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GIT > 13 Feb 24 > Flashcards

13 Feb 24 Flashcards

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1
Q

CF of alcoholic hepatitis

A

😵‍💫Jaundice , anorexia , fever

😵‍💫RUQ and epigastric pain

😵‍💫Abd distension due to ascites

😵‍💫Prox muscle weakness from muscle wasting if malnourished

😵‍💫Possible hepatic encephalopathy

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2
Q

Labs of alcoholic hepatitis

A

😵‍💫Elevated AST , ALT usually <300
😵‍💫AST/ALT >-2
😵‍💫Elevated GGT , bilirubin , INR
😵‍💫Leukocytosis , predominantly neutrophils
😵‍💫Decreased albumin if malnourished
Abd imaging may show fatty liver.

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3
Q

How to alcohol history can cause alcohol hepatitus

A

Heavy use > 7 drinks /day

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4
Q

Idiosyncratic hepatic cell injury causes

A

Isoniazid
Chlopromazine
Antiretroviral therapy

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5
Q

Impact of various drugs on liver

A

Cholestasis. Anabolic steroids
Fatty liver. Valproic acid
Hepatitis. Isoniazid
Toxic/fulminant. Acetaminophen
liver
Granulomatous changes. Allopurinol

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6
Q

Isoniazid induced liver injury Identify

A

Jaundice
Tender hepatomegaly
Elevated LFTs. (500s)
Panlobular mononuclear infiltration
Hepatic cell necrosis

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7
Q

GIT manifestations of sarcoidosis

A

Hepatospleenomegaly
Asymptomatic LFT abnormalities
Mild ALP elevations

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8
Q

Extrapulmonary sarcoidosis CF

A

Multisystem inflammatory granulomatous dx

Patchy infliltratiin by non caseating granulomas

CF :
AS
Hepatispleenomegaly
LFT elevations
Mix cholestatic and hepatocellular abnormalities
Hilar LAD
Hypercalcemia

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9
Q

DX of liver sarcoidosis

A

Liver , LYmph node biopsy
(Of most accessible lesion)

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10
Q

Whatis Lofgren syndrome

A

L. Lymph nOdes in hilum

F. Fever
GR miGRratory arthritis
E
N. Erythema nodosum

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11
Q

Autoimmune hepatitis CF

A

🤐A/S :
Identified by abnormal LFTs

🤐Symptomatic:

     Fatigue , anorexia , nausea , jaundice 
     Can progress to fulminant Liver failure / cirrhosis

🤐 often associated with other autoimmune disorder (vitiligo, autoimmune thyroiditis , celiac dx )

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12
Q

Autoimmune hepatitis Labs

A

🥴Hepaticellular pattern (inc AST ALT)
20X the upper limit of normal
🥴Hypergammaglobulinemia
🥴elevated gamma gap >4g/dl
🥴Elevated autoantibodies
Anti sm ms
Anti liver /kidney microsomal type 1
Antinuclear (non specific)

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13
Q

Histology of autoimmune hepatitis

A

Portal and periportal lymphoplasmacytic inflitration

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14
Q

Ttt of autoimmune hepatitis

A

Prednisone +- azathioprine

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15
Q

Diagnostic requirements for Acute liver failure

A

⏳Severe Liver injury ( ALT , AST > 1000U/L)
⏳Signs of hepatic encephalopathy
(Confusion, asterixis)
⏳Synthetic liver dysfunction INR >- 1.5

👼🏼No underlying liver dx or cirrhosis should be present.

👼🏼Hepatic enceph differentiates ALF from acute hepatitis

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16
Q

Mechanism of liver failure due to acetaminophen

A

Overproduction of N-Acetyl-p-benzoquinone imine NAPQI which leads to hepatic necrosis

NAPQI is normally safely detoxified through glucoronidation in liver
But this pathway is overwhelmed in overdose.

Chronic alcohol use potentiates acetaminophen hepatotoxicity by depleting glutathione levels and impairs glucuronidation.

Antidote N acetylcysteine increases glutathione levels.

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17
Q

Labs of acetaminophen toxicity

A

Inc LFTs. (>1000)
Inc INR >1.5
Bilirubin is elevated (not as elevated as other causes of liver failure)
ElevatedRFTs

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18
Q

Most common causes of Acute liver failure

A

Drug toxicity

Acute viral hepatitis ( A B )

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19
Q

Worsening ALF due to acetaminophen
Features and indications of transplant

A

Rising serum Bilirubin
Rising PT >100s
Acute renal insuff Cr > 3.4
Grade 3 hepatic enceph (marked confusion and incoherence)
Cerebral edema (may lead to coma)

20
Q

Signs of hyperestrogenism in CLd

A

Spider angiomata
Gynecomastia
Loss of sexual hair
Testicular atrophy
Palmar erythema

21
Q

Cirrhosis and hyperestrinism

A

👶🏾Impaired hepatic metabolism of circulating estrogens
👶🏾Ciculating estrogens affect vascular dilation.
👶🏾Spider angiomata is central dilated arteriole surrounded by smaller radiating vessels
👶🏾 palmar erythema is also result of increased normal speckling of palm due to increased vasodilation esp at thenar /hypothenar eminences.

22
Q

Hereditary hemochromatosis CF

A

Hyperpigmentation
Arthropathy
Hepatomegaly , cirrhosis , HCC
Diabetes Mellitus
Hypopituitarism , sec hypogonadism
Cardiomyopathy

23
Q

Herediatry hemochromatosis Dx

A

Elevated Liver transaminases
Elevated Serum ferritin , transferrin saturation
HFE genetic mutations

Ttt:
Phelobotomy (urgent if ferritin > 1000ng/mL) without waiting for genetic test results.

24
Q

HH labs

A

AR

Elevated LFTs
Elevated ferrtin
Elevated transferrin saturation
Serum iron /TIBC X 100
HFE genetic mutations

25
Q

Markers of Chronic HBV infection

A

HBsAg
IgG HBc
HBV DNA

26
Q

Marker for HBv vaccinated person

A

Anti HBs

27
Q

Marker for prev resolved HBV infection

A

IgG HBc
Anti HBs

28
Q

Markers for Acute HBV early infection

A

HBsAg
HBeAg
Anti IgM HBc
HBv DNA

29
Q

Marker for acute HBV window period

A

IgM HBc

30
Q

Acute HBV recovery

A

IgG Anti HBc
Anti HBe
Anti HBs

31
Q

Marker for inactive HBV carrier state

A

HBsAg
Anti HBe
Mildly positive HBV DNA

32
Q

Negative HbsAg means

A

Cleared infection

33
Q

Negative HBeAg means

A

Low infectivity and viral load

34
Q

First serologic marker to appear after HBv infectivity

A

HBsAg

After that :
Anti IgM HBc

35
Q

What markers need to dx acute HBV

A

HBsAg
Anti IgM HBc
Both are elevated in initial infection and anti IGM will be elevated in window period as well.

Window period is time between HBsAg and anti HBs

36
Q

Labs of Gilbert syndrome

A

Inc Unconjugated Bilirubin
Normal CBC , blood smear , reticulocyte count
Normal AST , ALT , ALP

37
Q

Hepatic encephalopathy ppt factors

A

🌞Drugs (sedatives , narcotics )
🌞Hypovolemia ( diarrhea)
🌞Electrolyte changes (hypokalemia)
🌞Inc Nitrogen load. (GI bleed)
🌞Infection. (Pneumonia , UTI , SBP)
🌞Portosystemic shunting
TIPs

38
Q

CF of enceph

A

Sleep pattern changes
AMS
Ataxia
Asterixis

39
Q

Ttt of hepatic enceph

A

➡️Correct ppting causes (fluids, antibiotics)
➡️Dec Blood ammonia conc
(Lactulose , rifaximin)
Pts who dont respond to lactulose and rifaximin are given neomycin

40
Q

Affect of diuretics in ppt enceph and ttt

A

Cause low intravascular volume
With

HYPOKALEMIA :
Dec intracellular K causes H+ to move in causing acidosis ➡️ inc NH3 production

Metabolic Alkalosis :
Promotes conversion of NH4 to NH3 which can enter CNS

Ttt: IV pottasiun repletion
Lactulose lowers NH3 levels.

41
Q

What is hepatic enceph

A

Imapired CNS function in cirrhosis due to neurotoxicity from NH3 in the setting of impaired liver function.

42
Q

Indication for TIPs in cirrhosis

A

Ascites not responding to medical ttt
(Diuretics )
Active or recurrent variceal bleed even after endoscopy

SE of TIPs :
HE -
NH3 rich blood bypasses liver

43
Q

Hep A transmission and RF

A

Feco oral transmission
Poor sanitation /hygiene
Travel to endemic area
Contaminated food and water
Unvaccination status
Men sex with men

44
Q

CF of hep A

A

Fever Nausea RUq pain
Jaundice
Hepatomegaly

45
Q

Dx of hep A

A

Elevted LFTs. (1000s)
Anti HAV igM

46
Q

Ttt of hep A

A

Supportive
Complete recovery in 2-3 Mon

GIT (20 decks)

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