Gastro

Question 1

Causes of ascites

Answer 1

1) related to portal hypertension
- cirrhosis
- alcoholic hepatitis
- cardiac ascites (RHF or constrictive pericarditis)
- Hepatic vein thrombosis or IVC obstruction
2) Not related to portal hypertension
- Peritoneal TB or Ca
- Pancreatitis
- nephrotic syndrome

Question 2

Causes of malabsorption

Answer 2

Pancreatic: chronic pancreatitis, cystic fibrosis
Bile salt: biliary obstruction, chronic liver disease, bacterial overgrowth, disease of terminal ileum e.g crohns
Mucosal: coeliac, tropical sprue, lymphoma, whipples, bowel resection/ischemia, amyloidosis, HIV, hypogammaglobulinaemia

Question 3

Causes of hepatomegaly

Answer 3

Massive: metastatic, alcoholic liver disease with fatty infiltration, myeloproliferative disease, RHF, HCC
Moderate: above and haemochromatosis, CLL, lymphoma, fatty liver (obesity, diabetes, toxins), infiltration (amyloidosis)
Mild: above and hepatitis, biliary obstruction, hydatid disease, HIV

Question 4

Causes of splenomagaly

Answer 4

Massive: CML, myelofibrosis, primary lymphoma of spleen, hairy cell, malaria
Moderate: above and portal hypertension, lymphoma, leukaemia, thalassemia, storage diseases
Small: above and PCV, ET, haemolytic anaemia, infection (EBV, hepatitis, infective endocarditis), connective tissue disease (RA, SLE, PAN), infiltration (amyloid, sarcoidosis)

Question 5

Causes of cirrhosis

Answer 5

Alcohol
Hepatitis B and C
NAFLD
Drugs (methyldopa, chlorpromazine, isoniazid, nitrofurantoin, methotrexate, amiodarone, PTU)
Autoimmune chronic hepatitis, PBC, PSC
Haemachromatosis, Wilson's disease 
Cystic fibrosis, alpha-1-antitrypsin 
Budd-chiari syndrome
Cardiac failure, constrictive pericarditis

Question 6

Causes of hepatosplenomegaly

Answer 6

chronic liver disease
haematological disease
- myeloproliferative disease, lymphoma, leukaemia, pernicious anaemia, sickle cell
Infection
- acute viral hepatitis, EBV, CMV
Infiltrative
- sarcoidosis, amyloidosis
Connective Tissue Disease
- SLE
Acromegaly
Thyrotoxicosis

Question 7

cause of jaundice

Answer 7

Pre-hepatic: increased haemolysis - unconjugated

• severe malaria
• sickle cell anaemia, G6PD, hereditary sphrecoytsosis, Gilbert’s disease (low glucuronyl transferase)
• MAHAs
• autoimmune haemolytic anaemia
• urine: urobilinogen but no urinary bilirubin *

Hepatic: Hepatocellular dysfunction - conjugated

• decreased uptake, conjugation and excretion
• hepatitis, alcoholic, cirrhosis, drug-induced
• PBC

Post-hepatic: obstruction - conjugated

• gallstones
• carcinoma of head of pancreas, cholangiocarcinoma
• cholestasis of pregnancy
• remember - only conjugated bilirubin is found in the urine
  if conjugated bilirubin is not excreted into the gut (obstruction or hepatic failure) then it will “overflow” into the urine