3B > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

(55 cards)

Study These Flashcards
1
Q

Alcoholic hepatitis histology and presentation

A

Histology

  • Steatosis
  • Mallory bodies
  • Swollen hepatocytes

Presentation

  • Rapid onset jaundice
  • Symptoms of liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Alcoholic hepatitis investigations and management

A

Investigations

  • NILS - Bilirubin / PT ^
  • AST : ALT ^
  • Gamma-GT ^
  • MCV ^

Management - Stop drinking!

  • Prednisolone
  • Chlordiazepoxide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cirrhosis aetiology

A

Alcohol
Viral hepatitis
NAFLD

Wilson's
Hereditary haemochromatosis
A1AT deficiency
PBC / PSC
Budd-Chiari syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Compensated cirrhosis presentation

A

Clubbing
Palmar erythema
Dupuytren’s

Excoriations
Spider naevi
Bruising

Gynaecomastia
Xanthelasma
Hepatosplenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Decompensated cirrhosis presentation

A 
Ascites
Asterixis
Encephalopathy
Caput medusa
Fetor hepaticus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cirrhosis investigations

A

FBC - Thrombocytopenia
U&E - Hyponatraemia
LFTs - Bilirubin + Albumin
Clotting

Wilson’s screen - Ceruloplasmin
HH screen - Transferrin
A1AT
PBC / PSC - ANA / ASM

Viral hepatitis serology
EBV / CMV screen

USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cirrhosis histology and management

A

Necrosis
Fibrosis
Nodules

Management - Treat cause

  • Flu vaccine
  • HCC screen
  • Endoscopy - Check for varices
  • Transplant - Must be 6 months sober
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cirrhosis complications

A

HCC - USS and aFP screen every 6 months
Hepatopulmonary syndrome
Hepatorenal syndrome

Portal HTN - Varices - Prevent with BB
Ascites ± SBP

Coagulopathy
Encephalopathy

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Portal HTN pathophysiology

A

Arterial blood supply to liver

  • Portal vein 75%
  • Hepatic artery 25%

Cirrhosis / blockage of portal vein
Blood backs up into left gastric vein
Oesophageal varices - Lower 1/3 oesophageal veins
Development of collateral veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Portal HTN aetiology and presentation

A

Pre-hepatic - SOL / Thrombus
Hepatic - Cirrhosis
Post-hepatic - Budd-Chiari

Presentation

  • Asymptomatic
  • GI bleed
  • Anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Variceal haemorrhage management

A

Prophylaxis - BB!

EVL - Endoscopic variceal band ligation
ABCDE
Major haemorrhage protocol
2 large-bore IV cannulae
Crossmatch
Terlipressin
Abx - Cipro

OGD

  • Banding / Sclerotherapy
  • Minnesota tube
  • Rebleed - TIPS procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hepatic encephalopathy pathophysiology

A

Gut bacteria normally breakdown nitrogen containing compounds
Ammonia released - Goes into urea cycle in hepatocytes

Cirrhosis disrupts urea cycle - Increased ammonia
Ammonia causes astrocytes to convert glutamate to glutamine
= Encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hepatic encephalopathy presentation and grading

A 
Confusion
Slurred speech
Drowsiness
Apraxia - Can't draw 5-point star
Liver flap
Fetor hepaticus
  1. Irritability
  2. Confusion and inappropriate behaviour
  3. Incoherent and restless
  4. Comatose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hepatic encephalopathy investigations and management

A

Find cause
EEG - Triphasic slow waves

Management

  • Lactulose - Reduce gut nitrogen
  • Neomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PBC aetiology and presentation

A

AI fibrosis of biliary tract

Females
Sjogren's
RA
Systemic sclerosis
Thyroid disease

Presentation - Itching female aged 40-50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PBC investigations / management / complications

A

AMA
SMA
IgM

Management

  • Itch - Cholestyramine
  • Ursodeoxycholic acid
  • Fat soluble vitamins - ADEK

Complications

  • Cirrhosis - HCC
  • Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PSC

A

Extra-hepatic bile duct destruction

Males
UC / Crohn’s

Presentation

  • Jaundice
  • RUQ pain

Investigations

  • pANCA +ve
  • ALP ^
  • Bilirubin ^
  • Biopsy - Onion skin fibrosis
  • MRCP - Beaded appearance

Complications

  • Cholangiocarcinoma
  • Colon cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gallstones

A

Aetiology - FFFF

  • Fat
  • Female
  • Forty
  • Fertile
  • Diabetes
  • OCP

Presentation - Post-prandial RUQ pain

Investigations

  • LFTs
  • CRP
  • USS

Management - Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute cholecystitis

A

Gallstones blocking cystic duct

RUQ pain
Fever
Murphy's sign +ve
Systemically unwell
N/V ± Rigors

Management - Cholecystectomy < 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ascending cholangitis

A

Bacteria ascends biliary tree
Creates a blockage

Charcot’s triad

  1. Fever
  2. Jaundice
  3. RUQ pain

Management

  • ERCP
  • Abx - Taz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Biliary colic

A

Presence of stones in gallbladder
RUQ pain

Imaging - ERCP
Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pancreatitis aetiology

A

GET SMASHED

Gallstones
Ethanol
Trauma
Scorpion bites
Mumps
AI
Steroids
HYPERcalcaemia / HYPERlipidaemia / HYPOthermia
ERCP
Drugs - Gliptin / GLT-1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pancreatitis presentation

Study These Flashcards
A

Epigastric pain - Worse lying down - Radiates to back

Signs of sepsis/shock - Fever
Cullen’s sign - Peri-umbilical bruising
Grey-Turner sign - Flank bruising

N/V

24
Q

Pancreatitis investigations

Study These Flashcards
A

Lipase / Amylase
AXR
Erect CXR

Bloods

  • Glucose ^
  • FBC
  • LFTs - AST ^
  • U&E
  • Blood cultures
  • VBG/ABG
  • CRP > 200 = Necrotising
  • MRCP - Check for gallstones
25
Pancreatitis severity scale and management
GLASGOW criteria - Indicates severe pancreatitis ``` GLA5COW Glucose - High LDH - High AST - High > 55 Calcium - Low Oxygen - Low White cells - High ``` Management - SUPPORTIVE - NBM - Fluids - Analgesia - IV abx? - IV PPI?
26
Pancreatitis complications
Hypocalcaemia Hyperglycaemia Metabolic acidosis Shock Perforation / Peritonitis Haemorrhage Abscess Pseudocyst Necrotising pancreatitis ARDS Renal failure
27
Chronic pancreatitis aetiology and presentation
Alcohol Cystic fibrosis Duct obstruction - Tumour Presentation - Stool changes - Pale steatorrhoea - Epigastric pain - Relieved sitting forwards - Worse on eating - Weight loss - DM - Jaundice
28
Chronic pancreatitis investigations and management
AXR - Calcification CT Faecal elastase Management - Stop drinking alcohol - Replace enzymes - Analgesia
29
Wilson's disease
AR - Ch13 Copper accumulation Presentation - Eyes - Kayser Fleisher rings - BG - Movement disorder - Renal - Renal tubular acidosis - Liver - Jaundice Investigations - NILS - Ceruloplasmin - LOW - MRI basal ganglia - Urinary copper ^ - Serum copper - LOW - Genetic testing Management - Penicillamine - Zinc - Transplant
30
Haemochromatosis
Aetiology - AR6 - HFE gene Iron accumulation Presentation - Joints - Arthralgia - Pancreas - DM - Liver - Cirrhosis and hepatomegaly - Skin - Hyperpigmentation - ED - Common - Cardio - Cardiomyopathy Investigations - NILS + Biopsy with pearl stain - Ferritin ^ - Iron ^ - TIBC - LOW - Transferrin saturations ^^^
31
Ascites | Transudate vs Exudate
Serum albumin -(MINUS)- Albumin level of ascitic fluid Transudate - SAAG > 11 - Portal HTN - Budd-Chiari - Cardiac failure - Meigs syndrome Exudate - SAAG < 11 - Peritoneal carcinoma - Peritoneal TB - Pancreatitis - Nephrotic syndrome
32
Ascites presentation
Fullness and distension Shifting dullness Pleural effusion Dyspnoea
33
Ascites investigations
NILS USS CXR ECG / ECHO Ascitic tap - Albumin - LDH - Cytology - Microscopy - Gram stain - Amylase - Pancreatic
34
Ascites management and complications
Management - Treat underlying cause - Dietary salt restriction - Spironolactone - Furosemide - Paracentesis - TIPS Complications - SBP - Respiratory distress - Dyspnoea
35
SBP
Aetiology - Ascites - E.Coli Presentation - Peritonitis - Ascites - Fever Investigations - Blood cultures - Paracentesis Management - IV cef - Prophylaxis - Ciprofloxacin
36
Budd Chiari
1. Occlusion of hepatic vein 2. Hypoxic liver damage 3. Necrosis Aetiology - Hypercoagulable state - Malignancy - OCP - Thrombophilia Clinical features - Rapid onset ascites! - Portal HTN - Jaundice - RUQ pain - Right-sided HF Investigations - USS doppler Management - Treat underlying cause - Thrombolysis - Warfarin - Surgical intervention - Stenting
37
Hepatitis risk factors
``` Endemic regions MSM IVDU High-risk sexual behaviours Family history Incarceration Blood transfusion - Pre 1992 Tattoos ```
38
Hepatitis A
RNA picornovirus Benign and self-limiting Incubation - 2-4 weeks Transmission - F/O (BOWELS ARE VOWELS) Clinical features - Flu-like prodrome - Abdo pain - RUQ - Tender hepatomegaly - Jaundice - Cholestatic LFTs - ALT ^ and ALP ^^^ Management - Supportive + IgG
39
Hepatitis B
Double-stranded hepadnavirus Transmission - H/V Incubation 6-20 weeks Clinical features - Fever - Jaundice - Hepatomegaly - Ascites - Malaise - RUQ pain - Elevated liver transaminases
40
Hep B serology HBsAg Anti-HBs Anti-HBc IgM Anti-HBc IgG HbeAG
HBsAg - Acute disease - Present > 6 months = Chronic disease (Infective) Anti-HBs - Implies immunity (Exposure or immunisation) Anti-HBc - IgM - Acute or recent infection Anti-HBc - IgG - Persists after infection HBeAG - Marker of infectivity
41
Hep B management
Pregnancy - All pregnant women offered Hep B screening - Babies born to infected mothers given complete vaccination course + Hep B Ig - Not transmitted via breastfeeding Acute - Supportive ± Entecavir / Tenofovir Chronic - Entecavir / Tenofovir - Pegylated interferon-A - Assess for transplant
42
Hep C clinical features
RNA flavivirus Transmission - H/V - Needle-stick 2% - Mother to child 6% - Breastfeeding not CI - Sexual intercourse - 5% Incubation - 6-9 weeks Symptoms - 30% - Jaundice - Ascites - B-symptoms - Elevated liver transaminases
43
Hep C management and prognosis
Aim to achieve sustained virological response Undetectable serum HCV RNA six months after the end of therapy Protease inhibitors - Glecaprivir - Sofosbuvir Prognosis - 15-45% clear the virus after acute infection - 55-85% develop chronic Hep C
44
Hep C complications
``` Rheumatological problems - Arthralgia and arthritis Eye problems - Sjogren's syndrome Cirrhosis - 5-20% HCC Cryoglobulinaemia Membranoproliferative glomerulonephritis ```
45
HCC aetiology and presentation
``` Cirrhosis Hep B/C Alcoholism DM Obesity Family Hx ``` ``` Abdo distension Variceal bleeding RUQ pain Weight loss / LOA Oedema Jaundice Hepatosplenomegaly Spider naevi ```
46
HCC investigations / management / prognosis
FBC - Microcytic anaemia + Thrombocytopenia U&E - Na + Urea ^ LFTs ^ Clotting - PT ^ Hepatitis screen AFP ^^ Liver USS CT/MRI - Avoid biopsy Management - Surgery ± Chemo/Radio Prognosis - Poor - 5 year survival is 15%
47
Cholangiocarcinoma aetiology and presentation
Adenocarcinoma ``` Age > 50 Bile duct disease UC Cirrhosis ALD Hep B/C HIV Typhoid ``` ``` Painless jaundice Weight loss RUQ pain Hepatomegaly Dark urine Pale stools Pruritus ```
48
Cholangiocarcinoma investigations / management / prognosis
LFTs ^ Clotting profile - PT ^ Abdo USS CT / MRI / MRCP Tumour markers - Ca199 - Ca125 - CEA Management - Surgery ± Chemo/Radio Prognosis - Poor - 5 year survival is 5-10%
49
A1AT deficiency aetiology and clinical features
AR - Ch14 Lack of protease inhibitor - Normally produced by the liver - Protects cells from enzymes such as neutrophil elastase - Causes COPD / emphysema in young non-smokers Lungs - Paracinar emphysema - Lower lobes - Productive cough - SOBOE Liver - Adults - Cirrhosis and HCC - Children - Cholestasis
50
A1AT deficiency investigations and management
A1AT concentrations Spirometry - Obstructive Management - Smoking cessation - Hep A/B vaccine - COPD treatment - Bronchodilators - Chest PT - IV A1AT protein concentrates - Surgery - Lung transplant
51
Liver abscess aetiology and clinical features
Localised infection in liver parenchyma Purulent collections Adults - E.Coli Children - Staph Risk factors - Biliary tract disease - Age > 50 - Underlying malignancy - DM - Interventional biliary or hepatic procedures - Endemic areas for amoebiasis Fever and chills RUQ tenderness Hepatomegaly
52
Liver abscess investigations and management
FBC - WCC ^ LFTs ^ + HYPOalbuminaemia Blood cultures Liver USS - Variably echoic lesion CT with contrast - Hypodense liver lesions Aspirate and culture Broad spec abx - Amox + Cipro + Met Needle aspiration / drainage Antifungals - Fluconazole Amoebic abscess - Nitromidazole
53
Pancreatic cancer aetiology
Adenocarcinoma Head of pancreas Risk factors - Smoking - Family Hx - Chronic pancreatitis - HNPCC - MEN - BRCA2 - KRAS mutation
54
Pancreatic cancer clinical features
``` Painless jaundice Pale stools / Dark urine Pruritus Epigastric pain or discomfort - Radiates to the back Weight loss / LOA ``` Courvoisier's Law Painless obstructive jaundice + Palpable gallbladder is NOT gallstones
55
Pancreatic cancer investigations and management
Abdo USS Pancreatic protocol CT Double-duct sign - Simultaneous dilatation of CBD and pancreatic ducts LFTs ^^^ (Cholestatic picture) Management - Whipple - Pancreaticoduodenectomy - Replacement enzymes - Pancreatin - Radio/Chemo - ERCP stenting - Palliative
3B
flashcards
Decks in class (23)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions