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Gastroenterology > AFLD, Pancreatitis, HCC, CLD, Hepatic Encephalopathy > Flashcards

AFLD, Pancreatitis, HCC, CLD, Hepatic Encephalopathy Flashcards

1
Q

ALD pathology and Pathophysiology of cx

A

Alcoholic steatosis –> accumulation of lipid droplets in hepatocytes

Alcoholic hepatitis or steatohepatitis - hepatocyte ballooning, neutrophil-risch inflammation, apoptosis

Fibrosis –> regerenation –> nodular formation–> cirrhosis

Dysplastic nodules –>HCC

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2
Q

Pancreatitis

Complications - pathophysiology

  1. HypoCa
  2. Pancreatic nec
  3. Third spacing
A
  1. HypoCa
    - release of lipase ++, break down of fat –> release FFA that bind calcium
  2. Pancreatic nec
    - uncorrected hypotension –> decreased organ perfusion –> MOF
  3. Third spacing
    - release of inflammatory cytokines by pancreatic enzymes ++
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3
Q

Pancreatitis CF

A

epigastric pain radiating to back
nausea, vomtiing

Cullens sign - periumbilical ecchymosis
Grey Turner sing - flank ecchymosis
Fox sign - ecchymosis over inguinal ligament

elevated lipase (x3 ULN), ALT, procalcitonin, inflammatory markers

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4
Q

Chronic pancreatitis

Cause
Complications
Mx

A

ETOH pancreatic cell damage –> INTRApancreatic activation of digestive enzymes –> auto digestion of pancreatic tissue

features of pancreatic insufficiency - weight loss, impaired glucose tolerance, weight loss, steatorrhea

pancreatic pseudocysts - after 4 weeks
Pancreatic ca

Depending on symtpoms

  1. small regular low fat meals
  2. insulin if necessary
  3. analgesia
  4. nutrition, creon, vit ADEK
  5. Abstinence
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5
Q

Hepatic encephalopathy

  • Pathophysiology
  • CF
A

Increased ammonia
Ammonia usually cleared by liver into glutamine

CF - behavioural changes, lethargy, confusions, asterisks
can have bradycardia, ataxia, nystagmus

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6
Q

Hepatic Encephalopathy

Management and MOA

A
  1. Treat precipitating causes
  2. Lower blood ammonia

a. Lactulose (1st line)
- increased cathartic effect
- lowers pH in gut, reduced production of ammonia
- increases non-ammoniagenic gut bacteria

b. rifaximin (can use as prophylaxis)
- poorly absorbed abx, kills ammonia forming gut bacteria

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7
Q

HCC

-Screening

A

Patients with cirrhosis

  • USS every 6m + AFP
  • RF: asian, hepatitis A1AT deficiency, hemachromatosis, fly hx
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8
Q

HCC Management

A

Based on CP score

  • Ablation
  • Resection
  • Transplant
  • TACE

Advanced stage
-Sorafenib (multikinase inhibitor)

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9
Q

Child Pugh Score - Factors

A 
Encephalopathy
Ascites
Bilirubin
Albumin
PT
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10
Q

TIPS - indications, contra-indications

A

Indications

  • refractory ascites
  • portal HTN bleeding
  • hepatic hydrothorax
  • Budd-Chiari syndrome

Contra-indications

  • Severe and progressive liver failure
  • Hepatic encephalopathy
  • Portal vein thrombosis
  • HCC
  • RHF and pul HTN
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11
Q

Variceal bleeding

  1. Prophylactic managemen
  2. Acute management
A
  1. Regular scope + banding
  2. Propanolol
  3. Resus, emergency scope <12h
  4. Terlipressin
  5. Octreotide
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12
Q

Hepatorenal syndrome

-Treatment

A
  1. Supportive - albumin

2. Terlipressin

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13
Q

Pancreatitis

Complications

  1. HypoCa
  2. Pancreatic nec
  3. Third spacing
A
  1. HypoCa
    - release of lipase ++, break down of fat –> release FFA that bind calcium
  2. Pancreatic nec
    - uncorrected hypotension –> decreased organ perfusion –> MOF
  3. Third spacing
    - release of inflammatory cytokines by pancreatic enzymes ++
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pancreatitis CF

A

epigastric pain radiating to back
nausea, vomtiing

Cullens sign - periumbilical ecchymosis
Grey Turner sing - flank ecchymosis
Fox sign - ecchymosis over inguinal ligament

elevated lipase (x3 ULN), ALT, procalcitonin, inflammatory markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chronic pancreatitis

Cause
Complications
Mx

A

ETOH pancreatic cell damage –> INTRApancreatic activation of digestive enzymes –> auto digestion of pancreatic tissue

features of pancreatic insufficiency - weight loss, impaired glucose tolerance, weight loss, steatorrhea

pancreatic pseudocysts - after 4 weeks
Pancreatic ca

Depending on symtpoms

  1. small regular low fat meals
  2. insulin if necessary
  3. analgesia
  4. nutrition, creon, vit ADEK
  5. Abstinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hepatic encephalopathy

  • Pathophysiology
  • CF
A

Increased ammonia
Ammonia usually cleared by liver into glutamine

CF - behavioural changes, lethargy, confusions, asterisks
can have bradycardia, ataxia, nystagmus

17
Q

Management and MOA

A
  1. Treat precipitating causes
  2. Lower blood ammonia

a. Lactulose (1st line)
- increased cathartic effect
- lowers pH in gut, reduced production of ammonia
- increases non-ammoniagenic gut bacteria

b. rifaximin (can use as prophylaxis)
- poorly absorbed abx, kills ammonia forming gut bacteria

18
Q

HCC

-Screening

A

Patients with cirrhosis

  • USS every 6m + AFP
  • RF: asian, hepatitis A1AT deficiency, hemachromatosis, fly hx
19
Q

Management HCC

A

Based on CP score

  • Ablation
  • Resection
  • Transplant
  • TACE

Advanced stage
-Sorafenib (multikinase inhibitor)

20
Q

Child Pugh Score - Factors

A 
Encephalopathy
Ascites
Bilirubin
Albumin
PT
21
Q

TIPS - indications, contra-indications

A

Indications

  • refractory ascites
  • portal HTN bleeding
  • hepatic hydrothorax
  • Budd-Chiari syndrome

Contra-indications

  • Severe and progressive liver failure
  • Hepatic encephalopathy
  • Portal vein thrombosis
  • HCC
  • RHF and pul HTN
22
Q

Variceal bleeding

  1. Prophylactic managemen
  2. Acute management
A
  1. Regular scope + banding
  2. Propanolol
  3. Resus, emergency scope <12h
  4. Terlipressin
  5. Octreotide
23
Q

Hepatorenal syndrome

-Treatment

A
  1. Supportive - albumin

2. Terlipressin

24
Q

ALD - gene associated

A

PNPLA 3

on chromosome 12

25
Q

ETOH hepatitis - Management (High Risk)

A

Supportive

NAC + Pred

Gastroenterology (11 decks)

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