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Gastro > Liver + Biliary Disease > Flashcards

Liver + Biliary Disease Flashcards

1
Q

Mechanism of chronic liver failure

A

Commonly due to cirrhosis

Progressive destruction + regeneration of liver parenchyma leads to fibrosis + cirrhosis

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2
Q

Causes of chronic liver failure

A

Hepatitis

Alcoholic liver disease

Methotrexate, amiodarone, nitrofurantoin

Fatty liver disease

Wilsons disease

Biliary cirrhosis

Sclerosing cholangitis

Right HF

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3
Q

RF of liver failure

A

Alcohol

Obesity

Metabolic syndrome

IVDUs

Unprotected sex with multiple partners

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4
Q

S+S liver failure

A

Ascites

Haematemesis

Itching

Gallstones

Jaundice

Loss of appetite

Easy bruising

Diarrhoea

Fatigue

Palmar erythema

Dupytrens contracture

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5
Q

Management of liver failure

A

Corticosteroids, interferons, antivirals, bile acids

Supportive: diuretics, albumin, vit K, abx

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6
Q

What causes a high serum urea?

A

Catabolic state

High protein intake

GI bleed

Dehydration

CV failure

Reduced renal function

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7
Q

What causes a low serum urea?

A

Liver failure

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8
Q

What causes a high serum creatinine?

A

Reduced renal function

Large muscle mass (young, male, muscular)

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9
Q

What causes a low serum creatinine?

A

Low muscle mass (elderly, wasting, females)

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10
Q

What are the causes of ascites?

A

Cirrhosis

Malignancy (GI tract)

HF

Nephrotic syndrome

TB

Pancreatitis

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11
Q

What is the management of ascites?

A

Spironolactone

Loop diuretics

Paracentesis

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12
Q

S+S gallstones

A

Biliary colic
N+V
Pain worse on eating fatty foods, may radiate to back
Positive Murphys sign = palpate liver border + pain on inhalation

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13
Q

Presentation of cholecystitis

A

Typically 2nd to gallstones

RUQ/ epigastric pain colicky, radiating to back

Fever + rigors

Vomiting

Murphys sign (pain in RUQ on inspiration)

Precipitated by consumption of fatty foods

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14
Q

Investigations + results for ?cholecystitis

A

FBC, U+Es LFTS (raised ALP + bilirubin)

Raised WCC

ECG, amylase, CXR

USS 1st line

MRCP if USS is inconclusive or EUS

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15
Q

Investigations + results for ?cholangitis

A

WCC+, CRP+, ALT+, ALP+

USS 1st line = shows bile duct dilatation

ERCP = diagnostic

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16
Q

What is Reynolds pentad?

A

Hypotensive + confused

Sign of cholangitis + septic shock

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17
Q

What is Charcot’s triad?

A

Sign of cholangitis

RUQ pain, jaundice, rigors

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18
Q

Management of cholecystitis

A

NBM, opioid/ diclofenac for severe pain, paracetamol/ NSAIDs for mild

IV co-amox/ metronidazole- cefurox

Lap cholecystectomy

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19
Q

Management of biliary colic

A

NBM, analgesia, rehydrate

Elective lap cholecystectomy

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20
Q

Management of cholangitis

A

IV cefuroxime/ co-amox + metronidazole

ERCP

Percutaneous transhepatic cholangiography - if pt too unwell for ERCP

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21
Q

RF for biliary tract infections

A

Fat

Fertile

Forty

Female

Fam hx

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22
Q

Complications of cholecystitis

A

Gallbladder empyema

Gangrenous cholecystitis

Perforation

Chronic cholecystitis

Cholecystenteric fistula

Bouveret’s syndrome + gallstone ileus

Obstructive jaundice

Pancreatitis

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23
Q

MRCP vs ERCP

A

MRCP = using MRI to get image

ERCP = use of contrast dye while images are being taken

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24
Q

Causes + presentation of cholangitis

A

Cholesterol stones

Charcot’s triad: jaundice, abdo pain + fever

Pruritis

Reynolds pentad: + hypotension + confusion

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25
Q

What is serum ammonia useful for?

A

Diagnosing acute liver failure due to hepatic encephalopathy

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26
Q

Pathology of gallstones

A

Occur due to cholesterol supersaturation, accelerated cholesterol crystal nucleation + impaired gallbladder motiligy

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27
Q

RF for developing gallstones

A

Crohns, DM, high fat diet, females, increasing age, NAFLD, obesity, HRT

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28
Q

Complications of gallstones

A

Bilary colic, acute cholecystitis, cholangitis + pancreatitis

Gallstone ileus, Mirizzi syndrome, gallbladder cancer

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29
Q

Pathology of cholecystitis vs cholangitis vs choledocholithiasis

A

Cholecystitis = inflammation of gallbladder, usually due to cholelithiasis (gallstones)

Cholangitis = infection of biliary tract (usually due to stasis of bile)

choledocholithiasis = presence of stones in CBD

30
Q

RF for acalculous cholecystitis

A

Trauma, burns, immobility

Starvation, sepsis, renal failure, DM, vascular disease

31
Q

What is Mirizzi’s syndrome?

A

Common hepatic duct obstruction from extrinsic pressure from gallstones

Causes jaundice, fever + RUQ pain

32
Q

Pathology of portal hypertension

A

Resistane to portal blood flow aggravated by increased portal collateral flow

Resistance is usually within liver (cirrhosis) but can be pre-hepatic (portal vein thrombosis) or post-hepatic (Budd-Chiari syndrome)

33
Q

Causes of portal hypertension

A

Cirrhosis

Hepatic schistosomiasis

Portal vein thrombosis

34
Q

Presentation of portal hypertension

A

Asymptomatic until complications develop

Splenomegaly, abdo wall collateral circulation + thrombocytopenia

35
Q

What are the complications of portal hypertension?

A

Variceal hemorrhage, portal hypertensive gastropathy, ascites, SBP

Hepatorenal syndrome, portopulmonary hypertension + cirrhotic cardiomyopathy

36
Q

How is portal hypertension diagnosed?

A

Pt with known RF has clinical signs of portal hypertension

Hepatic venous pressure gradient can be used to confirm diagnosis (>6mmHg = PH)

37
Q

Management of portal hypertension

A

Manage underlying cause

Endoscopy to screen for varices

Nonselective BB or endoscopic variceal ligation to prevent bleeding

Sodium restriction + diuretics for ascites

38
Q

What are the main causes of cirrhosis?

A

Alcohol, hep B + C, obesity, T2DM, NAFLD

39
Q

Definition of acute liver failure

A

Development of acute liver injury with encephalopathy + impaired INR >1.5 in a pt without cirrhosis or pre-existing disease

<26 weeks

40
Q

Causes of acute liver failure

A

Paracetamol OD

Viral, autoimmune or drug induced hepatitis

Wilsons disease

Ischaemic hepatopathy

Budd-Chiari syndrome

HELLP syndrome

Malignancy

Sepsis

41
Q

Presentation of acute liver failure + lab results

A

Hepatic encephalopathy, abnormal LFTs, INR >1.5

Jaundice, hepatomegaly, RUQ tenderness, thrombocytopenia

42
Q

Initial investigations for acute liver failure

A

PT/ INR

U+E, glucose, bicarb, Mg, Phosphate, lactate

LFTs

CBC

Paracetamol level

Tox screen

Hepatitis serologies

Autoimmune markers

ABG inc lactate

HIV testing

Amylase + lipase

Doppler US 1st line then CT or MRI

43
Q

Classifications of cirrhosis

A

Compensated - liver still functions effectively

Decompensated - cannot function, overt symptoms

44
Q

What are the main complications of cirrhosis?

A

Ascites, hepatic encephalopathy, hemorrhage from oesophageal varices, infection

45
Q

How to diagnose cirrhosis?

A

Transient elastography, US, biopsy

46
Q

What is NAFLD?

A

Presence of hepatic steatosis with no other cause

May progress to cirrhosis

47
Q

What are the types of NAFLD?

A

Nonalcoholic fatty liver (NAFL) + nonalcoholic steatohepatitis (NASH)

NAFL = hepatic steatosis present without inflammation

NASH = inflammation present

48
Q

S+S of NAFLD

A

Asymptomatic, fatigue, malaise, RUQ discomfort

49
Q

Diagnosis of NAFLD

A

Demonstration of hepatic steatosis by imaging or biopsy

Exclusion of significant alcohol consumption + other causes

Absence of co-existing chronic liver disease

50
Q

What imaging + lab results are consistent with NAFLD?

A

Elevations in ALT + AST (ALT higher than AST), increased echogenecity on US, decreased hepatic attenuation on CT, increased fat signal on MRI

51
Q

What are other causes (than NAFLD) of hepatic steatosis?

A

Significant alcohol use

Hep C - particularly genotype 3

Wilsons

Lipodystrophy

Starvation

Parenteral nutrition

Reyes syndrome

HELLP syndrome

52
Q

What is steatosis?

A

Excess triglycerides in the liver

53
Q

Complications of NAFLD

A

Portal hypertension, variceal hemorrhage, liver failure, hepatocellular carcinoma, sepsis, CV disease, T2DM

54
Q
A
55
Q

Characteristics of simple liver cysts

A

Don’t communicate with biliary tree

Asymptomatic or dull RUQ pain or bloating

56
Q

Characteristics of choledochal cysts

A

Malformation of pancreaticobiliary tree

High risk of malignancy

Present before 10 y/o

Causes recurrent abdo pain, intermittent jaundice, RUQ mass, cholangitis + pancreatitis

57
Q

Characteristics of hydatid liver cysts

A

Infectious cysts

Asymptomatic, maybe palpable RUQ mass

58
Q

What are the benign liver neoplasms?

A

Hemangiomas

Focular nodular hyperplasia

Adenoma

59
Q

What score is used for prognosis of liver disease?

A

Child-Turcotte-Pugh Score

60
Q
A
61
Q

Conditions leading to liver transplantation

A

Parenchymal disease = hepatitis, cirrhosis, liver failure, budd-Chiari syndrome

Cholestatic disease = biliary atresia, sclerosing cholangitis

Inborn errors = Wilsons, hemochromatosis

Hepatocellular carcinoma

62
Q

What is Mirizzi syndrome?

A

Complication of gall stones causing compression of CBD/ CHD

63
Q

What is Rouviere’s sulcus?

A

Fissure between right lobe + caudate process of liver

64
Q

What is Rigler’s triad?

A

Pneumobilia

Small bowel obstruction

Gallstone

Causes gallstone ileus

65
Q

What is Bouvert’s syndrome?

A

Gastric outlet obstruction caused by large gallstone

66
Q

Courvoisier’s sign?

A

Palpable non-tender distended gallbladder due to CBD obstruction

67
Q

What is a Klatskin tumor?

A

Cholangiocarcinoma located at bifurcation of common hepatic duct

68
Q

What is Trousseau’s sign?

A

Spontaneous peripheral venous thrombosis, associated with pancreatic cancer

69
Q

What is a Whipple resection?

A

Removal of CBD, gallbladder, duodenum, pancreatic head, distal stomach

70
Q

What is Kehr’s sign?

A

Left shoulder pain due to diaphragmatic irritation from splenic rupture

Worsens with inspiration

71
Q

Indications for splenectomy

A

Splenic abscess

Hereditary spherocytosis

Immune thrombocytopenic purpura

Rupture of spleen

Thrombotic thrombocytopenic purpura

Splenic vein thrombosis

72
Q

What are the biochemical signs for differentiating jaundice?

A

Hepatocellular = high bilirubin, high ALT/ AST

Cholestatic = high bilirubin, high ALP/GGT, duct dilatation on US

Hemolysis = low haptoglobin, high lactate

Gastro (11 decks)

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