Case rounds: Gastrointestinal & hepatology Flashcards
complications of primary haemachromatosis
skin pigmentation diabetes (pancreatic deposition) cardiomyopathy hepatic cirrhosis chondrocalcinosis and arthropathy hypogonadism and pituitary dysfunction
pattern of inheritance primary haemachromatosis
autosomal recessive and is associated with a gene mutation in the HFE gene – genetic testing will confirm the diagnosis
What investigations would you do for haemachromatosis?
DIAGNOSIS iron studies (show high iron/ferritin + low TIBC)
COMPLICATIONS ECG, echo liver biopsy radigraph joints with pain genotyping
What is the management of haemachromatosis?
Venesection -reduce serum iron/ferritin, haematocrit and transferrin saturation.
Manage diabetes
What is the first line treatment for oesophageal varices?
Non-cardioselective beta-blokers = first line treatment of prevention of variceal bleeding.
Regular endoscopy with variceal band ligation is the second-line managment
Why do long term alcohol abusers get splenomegaly?
Portal hypertension causes congestion in splenic vein- cirrhosis causes back-log of blood in spleen
3 key signs of portal hypertension
splenomegaly
visible abdominal veins
ascites
Blood tests for bleeding varices
- coagulation studies
- FBC, U+Es
- cross match 6 units
- blood glucose
acute management of bleeding varices
- blood transfusion
- refer to on call endoscopy
- IV vasopressin analogue
- IV antibiotics
best management for bleeding varices?
band ligation/sclerotherapy
Rifaximin- when is it used?
End stage liver disease
Broad spectrum non-absorbed Abx so bacteria in gut don’t survive, minimising work on liver
normal range HB
120-155
normal range WCC
4-11 x109
normal range PLT
150-450
Key word in AWS?
marked tremor, sweaty
Causes of macrocytosis
- alcohol abuse
- folate
- B12
- pregnancy
AWS common presentations
- seizures
- tachycardia, sweating, tremor
- -
Autoimmune hepatitis is positive for what antibody?
ANA
Serum immunoglobulins are also commonly raised
Management of autoimmune hepatitis
- Prednisolone 30mg initially
- Then taper steroids and continue azathioprine for 2-3 years minimum
AIH patients are at increased risk of what?
HCC
commonest site of pancreatic cancer
60% in head
prognosis pancreatic cancer
<2%
Typical presentation of PBC?
lethargy and pruritus
minor increase in AST/gamma-GT
increase of ALP
What may be markedly high in PBC?
serum lipids- often have hypercholesteraemia
contraindications for biopsy
Platelets <100 x10⁹/L INR >1.3 Hb <100 g/L ACS- cannot consent, increased complications Ascites- RF for bleeding
PBC patients are at risk of developing which conditions?
Malabsorption (fat soluble vits) Osteoporosis Hepatocellular carcinoma (cirrhosis) Liver failure Haematemesis (varices) Hypothyroidism
Which medications are used initially to treat PBC?
Cholestyramine (alleviate pruritus)
Ursodeoxycholic acid (lower lipids, statins affect liver function so not given)
Fat-soluble vitamin prophylaxis
Liver transplantation- last resort
