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2b deck > Gastro important > Flashcards

Gastro important Flashcards

1
Q

drugs that can cause drug induced liver injury

A

Paracetamol
Antibiotics (Augmentin, flucloxacillin, erythromycin, septrin, TB drugs)
CNS drugs (Chlorpromazine, Carbamazepine, Valproate, Paroxetine)
Immunosuppressants
Analgesics (Diclofenac)
Gastrointestinal drugs (PPIs)
Dietary supplements

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2
Q

Drugs apparently not involved in DILI

A 
NSAIDs other than Diclofenac
Beta blockers
Hormone replacement therapy (HRT)
ACE inhibitors
Thiazides
Calcium channel blockers
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3
Q

Paracetamol overdose treatment

A

N acetyl cysteine

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4
Q

Hep A transmission + diagnosis

A

contaminated food/water

Anti-HAV IgM shows acute infection. Usually full recovery

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5
Q

Hep B transmission

A

mother-child during birth, sexual contact, sharing needles

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6
Q

histological findings of liver cirrhosis

A

regenerative nodules surrounded with fibrotic tissue and collagen

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7
Q

causes of liver cirrhosis

A
  • alcohol abuse
  • hep B/C
  • Haemachromatosis, Wilson’s, Alpha-1-Antitrypsin deficiency
  • Budd-chiari
  • Primary billiary cholangitis, primary schlerosing cholangitis, autoimmune hep,
  • Drugs such as amiodarone, methyldopa, methotrexate
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8
Q

liver cirrhosis symptoms

A

late symptoms incude jaundice, priritus, ascites, confusion (due to hepatic encephalopathy- complication of cirrhosis), easy bruising (reduced clotting factor production)

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9
Q

diagnosis of cirrhosis

A

liver biopsy = confirms
Elevated AST>ALT,
low platelets + low WBC

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10
Q

what is Primary biliary cholangitis?

A

Autoimmune disease where T cells attack the cells lining the bile duct, leading to bile leaking between the cells into the interstitial space and then into blood and other liver cells –> leads to inflammation of the bile ducts and eventually cirrhosis

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11
Q

antibodies associated with primary biliary cholangitis

A

AMA (antimitochondrial antibodies)

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12
Q

presentation of primary biliary cholangitis

A
  • patients often asymptomatic and then increased ALP is incidentally found
  • Jaundice (bile and conjugated bilirubin leak into blood)
  • skin pigmentation
  • Xanthelasma
  • Xanthoma
  • Priritus
    Lethary/sleepiness/pruiritus
  • May have joint pain and arthropathy (may be connected to other autoimmune disorders like RA!)
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13
Q

investigations for primary billiary cholangitis

A
  • Anti-michondrial antibodies (AMA)

- Increased ALP and GGT

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14
Q

treatment for primary billiary cholangitis

A
  • symptomatic: codeine phosphate for diarrhoea, osteoporosis prevention, colestyramine (relives pruritus by binding to cholesterol so it can be excreted more easily)
  • fat soluble vitamin prophylaxis (A,D,K)
  • monitoring and possible liver transplant
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15
Q

alcohol withdrawal treatment

A

Chlordiazepoxide

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16
Q

treatment for alcoholic hepatitis

A
  • stop drinking + treat withdrawal
  • corticosteroids
  • Vit D and thiamine
17
Q

what is haemochromatosis

A

inherited disorder where increased intestinal absorption of
iron leads to iron deposition in joints, liver, heart,
pancreas, pituitary glands, adrenals and skin

18
Q

symptoms of haemochromatosis

A
  • “bronze” skin pigmentation
  • erectile dysfunction/fatigue/arthralgia (esp of hands) in early disease
  • hepatomegaly, cirrhosis
  • could have heart failure or hypogonadism as secondary consequences to deposition
19
Q

haemachromatosis diagnosis

A
  • high transferrin saturation (>50%)
  • raised ferritin and iron
  • low total iron binding capacity (TIBC)
  • liver biopsy- PERL’S STAIN diagnostic
  • genetic testing shows C282Y and H63D mutations
20
Q

Haemachromatosis treatment

A
  • venesection first line
  • deferoxamine second line (binds to free iron in the blood and makes it easier to excrete in urine - decreases iron load in blood)
21
Q

symptoms Wilson’s disease + transporting agent causing the disorder?

A
  • liver disease- hepatitis, cirrhosis etc
  • mood/personality changes
  • reduced memory/delusions
  • KAYSER-FLEISHER RINGS around Iris

disorder of transporting ATPase called ATP7B

22
Q

Treatment of Wilson’s disease

A
  • PENICILLAMINE- copper chelating agent (binds to copper, making it easier to excrete in the urine)
  • zinc + ammonium tetrathiomolybdate- reduces copper reabsorption in urine so more copper can be excreted
  • liver transplant
23
Q

diseases caused by A1AT deficiency

A
  • emphysema in lung (most common condition in adults)

- cirrhosis and hepatocellular carcinoma in liver

24
Q

investigations for A1AT deficiency

A
  • serum A1AT low
  • on biopsy: PAS (periodic acid schiff) positive
  • phenotyping
25
Q

treatment of A1AT deficiency

A
  • IV A1AT pooled from human plasma
  • smoking cessation
  • liver/lung transplant
26
Q

liver failure presentation

A
  • jaundice
  • liver flap
  • fetor hepaticus (breath smells sweet)
  • constructional apraxia (inability to copy 3D drawings)
27
Q

liver failure causes

A
  • Drugs: paracetamol, halothane, isoniazid
  • alcohol
  • viral hep A/B
  • acute fatty liver of pregnancy
28
Q

liver failure investigations

A
  • raised prothombin time and INR

2b deck (18 decks)

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