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Gastroentrology > 2: Jaundice, Hepatitis, Hepatic Failure, Chronic Liver Disease > Flashcards

2: Jaundice, Hepatitis, Hepatic Failure, Chronic Liver Disease Flashcards

1
Q

Define jaundice

A

yellow discolouration of the skin and sclera

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2
Q

What concentration of bilirubin results in jaundice

A

> 50

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3
Q

How can the aetiology of jaundice be divided

A

Pre-Hepatic
Hepatic
Post-Hepatic

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4
Q

What are the three categories of pre-hepatic jaundice

A
  1. Haemolytic
  2. Crigler-Najar
  3. Gilbert Syndrome
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5
Q

What are the four causes of haemolytic anaemia

A
  • Sickle Cell
  • G6PD
  • Hereditary spherocytosis
  • Haemolytic disease of foetus and new-born
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6
Q

Which enzyme is defective in Gilberts syndrome

A

UGT

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7
Q

What is the role of the UGT enzyme

A

In hepatocytes UGT converts unconjugated bilirubin to conjugated bilirubin

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8
Q

Explain Gilbert syndrome

A

There is low UGT enzyme. Meaning normally individuals are able to conjugate bilirubin. However, if haemolysis increases (illness, stress, dehydration) there will be an increase in unconjugated bilirubin as it exceeds the enzymes capacity

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9
Q

What is Crigler-Najar syndrome

A

Complete absence of UGT

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10
Q

What does Crigler-Najar syndrome usually lead to

A

Bilirubin encephalopathy and kernicterus

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11
Q

What are 6 hepatic causes of jaundice

A
  1. Hepatitis
  2. Hepatocellular carcinoma
  3. Primary biliary cirrhosis
  4. Primary sclerosing cholangitis
  5. Hereditary haemochromatosis
  6. Alcoholic liver disease
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12
Q

What are 5 causes of post-hepatic jaundice

A
  1. Gallstones
  2. Cholangiocarcinoma
  3. Pancreatic cancer
  4. Abdominal mass (eg. lymphoma)
  5. Dubin Johnson Syndromne
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13
Q

Which enzyme is deficient in Dupin-Johnson syndrome

A

Defect in MRP2

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14
Q

What is the function of MRP2

A

MRP2 is responsible for transporting conjugated bilirubin to hepatic duct

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15
Q

In pre-hepatic jaundice how will urine appear

A

Normal

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16
Q

In pre-hepatic jaundice how will stool appear

A

Normal - Dark

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17
Q

Why does urine appear normal and stool dark in pre-hepatic jaundice

A

As it is caused by an increase in physiological pathways

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18
Q

In hepatic jaundice how will urine appear

A

Dark

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19
Q

In hepatic jaundice how will stool appear

A

Clay

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20
Q

Explain why urine is dark and stool pale in hepatic jaundice

A

As there is a problem within the liver and hence conjugating bilirubin. Reduction in conjugated bilirubin reduces amount entering stool - hence causing pale stools. Unconjugated bilirubin accumulates in the circulation and hence is excreted by the kidneys.

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21
Q

How will urine appear in post-hepatic jaundice

A

Very Dark

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22
Q

How will stool appear in post-hepatic jaundice

A

Pale. Clay-coloured

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23
Q

Why is urine v.dark and stool pale in post-hepatic jaundice

A

Obstruction to outflow of bile. This means it cannot enter stool - giving stool a pale colour. Accumulating bilirubin backs-up the system enters the circulation causing dark urine.

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24
Q

How is bilirubin formed

A

From break-down of haem in RBC

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25
Q

Explain normal processing of bilirubin

A

Haem is a degradation production of RBC. Haem is converted to unconjugated bilirubin. This is conjugated at hepatocytes making it water-soluble and able to be excreted via the GI tract. Two main excretion productions are stercobillin and urobilinogen.

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26
Q

Explain the pathophysiology of pre-hepatic jaundice

A

Increase in RBC degradation. This increases unconjugated bilirubin. It is still able to be conjugated and therefore excreted in faeces. However, unconjugated bilirubin exceeds enzymes ability to conjugate causing an accumulation in the blood-stream resulting in jaundice.

Increase billirubin in bile also increases the risk of pigment stones.

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27
Q

Explain pathophysiology of hepatic jaundice

A

Liver looses ability to conjugate bilirubin, leading to excess unconjugated bilirubin. If the liver becomes cirrhotic it may obstruct bile - leading to a mixed conjugated and unconjugated hyperbilirubinaemia.

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28
Q

Explain post-hepatic jaundice

A

Obstruction of biliary drainage leads to a conjugated hyperbillirubinaemia. Pressure in the bile-duct can cause back flow through tight junctions and enter the circulation. Bile salts and cholesterol may cause pruritus. Reduced bile excretion can cause steatorrhoea.

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29
Q

What investigation should be ordered in jaundice

A

LFTs

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30
Q

Why is bilirubin useful in assessing jaundice

A

Determine extent of hyperbillirubinaemia

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31
Q

Why is albumin useful in assessing jaundice

A

Determine liver function

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32
Q

Why is AST and ALT useful in assessing jaundice

A

Liver damage

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33
Q

Why is ALP useful in assessing jaundice

A

Indicates obstruction

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34
Q

Why is GGT useful in assessing jaundice

A

Often elevated in alcoholic liver disease

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35
Q

If the AST: ALT ratio is more than two what does it indicate

A

Alcoholic liver disease

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36
Q

If the AST: ALT ratio is 1 what does it indicate

A

Viral Hepatitis

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37
Q

In pre-hepatic jaundice how will

a. ALT/AST present
b. ALP present

A

a. normal

b. normal

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38
Q

In hepatic jaundice how will

a. ALT/AST present
b. ALP present

A

a. raised

b. normal

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39
Q

In post-hepatic jaundice how will

a. ALT/AST present
b. ALP present

A

a. normal

b. raised

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40
Q

What is hepatitis

A

Inflammation of the liver

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41
Q

What are the two types of hepatitis

A
  1. Autoimmune

2. Viral

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42
Q

What is autoimmune hepatitis

A

inflammation of the liver caused by T cell function and autoantibodies directed against cell-surface antigens

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43
Q

What does the type of autoimmune hepatitis depend on

A

antibodies present

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44
Q

What 2 antibodies are present in type I autoimmune hepatitis

A

ANA

anti-SMA

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45
Q

Who does type I autoimmune hepatitis affect

A

adults and children

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46
Q

What antibodies are present in type 2 autoimmune hepatitis

A

anti-LKM1

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47
Q

Who does type II autoimmune hepatitis affect

A

children

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48
Q

What antibody is present in Type III autoimmune hepatitis

A

soluble liver and kidney antigen

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49
Q

Who does Type III autoimmune hepatitis affect

A

adults

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50
Q

Is autoimmune hepatitis more common in males or females

A

females (4:1)

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51
Q

what age-range does autoimmune hepatitis occur

A

10-20y and 45-70y

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52
Q

what three other conditions is autoimmune hepatitis associated with

A

Hashimotos thyroiditis
Coeliac disease
T1DM

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53
Q

what genes are associated with autoimmune hepatitis

A

HLAB8

HLADR3

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54
Q

how do symptoms vary in autoimmune hepatitis

A

Can vary from asymptomatic to liver failure

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55
Q

give 5 common symptoms of autoimmune hepatitis

A
  1. Lethargy
  2. Weight Loss
  3. Amenorrhoea
  4. Abdominal pain
  5. Jaundice
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56
Q

what will a third of patients with autoimmune liver disease develop

A

Acute liver failure

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57
Q

how will acute liver failure in autoimmune hepatitis present

A
  1. Fever
  2. RUQ pain
  3. Jaundice
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58
Q

what investigations may be ordered in autoimmune hepatitis

A
  1. LFTs
  2. Antibodies
  3. IgG
  4. Liver biopsy
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59
Q

how will LFTs present in autoimmune hepatitis

A

Raised AST and ALT

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60
Q

what antibodies may be present in autoimmune hepatitis

A

Anti-nuclear antibodies

Anti-smooth muscle antibodies

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61
Q

how will IgG present in autoimmune hepatitis

A

May be raised - hypergammaglobulinaemia

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62
Q

when is a liver biopsy performed in autoimmune hepatitis

A

If autoantibodies are positive

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63
Q

what is first-line management of autoimmune hepatitis

A

Prednisolone.

Azathioprine may be used as steroid-sparing alternative.

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64
Q

what is the ultimate treatment for autoimmune hepatitis

A

Liver transplantation - if decompensated cirrhosis or failure to respond to medical therapy.

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65
Q

what is hepatitis A

A

Infection with hepatitis A

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66
Q

in which countries is hepatitis A common

A

(The A’s!):
South America
Africa

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67
Q

how is hepatitis A spread and how can this be remembered

A

Faecal-Oral.

Hepatitis A and E are the vowels - they are spread by the bowels

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68
Q

what food is hepatitis A particularly associated with

A

Shell-Fish

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69
Q

what is risk factor for catching hepatitis A

A

Travelling

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70
Q

what is the incubation period of hepatitis A

A

1-2W

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71
Q

how does hepatitis A initially present

A

Pro-drome

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72
Q

what is a KEY feature of hepatitis A prodrome

A

RUQ pain and tender hepatomegaly

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73
Q

what are 4 features of hepatitis A pro-dromal phase

A
  1. Fever
  2. Anorexia
  3. N+V
  4. RUQ - tender hepatomegaly
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74
Q

what are 2 symptoms of icteral phase of hepatitis A

A

Jaundice
Dark Stool, Pale Urine
Pruritus

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75
Q

How will LFTs present in hepatitis A

A

Raised AST + ALT

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76
Q

What is the AST to ALT ratio in hepatitis A

A

AST:ALT = 1

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77
Q

What is another investigation for hepatitis A

A

anti- HepA IgM and IgG

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78
Q

what does a raised anti-hep A IgM indicate

A

Current Infection

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79
Q

what does a raised anti-hep A IgG indicate

A

Previous Infection

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80
Q

how is hepatitis A managed

A

Self-resolving

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81
Q

is there a vaccine for hepatitis A

A

Yes

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82
Q

how many vaccinations of hep A does a person need

A

initial vaccine, followed by a booster 6-12m later

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83
Q

who is given Hep A vaccines

A
  • Travellers
  • MSM, IVDU, HIV
  • Chronic liver disease
  • Occupational risk
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84
Q

does hep A cause chronic disease

A

No

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85
Q

What is hepatitis B

A

Infection with hepatitis b virus

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86
Q

In which countries is HBV more common

A
  • Far East
  • Africa
  • Mediterranean
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87
Q

What are the three methods of HBV transmission

A

Vertical
Parental
Sexual

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88
Q

What are 5 risk factors of HBV

A
  • MSM
  • IVDU
  • HIV
  • Baby of HbSAg +ve mother
  • Prison staff
  • Haemodialysis patients
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89
Q

What is the incubation period of HBV

A

6m

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90
Q

In acute infection what % will be symptomatic

A

30%

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91
Q

What are some symptoms of acute-hepatitis B

A
  • Fever
  • Lethargy
  • Arthralgia
  • Jaundice
  • RUQ pain
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92
Q

What defines acute-hepatitis B infection

A

Manifests within 6m of infection

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93
Q

What defines chronic hepatitis B infection

A

Manifests beyond 6m of infection, or longer with positive HbSAg

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94
Q

How do individuals with chronic Hep B present

A

Often asymptomatic carriers

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95
Q

If individual has re-activation of chronic hep B how may it present

A

Liver Failure

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96
Q

Explain pathophysiology of acute Hepatitis B

A

HBV infects hepatocytes, which then express it’s antigen on their surface. Lymphocytes respond to HBV antigen and are activated - causing destruction of hepatocytes and subsequent inflammation.

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97
Q

Explain pathophysiology of chronic hepatitis B infection

A

Chronic inflammation leads to necrosis resulting in cirrhosis. Also causes cell dysplasia which is a risk factor for hepatocellular carcinoma

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98
Q

What two investigations should be ordered for HBV patients

A

HBV serology

LFTs

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99
Q

What is the first-marker of HBV infection to appear

A

HbsAg

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100
Q

If HbsAg is present more than 6-months what does it indicate

A

Chronic Infection

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101
Q

What does HbsAg trigger

A

anti-HBS

102
Q

If anti-HBS is present on its own what does it indicate

A

individual has been vaccinated against HBV

103
Q

What is HbcAg

A

HBV core-antigen

104
Q

What does anti-HBC IgM imply

A

current infection

105
Q

What does anti-HBC IgG imply

A

previous infection

106
Q

What does presence of HbeAg indicate

A

highly infectious strain of HBV

107
Q

What else is included in HBV serology

A

anti-HBV DNA

108
Q

If individual has anti-HBS only what does it indicate

A

previously vaccinated against HBV

109
Q

If individual has
anti-HBS
anti-HBC IgG

what does it indicate

A

previous infection with HBV

110
Q

If individual has

HbsAg
anti-HBC IgG

What does it indicate

A

They are a carrier of chronic HBV

111
Q

If individual has

HbsAg
HbeAg

What does it indicate

A

Severe Infection

112
Q

If individual has

HbsAg
anti-HBC IgM
HBV DNA

What does it indicate

A

Current Infection with HBV

113
Q

How will LFTs present in HBV infection

A

Raised AST and ALT

114
Q

What is the AST: ALT ratio in HBV infection

A

<1

115
Q

What is first-line in managing HBV infection

A

Pegylated Interferon Alpha

116
Q

What is second-line in managing HBV infection

A

Tenofovir and Entecavir

117
Q

Is there a vaccine for HBV

A

Yes

118
Q

When is the HBV vaccine given

A

As part of routine immunisation schedule at:

2, 3 and 4 months

119
Q

When is testing for anti- HBs only recommended

A

Only if occupational exposure to HBV - test 4m following vaccine

120
Q

What does infection with HBV predispose to

A

HDV Infection

121
Q

What are three other complications of HBV infection

A

Chronic hepatitis
Fulminant hepatitis
Hepatocellular carcinoma

122
Q

What is acute hepatitis C infection

A

infection with hepatitis C in the past 6-months

123
Q

What is chronic hepatitis C infection

A

infection with hepatitis C more than 6-months ago

124
Q

What are the three methods of transmitting hepatitis C

A
  1. Sexual
  2. Parental
  3. Vertical
125
Q

What are three risk factors for hepatitis C

A
  • IVDU
  • Recipients of blood transfusions before 1992
  • Prisoners
126
Q

What is the incubation period of hepatitis C

A

6-9W

127
Q

what proportion of acute hepatitis C infections are asymptomatic

A

80%^

128
Q

what are 4 possible symptoms of hepatitis C infection

A
  • Malaise
  • RUQ pain
  • Jaundice
  • Tender hepatomegaly
129
Q

what % of hepatitis C patients develop silent chronic infection

A

85%

130
Q

what % of hepatitis C patients will develop cirrhosis

A

25%

131
Q

what % of hepatitis C patients will develop hepatocellular carcinoma

A

4%

132
Q

What are possible haematological complications of chronic cirrhosis

A

Cryoglobulinaemia

133
Q

What are possible rheumatological complications of chronic cirrhosis

A

Arthalgia

Arthritis

134
Q

What are possible ophthalmological complications of chronic cirrhosis

A

Sjogren’s

135
Q

What are possible dermatological complications of chronic cirrhosis

A

Percutaneous Cutanea Tarda

136
Q

what are liver complications of chronic hepatitis C

A

Cirrhosis

Hepatocellular carcinoma

137
Q

what are renal complications of HCV

A

Membroproliferative glomerulonephritis

138
Q

what is first-line investigation of HCV

A

ELISA

139
Q

how will LFTs present in HCV

A

Raised AST and ALT

140
Q

what will be seen on ELISA in hepatitis C

A

anti-HCV antibodies

141
Q

what diagnostic tests are ordered for HCV

A

PCR for HCV RNA

142
Q

if HCV RNA is positive what does it indicate

A

Current Infection

143
Q

If anti-HCV antibodies are positive, but HCV RNA negative what does it indicate

A

previous infection

144
Q

if HCV RNA positive what should be performed

A

Non-invasive elastography

145
Q

What is used to manage HCV

A

Protease inhibitor w/wo ribavirin

146
Q

Name two combination protease inhibitors

A

Daclatasvir and Sofosbuvir

Sofosbuvir and simeprevir

147
Q

What is the aim of treatment in HCV

A

sustained virological response: undetectable HCV RNA at 6-months

148
Q

Is there a vaccine for HCV

A

No

149
Q

What % will develop chronic HCV

A

50-80%

150
Q

What are three complications of HCV

A
  • Cirrhosis
  • Hepatocellular carcinoma
  • Fulminant hepatitis
151
Q

What does hepatitis D require for infection

A

Hepatitis B

152
Q

What is hepatitis D co-infection

A

When Hep B and Hep D infect at the same time

153
Q

What is hepatitis D super-infection

A

When a HbsAg positive individual is infected with Hep D

154
Q

Explain pathophysiology of hepatitis D

A

Hepatitis D is a single-stranded RNA virus. It requires HbsAg to complete its replication cycle.

155
Q

What is first-line investigation for HDV

A

ELISA:

anti-HDV antibody

156
Q

When should anti-HDV antibody only be requested

A

If HbsAg positive

157
Q

What is second line investigation for HDV

A

rtPCR for HDV RNA

158
Q

What is first-line management for HDV

A

pegylated interferon-alpha

159
Q

What is ultimate management for HDV

A

liver transplantation

160
Q

How can HDV infection be prevented

A

vaccination with hepatitis B at 2,3 and 4 months

161
Q

What are three risks of super-infection HDV

A
  • Chronic hepatitis
  • Fulminant hepatitis
  • Cirrhosis
162
Q

What is hepatitis E

A

Infection with RNA virus hepatitis E

163
Q

Which countries is hepatitis E infection more common

A

India

China

164
Q

Which countries is hepatitis A infection more common

A

Africa

South America

165
Q

How is hepatitis E transmitted

A

Faecal-Oral Route

166
Q

What food in particular is associated with hepatitis E

A

Pork

167
Q

What is the incubation period of hep E

A

2-8W

168
Q

How does hep E initially present

A

Pro-drome 1-2W

169
Q

What is are features of pro-drome in Hep E

A
  • RUQ pain
  • Tender hepatomegaly
  • Fever
  • Malaise
  • N+V
170
Q

What are 3 symptoms of icteral hepatitis E phase

A

Jaundice
Pale stools, Dark Urine
Pruritus

171
Q

What is first line investigation for Hep E

A

ELISA for anti-HEV antibodies

172
Q

What does anti-HEV IgM indicate

A

Current Infection

173
Q

What does anti-HEV IgG indicate

A

Previous Infection

174
Q

How is HEV managed

A

Supportive

175
Q

Is there a vaccine for hep E

A

No

176
Q

What is a good way to remember there is no vaccines for hep C and E

A

vaCcinEs
C
E
= have no vaccines

177
Q

in which population is hepatitis E a great risk

A

pregnant women

178
Q

why is hepatitis E a risk to pregnant women

A

20% risk fulminant hepatitis

179
Q

Define hepatic failure

A

Deterioration of liver function resulting in coagulopathy and encephalopathy

180
Q

What defines coagulopathy

A

INR > 1.5

181
Q

What is acute-liver failure

A

Development of encephalopathy or coagulopathy in a previously healthy liver

182
Q

what time-frame defines hyper-acute liver failure

A

<7d

183
Q

what time-frame defines acute liver failure

A

8-21d

184
Q

what time frame defines sub-acute liver failure

A

4-26W

185
Q

what is chronic liver failure

A

when liver failure develops on a background of previous liver disease

186
Q

what is fulminant hepatic failure

A

syndrome where there is massive necrosis of liver cells causing impairment of liver function

187
Q

what are the 4 etiological categories of liver failure

A
  • Medications
  • Infections
  • Vascular
  • Other
188
Q

what infections can cause liver failure

A

Hepatitis
Yellow Fever
Leptospirosis

189
Q

what drugs may cause liver failure

A

Paracetamol over-dose

Isoniazid

190
Q

what vascular disease can cause liver failure

A

Budd-Chiari

191
Q

what are other causes of liver failure

A
  • Alcohol
  • Fatty Liver Disease
  • Wilson’s
  • Haemochromatosis
  • Autoimmune hepatitis
192
Q

What are 5 symptoms of hepatic failure

A
  • Jaundice
  • Hepatic encephaloapthy
  • Constructional apraxia
  • Asterixis
  • Fetor hepaticus
193
Q

Why does hepatic encephalopathy occur

A

As the liver fails, ammonia accumulates in the brain.

This is cleared by astrocytes, which produce glutamine.

Glutamine causes a shift in the osmotic balance - drawing fluid into cells

194
Q

what is constructional apraxia

A

Unable to construct a 5-point star

195
Q

what is fetor hepaticus

A

Breath smells like pear drops

196
Q

what are the four features of grade I hepatic encephalopathy

A
  1. Constructional apraxia
  2. Mood disturbance
  3. Sleep disturbance
  4. Poor arithmetic
197
Q

what are the 5 features of grade 2 hepatic encephalopathy

A
  1. Drowsy
  2. Confused
  3. Slurred speech
  4. Liver Flap
  5. Inappropriate behaviour
198
Q

what are the 4 features of grade 3 hepatic encephalopathy

A

Incoherent
Restlessness
Liver Flap
Stupor

199
Q

what is grade 4 hepatic encephalopathy

A

coma

200
Q

what diagnostic system is used for liver failure

A

Kings-College Criteria in Acute Liver Failure

201
Q

According to kings college criteria in acute liver failure, if paracetamol-induced liver failure what arterial pH is required for diagnosis

A

pH <7.3

202
Q

According to kings college criteria in acute liver failure, if individual does not have pH <7.3 what 3 other criteria must be met to make a diagnosis

A
  1. PT > 100
  2. Creatinine > 300
  3. Grade III or IV encephalopathy
203
Q

According to kings college criteria in acute liver failure, if non-paracetamol acute liver failure what criteria should be met for diagnosis

A

Prothrombin time > 100s

204
Q

According to kings college criteria in acute liver failure, if non-paracetamol acute liver failure and PT <100s what criteria should be met for diagnosis

A

Requires 3 out-of the following 5:

  1. <10 or >40-years
  2. Medication induced liver failure
  3. > 1W between jaundice and onset encephalopathy
  4. PT > 50s
  5. Bilirubin > 300
205
Q

What investigations are ordered for liver failure

A
  1. LFTs
  2. Coagulation studies
  3. FBC
  4. Virology studies
  5. Ascitic tap
206
Q

How may prothrombin time and INR present

A
  • Prothrombin time = prolonged

- INR = >1.5

207
Q

How may LFTs present in liver failure

A
  • Raised billirubin
  • Raised AST and ALT
  • Raised/Normal ALP
208
Q

How may FBC present in chronic liver failure

A

Chronic liver disease is associated with IDA

209
Q

Why are viral serologies ordered

A

Check for hepatitis

210
Q

If an ascitic tap is ordered and has neutrophils >250 what does this indicate

A

Spontaneous bacterial peritonitis (SBP)

211
Q

How is liver failure treated

A
  • Intubate if required
  • NG tube
  • Catheter
  • 10% dextrose
  • Treat cause
  • Use phenytoin to treat any seizures
212
Q

If individual with liver failure has ascites how is this managed

A
  • Fluid restriction
  • Low salt diet
  • Diuretics
  • Daily weight
213
Q

If individual with liver failure is bleeding what is given

A

Vitamin K
FFP
Platelets

214
Q

When is hypoglycaemia treatment in liver failure

A

<2

215
Q

What two medications may be given to treat encephalopathy in liver-failure

A

Lactulose

Rifaximin

216
Q

What is the role of lactulose

A

Lactulose is catabolised by gut flora where it decreases pH trapping ammonia

217
Q

What is rifaximin

A

Non-absobable antibiotic that reduces concentration of ammonia-producing bacteria

218
Q

What is cirrhosis

A

chronic liver damage

219
Q

In which gender is cirrhosis more common

A

males (2:1)

220
Q

What are the 3 broad etiological categories for cirrhosis

A
  • Hepatotoxic
  • Inflammation
  • Metabolic
221
Q

What hepatotoxic substances may cause cirrhosis

A

Alcohol

Medications:

  • Amiodarone
  • Methotrexate
222
Q

What are 6 inflammatory causes of cirrhosis

A
  • Hep B
  • Hep C
  • Hep D
  • Primary sclerosing cholangitis
  • Primary biliary cholangitis
  • Autoimmune hepatitis
223
Q

What are 4 metabolic causes of cirrhosis

A
  • Wilson’s
  • Haemachromatosis
  • Budd-Chiari
  • Non-alcoholic fatty liver disease
  • a1 alpha trypsin deficiency
224
Q

What is the most common cause of liver cirrhosis

A

Hep C

225
Q

What is the second most common cause of liver cirrhosis

A

Alcohol

226
Q

What 3 nail signs may be present in cirrhosis

A
  • Clubbing
  • Leuconychia
  • Terry’s sign = telangiectasia of outer 1/3 of nail
227
Q

What 2 signs on the palm may present present in cirrhosis

A

Dupuytrens contracture

Palmar erythema

228
Q

What does enlargement of the parotid gland in cirrhosis indicate

A

Alcohol

229
Q

Explain pathophysiology of cirrhosis

A

Recurrent inflammation of hepatocytes heals by fibrosis and scarring which results in decrease in function.

Cytokines also activate stellate cells to produce collagen reducing liver function

Loss of liver function leads to:

  • Reduced clotting factor production = coagulopathy
  • Increase ammonia = hepatic encephalopathy
  • Decrease albumin = ascites
  • Decrease bile acids = malabsorption fat-soluble vitamins
230
Q

What 4 blood tests are ordered in cirrhosis

A
  1. LFT
  2. Coagulation profile
  3. FBC
  4. Viral serology
231
Q

How will LFTs present in cirrhosis

A

Raised ALT, AST
Raised ALP
Raised GGT

232
Q

How will coagulation studies present in cirrhosis

A

Raised INR

233
Q

why may an individual with cirrhosis have a microcytic anaemia

A

If caused by alcoholic liver disease - may have vitamin B12 deficiency.

234
Q

what is first-line imaging for cirrhosis

A

Fibroscan

235
Q

what is a fibroscan also called

A

Transient elastography and acoustic radiation force impulse imaging

236
Q

what should all individuals with a new diagnosis of cirrhosis be offered and why

A

Upper GI endoscopy to check for oeseophageal varices

237
Q

How should liver cirrhosis be managed

A
  • Good nutrition
  • Alcohol abstinence
  • Cholestyramine for tiching
  • Ursodeoxycholic acid for hepatitis
238
Q

How is ascites managed

A
  • Fluid restriction <1.5L
  • Low-salt
  • Spirinolactone
239
Q

What is the only definitive treatment for liver cirrhosis

A

Liver transplant

240
Q

If individual has liver cirrhosis how often should they receive an US scan and AFP to check for hepatocellular carcinoma

A

Every 6-months

241
Q

What scoring system is used to predict prognosis in liver cirrhosis

A

Child-Pugh

242
Q

What is the child-pugh score based on

A

Ascites

Albumin

Bilirubin

PT

Encephalopathy

243
Q

What are two complications of liver cirrhosis

A

Acute liver failure

Portal HTN

244
Q

How may portal hypertension manifest

A
  • Caput medusa
  • Oesophageal varices
  • Splenomegaly
  • Ascites
245
Q

What is spontaneous bacterial peritonitis

A

Type of peritonitis seen in those with ascites secondary to liver failure

246
Q

how will SBP present

A
  • Fever
  • Abdominal pain
  • Ascites
247
Q

what is used to investigate SBP

A

Paracentesis

248
Q

what is seen on paracentesis in SBP

A

Neutrophils > 250

249
Q

what is used to managed SBP

A

IV Cefotaxime

250
Q

Who is prophylactic cirpofloxacin against SBP given to

A
  1. One episode of SBP
  2. Serum protein <15 and one of:
    - Child-pugh 9
    - hepatorenal syndrome

Gastroentrology (18 decks)

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