Year 3 MedEd > GI3 > Flashcards

GI3 Flashcards

Liver and Biliary (97 cards)

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1
Q

What are the three causes of jaundice?

A

Pre-hepatic
Hepatic
Post-hepatic

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2
Q

What is pre-hepatic jaundice?

A

Excess bilirubin due to excessive haemolysis

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3
Q

What is hepatic jaundice?

A

Impaired hepatocellular uptake, defective conjugation, or abnormal secretion of bilirubin

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4
Q

What is post-hepatic jaundice?

A

Impaired excretion due to a mechanical obstruction of the biliary flow

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5
Q

Which serum markers will be elevated in pre-hepatic jaundice?

A

Unconjugated bilirubin

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6
Q

Which serum markers will be elevated in hepatic jaundice?

A

AST
ALT
Conjugated + unconjugated bilirubin may also be elevated

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7
Q

Which serum markers will be elevated in post-hepatic jaundice?

A

ALP
GGT
Conjugated bilirubin

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8
Q

What are some signs of portal hypertension?

A 
Oesophageal varices
Splenomegaly
Caput medusae
Ascites
Haemorrhoids
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9
Q

What are some signs of liver failure?

A 
Asterixis
Bruising
Clubbing
Dupuytren's contracture
Erythema (palmar)
Fetor hepaticus (breath of the dead)
Gynaecomastia
Hypertension (portal)
Itching
Jaundice
Spider naevi/testicular atrophy
(ABC...)
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10
Q

Which hepatitides are transmitted through the faecal-oral route?

A

Hepatitis A, E

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11
Q

Which hepatitides are transmitted through bodily fluids?

A

Hepatitis B, C, D

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12
Q

What is the incubation period of Hepatitis A?

A

2 weeks

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13
Q

What is the incubation period of Hepatitis B?

A

4-12 weeks

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14
Q

What is the incubation period of Hepatitis C?

A

2 weeks - 6 months

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15
Q

What is the incubation period of Hepatitis D?

A

4-12 weeks

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16
Q

What is the incubation period of Hepatitis E?

A

5-6 weeks

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17
Q

What are the risk factors for Hepatitis A?

A

Poor hygeine

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18
Q

What are the risk factors for Hepatitis B?

A

Health workers
IVDU
M-M sexual relations

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19
Q

What are the risk factors for Hepatitis C?

A

IVDU

M-M sexual relations

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20
Q

What are the risk factors for Hepatitis D?

A

Only co-infects with Hep B

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21
Q

What are the risk factors for Hepatitis E?

A

Immunocompromised Pts

Pregnancy

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22
Q

Which hepatitides are at risk of chronic development?

A 
Hepatitis B (in children)
Hepatitis C (60-80%)
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23
Q

What are some generic symptoms of viral hepatitis?

A 
REduced appetite
N+V
Abdo pain
Pruritus
Skin rash
Joint pain
Jaundice
Hepatomegaly
Recent travel from Africa/East Mediterranean
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24
Q

What investigations would you do on a Pt with viral hepatitis?

A 
LFTs
FBC
U+Es
Antibodies
NAAT (nucleic acid amplification test can indicate viral load)
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25
What is the interpretation of the following HBV antibodies? Anti-HBc IgM: -ve Anti-HBc IgG: -ve HbSAg: -ve Anti-HBs: -ve
Not infected
26
What is the interpretation of the following HBV antibodies? Anti-HBc IgM: -ve Anti-HBc IgG: -ve HbSAg: -ve Anti-HBs: +ve
Not infected, with prior vaccination
27
What is the interpretation of the following HBV antibodies? Anti-HBc IgM: -ve Anti-HBc IgG: -ve HbSAg: +ve Anti-HBs: -ve
Early acute HBV infection
28
What is the interpretation of the following Hep B antibodies? Anti-HBc IgM: +ve Anti-HBc IgG: -ve HbSAg: +ve Anti-HBs: -ve
Acute HBV infection
29
What is the interpretation of the following HBV antibodies? Anti-HBc IgM: -ve Anti-HBc IgG: +ve HbSAg: -ve Anti-HBs: +ve
Resolved acute HBV infection
30
What is the interpretation of the following HBV antibodies? Anti-HBc IgM: -ve Anti-HBc IgG: +ve HbSAg: +ve Anti-HBs: -ve
Chronic HBV infection
31
Notes for HBV antibody interpretation
HBsAg: surface antigens If these are present, there is an infection Anti-HBs: surface antigen antibodies If these are present, body is successfully protected against virus Anti-HBc IgM/IgG: core antigen antibodies IgM precedes IgG, hence IgM indicates a more recent infection
32
What is the management for hepatitis A?
Supportive care
33
What is the management for hepatitis B?
Supportive care if acute | Antivirals and peginterferon if chronic
34
What is the management for hepatitis C?
Supportive care if acute | Antivirals if chronic
35
What is the prognosis for hepatitis A?
Nearly all resolve in 6 months
36
What is the prognosis for hepatitis B?
Viral suppression in 90% of chronic cases
37
What is the prognosis for hepatitis C?
79% mortality at 10 years for chronic cases
38
What is the cause of NASH/NAFLD?
Insulin resistance -> increased triglycerides -> steatosis -> inflammation -> steatohepatitis
39
What are the risk factors for NASH?
T2DM Metabolic syndrome Some medications No alcohol Hx
40
What is the triad for NASH?
RUQ pain Hepatomegaly Metabolic syndrome without alcohol
41
What are the investigations for NASH?
``` Liver function tests -AST:ALT will be <1 (>2 in alcoholic liver disease) FBC Metabolic profile Lipid profile Hepatic ultrasound ```
42
What is the management for NASH?
Diet and exercise Correction of glucose and lipid levels Liver transplant if in liver failure
43
What is the prognosis for NASH?
1/3 reverse the condition 1/3 keep the condition 1/3 develops into cirrhosis
44
What are the complications of NASH?
``` Cirrhosis HCC Ascites Portosystemic thrombosis Haemorrhaege ```
45
What is the cause for ALD?
Alcohol metabolism -> XS NADH -> inhibits gluconeogenesis -> increased triglycerides -> steatosis -> inflammation -> steatohepatitis
46
What is the triad for ALD?
RUQ pain Hepatomegaly Associated with a Hx of alcohol consumption
47
What are the investigations for ALD?
``` Liver function tests (AST:ALT >2, raised GGT) FBC U+Es Vitamin screen Hepatic ultrasound ```
48
What is the management for ALD?
Abstinence support Address metabolic syndrome Steroids/nutritional support Liver transplant if in liver failure
49
What is liver cirrhosis?
Scarring of the liver due to hepatocyte damage
50
What are the symptoms of liver cirrhosis?
Abdominal distension Pruritus Coffee-ground vomit (due to gastro-oesoph varices)
51
What are the signs of liver cirrhosis?
``` Jaundice Ascites Asterixis Dupuytren's contracture Palmar erythema Caput medusae ```
52
What are the investigations for liver cirrhosis?
``` LFTs -low albumin -prolonged PT U+Es -hyponatraemia: ascites US/CT/MRI can see atrophy/fibrotic nodules ```
53
What is the management for liver cirrhosis?
Treat underlying cause | Liver transplant if in liver failure
54
What is Wilson's disease?
Autosomal recessive disease of impaired copper excretion in the bile ATP7B mutation Accumulates in the liver -> cirrhosis + the basal ganglia -> neuropsychiatric disorder
55
What are the signs and symptoms of Wilson's disease?
``` Hepatitis symptoms Ataxia Tremor Dysdiadochokinesia Kayser-Fleischer rings ```
56
What investigations would you do for Wilson's disease?
LFTs: abnormal Urinary copper: high Serum caeruloplasmin: low
57
What is haemochromatosis?
Autosomal recessive multisystem disorder of dysregulated dietary iron absorption and increased iron release from macrophages Commonly C282Y or H63D mutation Due to hepcidin abnormality so there is no inhibition of Fe uptake
58
What are the signs and symptoms of haemochromatosis?
``` Brown skin T1DM Liver symptoms -hepatomegaly -fatigue -pruritus ```
59
What are the investigations for haemochromatosis?
Iron studies: - high ferritin - low transferrin - high transferrin saturation
60
What is cholelithiasis?
Presence of solid concentrations in the gall bladder
61
What is choledocholithiasis?
Formation of solid concentrations in the gall bladder which exit the bile duct
62
What is the anatomy of the biliary tree, starting from the sphincter of Oddi?
Sphincter of Oddi -> hepatopancreatic ampulla of Vater AoV -> common bile duct and pancreatic duct CBD -> cystic duct and common hepatic duct CHD -> left and right hepatic duct
63
What are the risk factors for gallstones?
``` Fair skinned Fat Female Fertile Family Hx Forty+ (6 F's) ```
64
What are the symptoms of gallstones?
RUQ pain- colicky, post-prandial | Nausea
65
What is Murphy's sign and what pathology does it present in?
Palpate the costal margin mid-clavicular plane Pain/wince upon inspiration Gallstones
66
What is Boas' sign and what pathology does it present in?
Pain radiating to below the scapula | Gallstones
67
What is Kehr's sign and what pathology does it present in?
Pain radiating to the shoulder tip | Gallstones
68
What investigations would you do for gallstones/cholelithiasis?
``` LFTs (first line) Abdo US (diagnostic) ```
69
What is the management for cholelithiasis?
Cholecystectomy
70
What is the management for choledocholithiasis?
ERCP
71
What is ascending cholangitis?
Gallstone in the common bile duct Leads to bile stasis Bacteria enter the hepatopancreatic duct Leads to inflammation and infection
72
What is acute cholecystitis?
Gallstone in the gall bladder/cystic duct | Leads to bile stasis, inflammation, and infection
73
What is Mirizzi syndrome?
Blockage of the cystic duct causing inflammation | Inflammation blocks CHD leading to obstructive jaundice
74
What are the signs and symptoms of acute cholecystitis?
``` Constant RUQ pain +/- Boas' sign Fever N+V Rebound tenderness Murphy's sign +ve ```
75
What are the signs and symptoms of ascending cholangitis?
Charcot's triad | If septic, Reynold's pentad
76
What is Charcot's triad?
RUQ pain Fever Jaundice
77
What is Reynold's pentad?
``` RUQ pain Fever Jaundice Hypotension Confusion ```
78
What is primary biliary cirrhosis?
Autoimmune damage and destruction of the biliary epithelial cells lining the small intrahepatic bile ducts
79
What is the epidemiology of PBC?
55-65 yrs F:M 10:1 AI conditions Hypocholesterolaemia
80
What are the symptoms of PBC?
Pruritus Fatigue Sjogren's (dry mouth and eyes)
81
What are the investigations of PBC?
LFTs Anti mitochondrial antibodies Abdo US- rule out obstructive duct lesion
82
What is primary sclerosing cholangitis?
Inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts, leading to diffuse, multi-focal stricture formation.
83
What is the epidemiology for PSC?
40-50s Male Concurrent IBD
84
What are the symptoms of PSC?
RUQ pain Pruritus Fatigue
85
What are the investigations for PSC?
LFTs (elevated GGT) MRCP: beading AMA: -ve
86
What is the epidemiology for pancreatic cancer?
65-75 yrs old Smoking FHx
87
What are the symptoms for pancreatic cancer?
Jaundice Nonspecific abdo pain FLAWS
88
What are the investigations for pancreatic cancer?
LFTs Ultrasound CT
89
A 26 y/o male returns from holiday in India. He has had diarrhoea after eating at a seafood restaurant on his last night. He is feverish and nauseous. You notice that the whites of his eyes are yellow. ``` A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E ```
A. Hepatitis A
90
A 64 y/o male with thalassaemia is investigated under the two-week wait for jaundice and weight loss. His blood tests show a raised αFP. Which chronic infection is he most likely to have? ``` A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E ```
C. Hepatitis C aFP is raised in cancer. Hep C chronicity has a high risk of HCC.
91
A 32 y/o male returns from holiday in Thailand, feeling ‘under the weather’ with RUQ pain, fevers and nausea. He is jaundiced. He reveals he has used IV drugs and had unprotected sex with a stranger while on holiday. Which test is most likely to give the correct diagnosis? ``` A. Liver function tests B. HIV serology C. Hepatitis B serology D. Hepatitis C PCR E. CXR ```
C. Hepatitis B serology
92
A 43 y/o confused man is brought to A&E by police after being found wandering the streets. He is disorientated and unable to give a clear history. You notice brown rings in his eyes. What is he likely to have? ``` A. Alcohol intoxication B. Wilson’s disease C. Opiate overdose D. Haemochromatosis E. Hypoglycaemia ```
B. Wilson’s disease
93
72 y/o man with cirrhosis presents to A&E with diffuse abdominal pain and fever. He is nauseous and has vomited. His abdomen is distended and there is shifting dullness on examination. Which investigation would be most urgent? ``` A. Paracentesis B. Stool sample MC&S C. Abdominal USS D. LFTs E. Blood cultures ```
A. Paracentesis Has signs of bacterial peritonitis, which needs to be treated more urgently than the cirrhosis
94
A 41 y/o female presents with a history of colicky, right sided abdominal pain. She states the pain is worse after eating fish and chips and Indian takeaways. On examination her abdomen is soft and non-tender. Which is the best investigation to confirm her diagnosis? ``` A. Abdominal X-ray B. ERCP C. Liver biopsy D. USS of biliary tree E. CT-KUB ```
D. USS of biliary tree
95
A 41 y/o female presents to A&E with a history of severe, continuous, RUQ pain. She feels feverish and complains of an occasional pain in her right shoulder. On examination she displays RUQ tenderness and a positive Murphy’s sign. What is the most likely diagnosis? ``` A. Biliary colic B. Ascending cholangitis C. Acute cholecystitis D. Primary biliary cirrhosis E. Cholangiocarcinoma ```
C. Acute cholecystitis
96
A 41 y/o female presents to A&E with a history of severe, continuous, RUQ pain. She feels feverish and complains of an occasional pain in her right shoulder. On examination she displays RUQ tenderness and a positive Murphy’s sign. While waiting to be admitted, her RUQ pain becomes worse and she starts shaking uncontrollably. You notice she now looks jaundiced. What is the most likely diagnosis? ``` A. Biliary colic B. Ascending cholangitis C. Acute cholecystitis D. Primary biliary cirrhosis E. Cholangiocarcinoma ```
B. Ascending cholangitis
97
A 35 y/o man presents with a two week history of jaundice and RUQ pain. He is taking mesalazine for a “bowel condition”. What is the most likely cause of his jaundice? ``` A. Autoimmune hepatitis B. Haemochromatosis C. Primary sclerosing cholangitis D. Primary biliary cirrhosis E. Drug side effect ```
C. Primary sclerosing cholangitis
Year 3 MedEd
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