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GI JC > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Man presents with itch and no rash. Alkaline phosphatase is elevated. What type of jaundice is this

A

Cholestatic jaundice

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2
Q

Man presents with dark stools, obstructive jaundice, dilated bile ducts, this has been shown on CT. what treatment do you offer?

A

ERCP to unblock the bile duct

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3
Q

If you suspect autoimmune hepatitis what single best investigation would you choose?

A

Liver biopsy

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4
Q

How do you treat for autoimmune hepatitis?

A

Corticoidsteroids like prednisolone and azathioprine

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5
Q

Man 23 presents with a morning of vomiting and suddenly outburst of bright red blood. Diagnosis? Treatment?

A

Mallory-weiss tear

Only about 20% need endoscopic intervention to stop bleeding

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6
Q

What is the average units in a pint of beer?

A

2

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7
Q

What is the average units in a bottle of wine?

A

9.8

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8
Q

What is the toxic metabolite of alcohol metabolism? Saturation of what enzyme causes this ?

A

Acetaldehyde due to saturation of aldehyde dehydrogenase

Causes inflammation, fibrosis, hepatic injury

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9
Q

What are some of the chronic effects of excess alcohol?

A 
Liver cirrhosis -> hepatocarcinoma
Cardiomyopathy, MI , stroke
Cerebellar degeneration, dementia
Foetal alcohol syndrome.        
 Bone marrow suppression -> anaemia
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10
Q

What are the presentations of chronic liver disease ?

A

Spider naevi
Encephalopathy
Prolonged prothrombin time
Hypoalbuminaemia

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11
Q

What are some presentations of portal hypertension

A

Caput medusa
Hypersplenism
Thrombocytopenia

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12
Q

You expect someone to have alcoholic hepatitis. What results would you expect from bilirubin, AST?

A

Bilirubin > 80mmol/l

AST < 500

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13
Q

What treatment is good short term for alcoholic hepatitis?

A

Prednisolone

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14
Q

What is osler-weber-rendu syndrome

A

Rare autosomal dominant genetic disorder of the blood vessels-in the skin, mucous, lung, liver and brain.

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15
Q

Young women presents with a central scar radiating out to the periphery of the liver, it is affecting all liver structures. Women also has olser-weber rendu. Diagnosis?

A

Focal nodular Hyperplasia

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16
Q

Women presents with right upper abdomen pain, but no other symptoms. She is on the contraceptive pill and takes steroids. Histologically, in the right lobe, there are hepatocytes with no portal tracts, central vein or bile duct. Most likely diagnosis?

A

Hepatic adenoma

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17
Q

Man from south america presents with the presence of serological anti-echinococcus antibodies. Diagnosis? Treatment?

A

Hydatid cyst

Surgical removal of cysts, albendazole

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18
Q

Women presents with numerous cysts throughout the liver parenchyma, she has abdominal pain and distention.

A

Autosomal dominant polycystic kidney disese

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19
Q

Man presents with cirrhosis secondary to alcohol, he has weight loss and pain in the right upper quadrant. Investigations? Diagnosis?

A

Hepatocellular carcinoma

Elevated AFP (tumour marker), ultrasound, CT

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20
Q

Man presents with a CT displaying a stellate scar on the liver with radial septa, he does not drink and has no signs of cirrhosis. Diagnosis?

A

Fibro-lamellar carcinoma

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21
Q

What are some of the functions of the liver

A 
Bile production 
Storage of fuel iron vitmains
Carbohydrate and lipid metabolism;fuel storage
Amino acid metabolism; urea cycle
Storage of vitamins A,D and B12
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22
Q

Where is albumin produced? What are its function

A

Liver

Determines plasma osmotic pressure

Bound to bilirubin to move around body, as well as thyroid hormones and drugs

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23
Q

What is the functions of alpha globulins? Give an example

A

Transports lipoproteins, lipids, hormones, bilirubin, vitamin A

Ceruloplasmin

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24
Q

What does a deficiency in VIT A cause?

A

Visual impairment

25
What is the function beta globulins? Give examples
Role in iron transport e.g transferrin Clotting of blood e.g fibrinogen
26
What is the functions of chylomicrons
Transports exogenous fat to the liver
27
What is the functions of VLDL
Transport of ENDOgenous fat to peripheral cells
28
What is the functions of LDL
Cholesterol transport to peripheral tissues
29
What is the functions of HDL
Takes cholesterol from peripheral tissues to the liver
30
What enzyme regulates cholesterol synthesis
HMG-CoA reductase
31
Explain the physiology behind increasing cholesterol causing gallstones
Bile salts are a bi-product of cholesterol metabolism, so if increase cholesterol intake more metabolism = more salts which accumulate to make stones
32
What are some causes of liver cirrhosis?
``` Alcohol Iron overload Autoimmune liver disease Obstructive liver disease Hepatitis ```
33
What are some of the complications of liver cirrhosis?
Portal hypertension Ascites (due to lack of albumin production) Liver failure
34
What is alcoholic liver disease?
Release fatty and acid aldehyde a by product of alcohol break down which are toxic hepatocytes and can cause their death
35
In what time period of alcohol consumption causes steatosis? Reversible or non?
2-3 days of heavy drinking which is reversible
36
What is NASH (NAFLD)? Who is it common in?
Non-alcoholic steatohepatitis Similar presentation to alcoholic liver disease but common in; Overweight and type 2
37
What is the treatment for NASH?
Weight loss and exercise | Investigate using ultrasound
38
Middle aged women presents with fatigue, itch without a rash, xathelasma. What investigations would you order? What is likely diagnosis?
``` AMA antibodies (antimitochondrial antibodies) Cholestatic LFTs Liver biopsy ``` (Need 2/3 to diagnose for PBC)
39
What is the treatment for PBC? What is the physiology behind it
Urseo deoxycholic acid Increases bile flow so increasing the clearance of the bile stops the itch and some of the damage of the liver from backed up bile
40
What is haemochromatosis?
The genetic overload of iron due to enterocytes constantly absorbing iron to allow higher haemoglobin levels
41
What is Budd chiari? How does it present?
Thrombosis of hepatic veins due to protein C or S deficiency Presents with jaundice hepatomegaly ascites
42
What is the function of the hepatic stellate cells?
When liver becomes damaged they increse matrix production, proliferate, this is to cause fibrosis Also allows absorption of vitamin A
43
What does methotrexate treat? What are the side effects?
Rheumatoid arthritis and psoriasis Liver toxic so can cause progressive fibrosis
44
What can cause cardiac cirrhosis? What is it?
It is a spectrum of hepatic derangements secondary to right sided heart failure. So incompetent valves, congenital defects, rheumatic fever and constrictive pericarditis can cause this
45
What are some of the presentations of compensated liver cirrhosis
``` Spider naevi Palmar erythema Clubbing Gynaecomastia Hepatomegaly Spleenomegaly ```
46
What are some of the presentations of decompensated liver failure
Jaundice, ascites, encephalopathy, easy bruising
47
Explain portal hypertension secondary to cirrhosis leading to ascites
This results in shunting (venous blood bypassing the liver), release of vasodilators, this causes lower SVR so lower arterial blood flow to heart, so RAAS system increases to absorb more sodium, causing ascites.
48
What physiological cause of encephalopathy ? What can it present as?
Due to the excess ammonia due to the liver being unable to break it down and excrete as urea. Hepatic flap, tremor, neurology
49
What is the UKELD score used to determine? What does it base patient ranking on?
Determine if people are eligble for liver transplant Event based, liver function, quality of life
50
What is the treatment for ascites?
Spironolactone and furosemide
51
Name some common screening tests and what age group they target
``` AAA men at 65 years Bowel cancer (50-74 years Breast cancer 50-70 years Cervical cancer 25-64 Diabetic retinopathy ```
52
Women presents with sudden onset of abdominal pain radiating to the back, she has a rapid pulse and is feverish. She also has hyperparathyroidism. You do a blood test and it shows serum amylase. Diagnosis?
Pancreatitis
53
What is treatment of carcinoma of the pancreas?
Whipple operation (removal of pancreas)
54
Define jaundice
Presence of yellow scerla (eyes) that proves bilirubin of levels 40mmol/l
55
Define liver failure
Abnormailities of bilirubin and prothrombin time Ascites and encephalopathy are signs of this
56
Women presents with itchy skin, dry eyes and mouth, fatigue and pain in the upper right quadrant of the abdomen. Diagnosis?
Primary biliary cholangitis BITCH WITH AN ITCH
57
On liver function tests ALT is raised, what does this suggest?
Enzymes in hepatocytes that will be released when damaged
58
On liver function tests GGT is raised, what does this suggest?
Biliary canuulicius when ducts are damaged Increased in alcohol, gallstones

GI JC (8 decks)

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