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Gastrointestinal > step 2 - HPB > Flashcards

step 2 - HPB Flashcards

(58 cards)

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1
Q

diagnosis of suspected gallstones if USS inconclusive

A

hepatobilliary iminodiacetic acid scan (HIDA)

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2
Q

hepatitic C antibody positive, what is the next step ?

A

confirm infection with hepatitic C RNA PCR (HCV-RNA PCR)

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3
Q

indications for discontinuation of NAC in paracetamol overdose

A

acetaminophen level undetectable
improvement of aminotransferases (AST more reliable)
clinical stability

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4
Q

patient presents with fever, RUQ pain, jaundice, altered mental status and shock. what are you concerned for? how would you manage?

A

presence of Reynolds pentad suggests acute suppurative cholangitis
may require urgent biliary duct decompression with ERCP/sphincertotomy, transhepatic drainage or open decompression

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5
Q

fever, RUQ pain, jaundice, elevated AST/ALT, lipase and bilirubin. ?diagnosis ?management

A

gallstone pancreatitis due to elevated lipase
manage with supportive measures IV fluids, analgesia for pancreatitis then elective cholecystectomy

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6
Q

patient presents with abdominal pain, distension, constipation, vomiting. AXR shows SBO with pneumobilia. Upper GI barium contrast shows no contrast in the colon. ?diagnosis

A

gallstone ileus

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7
Q

persistant diarrhoea after cholecystectomy

A

part of the range of post cholecystectomy syndromes

with the gallbladder no longer present, excess secretion of bile acids enter the colon and are able to overcome the terminal ileums ability to absorb them . this results in diarrhoea.
usually resolves on its own.
can manage symptoms with cholestyramine or colestipol

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8
Q

10 year old with abdominal pain, jaundice and palpable abdominal mass ?diagnosis ?treatment

A

biliary cyst (choledochal cyst)
(note this presentation in an adult would suggest cholangiocarcinoma/pancreatic ca)

at risk of cholangiocarcinoma
roux en Y hepaticojejunostomy may be indicated

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9
Q

tumour markers for cholangiocarcinoma and from what cell type does this cancer arise

A

squamous cell

CA 19-9
CEA
AFP

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10
Q

what hepatitis has a high mortality rate in pregnant women

A

hepatitis E

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11
Q

ceuroplasmin and urine copper levels in wilsons disease

A

low ceruoplasmin
elevated urinary copper

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12
Q

antibodies associated with autoimmune hepatitis

A

Type 1
- Anti-smooth muscle antibody (Anti-Sm antibody)
- Anti-nuclear antibody (ANA)

Type 2
- Anti- liver kidney microsomal 1 antibody (anti-LKM1)
- Anti- liver cytosol antibody

may also have elevated IgG and P-ANCA

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13
Q

elevated levels of what marker indicate high infectivity with Hepatitis B

A

HBeAg
raised 1-4 months after exposure

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14
Q

what marker indicates immunity to hepatitis B

A

HBsAb

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15
Q

valproic acid can cause drug induced hepatitis. what is the antidote?

A

l-carnitine

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16
Q

most commonly used anti-viral for chronic hepatitis B

A

Tenofovir and Entecavir most commonly used

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17
Q

what is the post exposure protocol for hepatitis B

A

if not vaccinated then require post exposure prophylaxis vaccine + immunoglobulin

if previously vaccinated and those exposed to hep C don’t require any post exposure prophylaxis

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18
Q

what is the medication used to treat chronic hepatitis C

A

depends on genotype, cirrhosis and previous treatment

however generally includes either x2 direct-acting antivirals (DAA) or x1 DAA + Ribavirin

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19
Q

West haven criteria for encephalopathy

A

I: mild confusion, possible asterixis, normal eeg

II: moderate confusion, asterixis, abnormal EEG

III: marked confusion, sleeping but arousable, incoherent, asterixis, abnormal EEG

IV: coma, no asterixis, abnormal EEG

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20
Q

causes of ascites with SAAG >1.1

A

related to portal hypertension

presinusoidal: splenic or portal vein thrombosis, schistosomiasis
sinusoidal: cirrhosis
postsinusoidal: RHF, constrictive pericarditis, budd-chiari malformation

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21
Q

causes of ascites with SAAG <1.1

A

not related to portal hypertension

malignancy i.e. meigs syndrome
TB
nephrotic syndrome

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22
Q

causes of high protein ascites vs low protein ascites

A

high protein >2.5
- CHF, constrictive pericarditis, TB, malignancy

low protein <2.5
- cirrhosis, nephrotic syndrome

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23
Q

causes of spontaneous bacterial peritonitis

A

perforation i.e. peptic ucler
nonperforation i.e. perinephric abscess
translocation of GI flora

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24
Q

treatment of SBP

Study These Flashcards
A

IV abx (i.e. cephalosporin - ceftriaxone)
IV albumin

25
abx of choice for SBP prophylaxis
flouroquinolone i.e. ciprofloxacin
26
what is the mechanism of hepatorenal syndrome
liver failure with portal hypertension causes splanchnic vasodilatation to try compensate which causes reduced blood flow to the kidneys = prerenal kidney injury urinary Na < 10
27
patient with known cirrhosis presents with declining renal function and reduced urine output ?diagnosis ?1st line management
hepatorenal syndrome 1st line: IV fluid replacement + rule out other causes of renal failure (diagnosis of exclusion) may require ocreotide or midodrine (BP support) may require dialysis liver transplant can be curative
28
management of acute bleeding in a patient with cirrhosis
bleeding due to coagulopathy will require fresh frozen plazma, wont respond to vitamin K
29
patient is involved in car accident and drops bP to 60/30. Patient is resuscitated and transferred to the hospital. the next day bloods show elevated AST/ALT and markedly raised LDH. ?diagnosis
ischaemic hepatitis manage by addressing underlying cause of ischaemic insult LFT's usually resolve within 7-10 days but may progress to acute liver failure
30
diagnostic criteria for fulminant hepatic failure (acute hepatic failure)
severe acute liver injury, hepatic encephalopathy and INR >1.5 that developes within < 26 weeks
31
what is hepaticpulmonary syndrome and how does it present
splanchnic vasodilatation from increased NO results in increased blood delivery to the pulmonary vasculature without an equal increase in ventillation. results in more blood being delivered to the left side of the heart unoxygenated = V/Q mismatch dyspnoea worse on standing, relived when lying down decrease in 02 sats upon standing A-a gradient < 20 mmHg Pa02 <70mmHg
32
patient with known liver disease presents with dyspnoea, chest pain and cough. CXR shows left sided pleural effusion. No sign of infection. thoracentesis shows SAAG >1.1. ?diagnosis ?management
hepatic hydrothorax - leakage of ascites into the thoracic cavity due to defect in the diaphragm treat similar to ascites with fluid restriction and diuretics refractory may reuqire tips
33
1st line treatment for ascites
fluid (+Na) restriction + diuretics large volume paracentesis SBP prophylaxis with flouroquinolone
34
absolute contraindications to TIPS procedure
congestive heart failure severe tricuspid regurgitation severe pulmonary hypertension polycystic liver disease active systemic infection / sepsis unrelieved biliary obstruction
35
patient diagnosed with primary sclerosis cholangitis. what further investigation is required?
colonoscopy to check for underlying IBD
36
liver biopsy reveals periductal fibrosis 'onion skinning' ?diagnosis
PSC
37
1st line treatment for PBC
1st line: ursodeoxycholic acid obeticholic acid if intolerant cholestyramine for pruritus
38
wat vitamin supplementation is beneficial in NASH
vitamin E +pioglitazone
39
what toxin is a risk factor for hepatocellular carcinoma
aflatoxins
40
when is an orthotopic liver transplantation considered fro treatment of hepatocellular carcinoma
Milan criteria; - single lesion <5cm - or 3 lesions < 3cm also no gross vascular invasion or lymph node involvement
41
what is used for screening recurrence of hepatocellular carcinoma
AFP serial USS / CT
42
non surgical options for hepatocellular carcinoma
transarterial chemoembolization (TACE) +/or radiofrequency ablation (TACE) immunotherapy tyrosine kinase inhibitors e.g. levatinib anti-VEGF antibodies i.e. bevacizumab
43
best initial and accurate tests for suspected wilsons disease
best initial: serum ceruplasmin most accurate: liver biopsy or ATP7B gene testing
44
best initial and accurate tests for haemochromatosis
initial: iron studies (iron, ferritin, transferrin, transferrin saturation (serum iron divided by TIBC >45%) accurate: liver biopsy. HFE gene mutation + MRI also done
45
contrast-CT shows peripherally enhancing liver lesion with central stellate appearance
focal nodular hyperplasia benign often found in females no intervention if asymptomatic
46
contrast-CT of liver shows arterial phase enhancement with heterogenous washout on portal phase imaging
hepatic haemangioma if lesion <5mm and asymptomatic then no intervention lesions >5mm should have follow up if growth >3mm per year then requires intervention
47
how does hepatic adenoma present
usually in patient taking oral contraceptives mostly accidental finding but may present with haemorrhage due to adenoma rupture manifesting as sudden onset abdominal pain and hypotension
48
management of hepatic adenoma
asymptomatic and < 5cm then discontinue OCP and return for 6 months follow up MRI. If no growth then no intervention and requires annual MRI. if growth >5cm +or symptomatic then surgical removal
49
causative organism of hydatid cysts
echinococcus granulosus exposure through parasitic egg from contaminated water, soil or direct contact from animals esp dogs
50
red flag features of pancreatic cyst
usually accidentally found in older patients if presence of red flag then EUS-guided biopsy - cyst >3cm - involvement of main pancreatic duct (evident by duct dilatation) - calcifications or solid component thickened or irregular cyst wall
51
50 year old smoker male presents with abdominal pain. examination shows non-tender palpable gallbladder, migrating rash and jaundice. ?diagnosis
think pancreatic cancer
52
treatment for pancreatic cancer in the body or tail of pancreas without mets or coeliac artery involvement
distal pancreatotomy + chemo
53
treatment for small tumour in head of pancreas with no mets or major vessel involvement
whipples procedure (pancreaticoduodenectomy)
54
best initial and most accurate tests for investigating insulinoma
best initial: fasting serum insulin (elevated) + c-peptide (elevated) most accurate: 72 hour fast. then once hypoglycaemia occurs labs are drawn for glucose, c-peptide, insulin, sulphonylurea, cortisol and beta-hydroxybutyrate levels
55
patient complains of ongoing watery diarrhoea, flushing and weakness. Stool shows an osmotic gap of 40. ?diagnosis
VIPoma low osmotic gap (<50) secretory diarrhoea (normal 50-100) hyperglycaemia, hypercalcaemia, elevated VIP levels, achlorhydria CT scan
56
features of stomatostatinoma syndrome
stomatostatinoma is a tumour arising from pancreatic D cells somatostatinoma presents insiduously with abdominal pain and weight loss but rarely can present with stomatostatinoma syndrome; - diabetes/insulin intolerence - galllstones - diarrhoea/steatorrhoea
57
Ranson criteria for predicting severity of acute pancreatitis on admission
age > 55yrs glucose >200 WBC >16,000 AST >250 LDH >350
58
ranson criteria for predicting severity of acute pancreatitis within first 48 hours of admission
BUN rises > 5 base deficit > 4 haematocrit drops >10% Pa02 < 60 calcium < 8 fluid sequestration > 6l

Gastrointestinal (5 decks)

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