Gastroenterology Flashcards
What is the cause of nutmeg liver?
Right heart failure
What is the clinical and lab criteria required to diagnose alcoholic hepatitis? Either clinical or lab is required for diagnosis
Clinical: Person drinking >= 6 months, known liver disease, can’t be abstinent in last 60 days before jaundice
LAB: AST:ALT 2:1, AST & ALT < 400
What symptoms does alcoholic hepatitis have?
Epigastric pain, fever, neutrophilia, rapid onset jaundice, occasionally encephalopathy
Mx of Alcoholic hepatitis?
AWS -> manage with benzos (Diazepam or oxazepam - Better in liver dysnfunction)
Thiamine before glucose -> hydrate and electrolytes
ATODS Referral
Council on long term abstinence = liver regeneration
MELD score >18 = start prednisolone
Give prednisolone if encephalopathy present
What demographic of patient gets NAFLD?
T2DM and metabolic syndrome pts
What is the basic pathology of NAFLD?
Insulin resistance -> Decrease sensitivity to lipoprotein lipase -> increase Free fatty acids in circulation -> stores in liver -> steatosis
What are the clinical features of NAFLD?
RUQ pain, fever, N&V
NAFLD Ix?
FBC, BSL/HbA1c, Lipids, LFTs, fibroscan for cirrhosis
What is the mx of NAFLD?
Manage CVS risk factors - SNAP + Weight loss
If absolute CVD Risk factor >15% -> lipid and BP lowering meds
How many paracetamol tablets are deadly?
> 20
Explain the paracetamol nomogram and how it is used in treatment?
Levels rise until 4 hours
After 4 hours, take levels and see where on nomogram. Below line do not treat, above line treat with N-acetylcystine
Alpha 1 AT deficiency can cause symptomatic disease / liver cirrhosis at any age. What is the definitive management?
Liver transplant
What are the risk factors for haemachromatosis?
Family Hx, Alcoholics, Celtic
What is the basic pathology of haemachromatosis?
HFE gene mutation -> decreased hepcidin -> Increased iron absorption -> tissue deposition
What is wilson’s disease, clinical features, Ix and MX?
Lack of copper excretion in bile -> copper accumulation
CF: KF rings, blue lunulae, liver failure, neuropsych sx, jaundice
IX: Decreased ceruloplasmin concentration, high 24 hour urinary copper excretion
MX: Lifelong zinc, refer to specialist
Autoimmune Hepatitis affects middle aged women. What tests do you perform to confirm this and what is the management?
ASMA, ANA, Elevated IgG
Mx: Prednisolone + referral to specialist
What are some clinical features of PBC and management?
Joint pain, pruritis, jaundice, xanthelasma
Ursodeoxycholic Acid
What are the PBC investigations?
AMA, LFTs. Fibroscan for cirrhosis
Who gets PBC?
Old women (50s) and associated with sjogren’s syndrome (dry eyes and mouth due to gland distruction)
Who gets PSC?
Young male, associated with Ulcerative Collitis
What is the investigations and management for PSC?
ix: pANCA, MRCP
Mx: Ursodeoxycholic Acid
What are your differentials for viral hepatitis?
EBV, HIV, CMV, HSV
Hepatitis A&E are forcal oral transmitted. What is the incubation period and risk factors?
<6 Weeks
RF: Travelling, poor hygiene, Shellfish for Hep A
How is Hepatitis B,C,D spread? What are the risk factors?
Blood, Birth, Banging
RF: Transfusions, tattoos, Taking drugs, Toothbrush, DeTention, Taboo (MSM), healTh care workers
What are the clinical features of all acute hepatitis?
Fatigue
Lethargy
Jaundice
RUQ pain
N&V
Fever
Myalgia
Arthralgia
Which hepatitis is more common / more commonly causes cirrhosis?
Hep C more likely to cause cirrhosis, however hep B more common
Why is vertical Hep B transmission bad?
90% chance of cirrhosis
How do you diagnose Hep A?
IgM and anti HAV Ab
How do you diagnose Hep B?
Check HBsAg -> positive = current infection
Check Anti-HBs -> Positive = vaccinated or resolved infection
Check Anti-HBc -> Positive = resolved infection, negative = vaccinated
Acute = IgM, Chronic = IgG
How do you test for hep C?
Anti-HCV Ab = Acute
HCV RNA test (PCR) = Chronic
How do you diagnose Hep E?
HEV RNA & Anti-HEV Ab (IgM & IgG)
