Gastro Flashcards
how does liver cirrhosis affect the portal system
portal hypertension
causes of liver cirrhosis
NAFLD
alcoholic liver disease
hep B
hep C
size of liver in cirrhosis
can be small or large
nail change in cirrhosis and why
leukonychia due to hypoalbuminaemia
what test is used for assessing extent of fibrosis in NAFLD
enhanced liver fibrosis blood test
examination signs of liver disease
jaundice
bruising
palmar erythema
spider naevi
gynacomastia
ascites
splenomegaly
asterixis
caput medusae
leukonychia
what happens to platelets in cirrhosis
thrombocytopenia
what is transient elastography
test for assessing degree of liver fibrosis
components of child pugh score pneumonic and scoring
ABCDE
albumin
bilirubin
clotting (INR)
dilated (ascites)
encephalopathy
each scored 1-3 so max score 15
what score is used in cirrhosis patients to assess mortality
how often is it done
MELD score
done every 6 months
how often should cirrhosis patients have an endoscopy
every 3 yrs
dietary advice in cirrhosis
high protein and high calorie diet (pts have appetite loss and protein metabolism is affected)
reduced sodium intake
avoid alcohol
what organ is enlarged as a result of portal hypertension
spleen
what type of ascites do you get in cirrhosis
transudate
what prophylactic abx are given for ascites and when
cipro or norfloxacin
when protein in fluid <15g
hepatic encephalopathy mx
lactulose
abx (rifaximin)
nutritional support (NG feeds)
stages of alcoholic liver diease
alcoholic fatty liver
alcoholic hepatitis
cirrhosis
recommended alcohol intake and over what time
no more than 14 units/ week
spread out over 3 or more days
not more than 5 units a day
dietary advice for alcoholic liver disease
thiamine supplementation
high protein diet
CAGE questions
cut down- do you feel the need to down
annoyed- do you get annoyed at people for commenting about your drinking
guilty- do you feel guilty about how much you drink
eye opener- do you ever drink first thing in the morning
AUDIT questionnaire is used for
screening for harmful alcohol use
AUDIT questionnaire score above what is concerning
8
in alcohol withdrawal when do people get hallucinations
12-24 hrs after last drink
in alcohol withdrawal when do people get seizures
24-48 hrs after last drink
in alcohol withdrawal when do people get delirium tremens
24-72 hrs after last drink
what receptors does alcohol stimulate
GABA
what receptors does alcohol inhibit
glutamate
what tool is used to score patients on alcohol related symptoms
CIWA-Ar
what drug is used to prevent alcohol withdrawal
chlordiazepoxide
wernickes encephalopathy triad
confusion
opthalmoplegia
ataxia
korsakoff syndrome features
memory impairment
behavioural changes
wernicke/korsakoff arises due to deficiency in
thiamine
stages of non alcoholic fatty liver disease
normal
fatty liver
steatohepatitis
fibrosis
cirrhosis
rf for NAFLD
same as cardiovasc disease:
diabetes
age
smoking
obesity
sedentary lifestyle
poor diet
hypertension
hypercholesterolaemia
what LFT is raised in NAFLD
ALT
enhanced liver fibrosis test what level indicates advanced fibrosis
> 10.51
gold standard ix for NAFLD
liver biopsy
what types of virus are hep A-E
all RNA apart from hep B is DNA
vaccines for what hepatitis virus exist
A and B
how is hep A treated
supportive care
how is hep B treated
supportive care
how is hep C treated
antiviral
how is hep D treated
pegylated interferon alpha
how is hep E treated
supportive care
which hepatitis viruses are notifiable
all of them
what does HBeAg indicate
if the person has active infection and wether they are infectious currently
it will be high when the virus is replicating
what antibody is raised in autoimmune hepatitis
IgG
autoantibodies for type 2 autoimmune hep
anti LKM-1
anti LC1
how do type 1 and 2 autoimmune hepatitis differ
1 is usually in older post menopausal women and is less aggressive
2 is usually in younger girls and is more acute
haemochromatosis inheritance
autosomal recessive
haemochromatosis gene and chromosome
HFE gene on chromosome 6
what stain is used to look at iron deposition in the liver
perls stain
how does haemochromatosis affect the thyroid
hypothyroidism
complications of haemochromatosis
diabetes
erectile dysfunction
reduced fertility
hepatocellular carcinoma
hypothyroidism
cirrhosis
cardiomyopathy
arthritis
wilsons disease inheritance
autosomal recessive
wilsons disease gene and chromosome
ATP7B gene
chromosome 13
what neuro sx are seen in wilsons disease
dysarthria
tremor
dystonia
parkinsonism (rigidity, tremor, bradykinesia)
depression
cognitive impairment
psychosis
what anaemia can you get in wilsons disease
haemolytic
initial screening test in wilsons disease and result
serum caeruloplasmin
it will be low
double panda sign on MRI brain
wilsons disease
wilsons disease mx
penicillamine or trientine
zinc salts
what 2 main organs does alpha 1 antitripsin deficiency affect and how
lungs- causes COPD and bronchiectasis
liver- fibrosis, cirrhosis
what does alpha 1 antitripsin do
inhibits proteases
stain used for alpha 1 antitripsin deficiency in liver biopsy
periodic acid schiff
what is attacked in PBC
small bile ducts in liver
how does PBC affect cholsterol
its high
PBC sx
white middle aged woman
fatigue
pruritus
abod pain
jaundice
pale greasy stools
dark urine
