42&43: GI problem 3 Flashcards
Which clinical signs are stigmata of chronic liver disease?
- Scleral jaundice
- Palmar erythema
- Spider naevi
Interpret elevated:
- GGT in isolation
- GGT and ALP
- AST and ALT
- Steatosis
- Cholestasis
- Hepatitis
Explain the pathophysiology of alcoholic liver disease
- Occurs on a spectrum between steatosis and hepatitis
- With exposure to alcohol, fatty change occurs
- Large or sudden volume exposure results in hepatitis
- Eventually leads to cirrhosis
What is metabolic syndrome?
A number of conditions that are driven by insulin resistance and associated conditions
Which types of hepatitis are transmitted by blood/body fluid?
Hepatitis B-D
What are the causes if AST and ALT are in the thousnads?
- Viral
- Ischaemia
- Paracetamol
AST > 2x ALT suggests….
Alcoholic hepatitis
Low platelet count is related to which liver condition?
Portal hypertension (causing hypersplenism)
What does an echogenic, nodular liver indicate?
Echogenic = steatosis Nodular = cirrhosis
Why would you give protein supplements to someone with portal hypertension?
- Inc. albumin production
- Improve nutrition
- Increase oncotic pressure
What is the mechanism of spontaneous bacterial peritonitis
- Translocation of bacteria and endotoxins from GI tract to peritoneal fluid
- Gut bacteria compromised in cirrhosis allowing free bacterial movement
- Facilitated by impaired defence mechanism in cirrhotic patients
How do you diagnose spontaneous bacterial peritonitis?
Ascitic tap (neutrophils > 250x10^6/L)
What are the 4 modes of transmission of Hepatitis B
- Perinatal (vertical)
- Horizontal (childhood)
- Sexual
- Parenteral (IV drug use)
Why will someone infected with HBV as a child develop chronic disease as an adult?
- Immune system underdeveloped as a child (tolerance)
- With maturation there is immune response that occurs in flares - greater risk of inflammation and fibrosis
What are the two types of hepatorenal syndrome?
- In context of precipitant e.g. unwell, infection
- In context of ascites
