathy
Fetor hepaticus - breath smells like pear drops
Asterixis
Cerebral oedema
Hypertension
Tachypnoea
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16
Q

How is liver failure investigated?

A 
FBC, U&Es, LFT
Clotting, glucose, paracetamol levels
Blood culture
Urine culture
CXR
Abdominal ultrasound
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17
Q

How is liver failure treated?

A

Supportive

Liver transplant

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18
Q

What are the complications of liver failure?

A

Renal failure
Sepsis
Circulatory failure
Pancreatitis

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19
Q

What is the pathology of autoimmune hepatitis?

A

Inflammatory liver disease, antibodies directed against hepatocyte surface antigens

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20
Q

Who is more likely to get autoimmune hepatitis?

A

Young women

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21
Q

What are the symptoms of autoimmune hepatitis?

A 
Fatigue
Abdominal discomfort
Decreased appetite
Myalgia
Hepatomegaly
Jaundice
Signs of cirrhosis
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22
Q

What investigations would be done if autoimmune hepatitis was suspected?

A 
All LFTs raised
Increased ESR
Positive ASMA antibodies (anti-smooth muscle antibodies)
Increased IgG
Liver biopsy
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23
Q

How is autoimmune hepatitis treated?

A

Steroids
Azathioprine
Ursodeoxycholic acid
Liver transplant

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24
Q

Are primary or secondary liver tumours more common?

A

Secondary - 90% are metastases
Men - stomach, colon, lung
Women - stomach, colon, breast, uterus

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25
What are the symptoms of liver tumours?
``` Fever Malaise Anorexia RUQ pain Jaundice - late except in cholangiocarcinoma Hepatomegaly Listen for liver bruits ```
26
What investigations would be done if a liver tumour was suspected?
FBC, clotting, LFT, hepatitis serology Ultrasound MRI Liver biopsy
27
How are secondary liver tumours treated?
Chemotherapy | Most is palliative
28
What are the causes of hepatocellular carcinoma?
HBV Cirrhosis Fatty liver disease
29
What are the symptoms of hepatocellular carcinoma?
``` Fatigue Decreased appetite RUQ pain Decreased weight Jaundice Ascites Hepatomegaly ```
30
What investigations would be done if hepatocellular carcinoma was suspected?
``` Increased transaminases Increased alpha-fetoprotein Increased CRP and ESR Ultrasound CT, MRI Liver biopsy ```
31
How are hepatocellular carcinomas treated?
Resection | Liver transplant
32
What is the pathology of primary biliary cholangitis?
Chronic inflammation and destruction of the small and medium bile ducts
33
What sex is primary biliary cholangitis more common in?
Female
34
What are the symptoms of primary biliary cholangitis?
``` Fatigue Pruritus Arthralgia Xanthelasma Hepatomegaly Splenomegaly Jaundice Signs of chronic liver disease ```
35
What investigations would be done if primary biliary cholangitis was suspected?
Increased LFTs, IgM Positive AMA (anti-mitochondrial antibodies) Ultrasound
36
How is primary biliary cholangitis treated?
Pruritus - colesyramine Ursodeoxycholic acid Steroids Liver transplant
37
What are the complications of primary biliary cholangitis?
Osteoporosis
38
What is the pathology of primary sclerosing cholangitis?
Progressive cholestasis with bile duct inflammation and strictures
39
What sex is primary sclerosing cholangitis more common in?
70% men - strong association with IBD (UC)
40
What are the symptoms of primary sclerosing cholangitis?
``` Asymptomatic Fatigue Weight loss Pruritus RUQ pain Hepatomegaly ```
41
What investigations would be done if primary sclerosing cholangitis was suspected?
Increased LFTs (ALP first) Increased bilirubin ERCP/MRCP Liver biopsy
42
How is primary sclerosing cholangitis treated?
Liver transplant
43
What are the risk factors for cholestasis?
Obesity Cirrhosis CF Haemolytic anaemia
44
What are the symptoms of cholestasis?
RUQ pain | Depends where the stone is lodged
45
What investigations would be done if cholestasis was suspected?
LFTs | Ultrasound
46
How is cholestasis treated?
Dissolution | Cholecystectomy
47
What are the complications of cholestasis?
Perforation | Abscess
48
What are the causes of acute pancreatitis?
``` GET SMASHED: Gallstones Ethanol Trauma Steroids Autoimmune Scorpion venom Hyperlipidaemia/hypercalcaemia/hypothermia ERCP Drugs ```
49
What are the symptoms of acute pancreatitis?
Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards Jaundice
50
What investigations would be done if acute pancreatitis was suspected?
``` Increased serum amylase and lipase ABG AXR Erecr CXR CT ```
51
How is acute pancreatitis managed?
Severity assessment - Glasgow criteria Nil by mouth Analgesia Treat cause and complications
52
What are the complications of acute pancreatitis?
``` Shock ARDS DIC Sepsis Pancreatic necrosis Abscess Bleeding Thrombosis ```
53
What is the pathology of chronic pancreatitis?
Structure of the pancreas is permanently damaged
54
What are the causes of chronic pancreatitis?
``` CAMP: Cystic fibrosis Alcohol Malnourishment Pancreatic duct obstruction Smoking ```
55
What are the symptoms of chronic pancreatitis?
Gradual/sudden onset epigastric pain - radiates to the back, relieved by sitting forwards Jaundice
56
What investigations would you do if chronic pancreatitis was suspected?
Ultrasound/CT - pancreatic calcifications confirm diagnosis MRCP Faecal elastase
57
How is chronic pancreatitis treated?
Analgesia No alcohol Insulin Pancreatic enzyme supplements
58
What are the complications of chronic pancreatitis?
Pseudocyst Diabetes Biliary obstruction Pancreatic carcinoma
59
At what age does pancreatic carcinomas usually present?
>70
60
What is the pathology of pancreatic carcinoma?
Ductal adenocarcinoma - 65% head
61
What are the risk factors for pancreatic carcinoma?
Smoking Alcohol Diabetes mellitus Chronic pancreatitis
62
What are the symptoms of pancreatic carcinoma?
Head - painless obstructive jaundice | Body/tail - epigastric pain radiating to back, relieved by sitting forwards
63
What investigations would be done if pancreatic carcinoma was suspected?
Ultrasound CT ERCP/MRCO
64
How is pancreatic carcinoma treated?
Resection if no mets Chemotherapy Palliation

1st/2nd Year Revision (15 decks)

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