d Flashcards
INR in coagulopathy
> 1.5
how is the severity of Hepatic encephalopathy graded?
West haven criteria
criteria used to select patients to undergo liver transplantation
King’s college criteria
Risk assessment for patient presenting with paracetamol overdose
- Date of ingestion
- Timing of ingestion
- Time since last ingestion (was it staggered)
- Weight of patient
- Pregnancy?
- Total amount ingested
- Current suicide risk
> 150 mg/kg in a 24 hour period, of paracetamol
serious toxicity
when does paracetamol reach peak concentration following ingestion?
@ 4 hours
possible treatment for paracetamol overdose as per graph
N-acetylcysteine (NAC)
what can be considered for acute ingestion of paracetamol < 8 hours
activated charcoal
when to take paracetamol levels
4 hours post ingestion
name of the chronic autoimmune condition whereby the interlobular bile ducts are damaged by inflammation causing cholestasis which may lead to fibrosis, cirrhosis and portal htn
primary biliary cirrhosis
antibodies present in primary biliary cirrhosis
AMA (antimitochondrial ab)
medication to lower cholesterol level in PBC
Ursodeoxycholic acid
pathophysiology of primary biliary cirrhosis
autoimmune inflammation of the intralobar ducts (canals of hering) causing obstruction of outflow of bile –> back pressure of bile obstruction leads to fibrosis, cirrhosis and liver failure
3 things that build up in the blood in primary biliary cirrhosis and associated symptoms
- Bile acids: itching
- Bilirubin: jaundice
- Cholesterol: deposits such as xanthalasma
lack of bile in bowel causes?
GI disturbance (malabsorption of fats and greasy stools) and pale stools due to lack of biliburuni
blood tests raised in Primary biliary cirrhosis (4)
- ALP
- AMA
- IgM
- ESR
Ursodeoxycholic acid mechanism
reduces intestinal absorption of cholesterol
Colestyramine role?
in PBC
is a bile acid sequestrate - binds to bile acids to prevent absorption in the gut & can help with pruritus due to raised bile acids
biliary condition with established association with Ulcerative colitis
Primary sclerosing cholangitis
4 risk factors for primary sclerosiing cholangitis
- male
- age 30-40
- ulcerative colitis
- family history
pathophysiology of primary sclerosing cholangitis
stricturing and fibrosing of intrahepatic & extrahepatic bile ducts (stiffening & hardening)
antibodies in primary sclerosing cholangitis
p-ANCA
ANA
anticardiolipin
gold standard diagnosis of primary sclerosing cholangitis
MRCP - showing bile duct lesions/strictures
management of primary sclerosing cholangitis
- ERCP: dilate & stent strictures
- Ursodeoxycholic acid
- Colestyramine
- monitor for complication
complications to be monitored for in prmary scleroising cholangitis
- cholangiocarcinoma
- cirrhosis
- oesophageal varcies
what is a positive murphys sign
hand placed at costal margin at RUQ & patient breathes in illiciting pain in the patient as gal bladder moves upwards
name for when a gall stone in present in the common bile duct
choledocholithiasis
charcots triad
- fever
- RUQ pain
- jaundice
what condition is charcots triad present in
Ascending cholangitis
Reynolds pentad
- hypotension
- tachycardia
- jaundice
- RUQ pain
- Jaundice
features seen on abdominal ultrasound in Cholecystitis
- thickening of gall bladder wall
- pericholecystic fluid
- ultrasonographic murphys sign
how is acute pancreatitis diagnosed?
> 3 times normal amylase
CT scan
3 most common causes of acute pancreatitis
- gall stones
- alcohhol
- post ERCP
score to assess severity of acute pancreatitis
glasgow score
PANCREAS pneumonic for Glasgow score
- P: PaO2 < 60
- A: Age > 55 years
- N: Neutrophils (WCC > 15)
- C: Calcium <2
- R: Urea > 16
- Enzymes (LDH > 600 ro AST/ALT > 200)
- A- Albumin < 32
- S - Sugar: Glucose >10
4 complications of acute pancreatitis
- pancreatic necrosis
- infection of necrotic areas
- pseudocysts
- chronic pancreatitis
severe adverse effect of aminosalicylates e.g. mesalazine
agranulocytosis, presenting with sore throat
- check FBC
biopsy finding that is diagnostic for Primary biliary cholangitis?
M2 anti-mitochondrial anitbodies
3 M of primary biliary cholangitis
- Middle aged females
- IgM
- anti-mitochondrial Ab M2 subtype
AST/ALT ratio in alcoholic hepatitis
2:1
(2) for secondary prophylaxis of hepatic encephalopathy
lactulose & rifaximin
what is the double duct sign and when is it seen?
pancreatic cancer
the presence of simultaneous dilatation of the common bile ducts and pancreatic ducts
side effects of mesalazine
- GI upset
- headache
- agranulocytosis
- pancreatitis
- intersitial nephritis
the only test that is recommended for H. Pylori post eradication therapy
Urea breath test
plummer vinson syndorme triad
- dysphagia
- glossitis
- iron deficiency anaemia
grade 4 hepatic encephalopathy
coma
deficiency in pellagra?
Vitamin B3 (niacin)
type of rash seen in Pellagra?
sunburn-like dermatitis rash
what is melanosis coli?
abnormal pigmentation of the large bowel due to presence of pigment laden macrophages
causes of malenosis coli
laxative abuse
