Gastroenterology Flashcards
What dx should you consider with a signficantly elevated serum ferritin
After exclusion of hereditary haemochromatosis
* infection or inflammation
* alcohol consumption
* metabolic syndrome
* obesity
* diabetes
* liver or renal disease
* thyrotoxicosis
* malignancy
How is HHC inherited
AR gene inheritence
>90% is from homozygous C282Y-HFE gene
heterozygot is nil risk, 1/10 people are this
What are HHC symptoms
- Fatigue
- deression/anxiety
- joint pain, escpecially in the fngers
- bronze/grey skin
- erectile dysfuction
- Ammennorhhea or oligomennorrhea
- brain fog
Treatment of HHC
- Primaily venesections
- Chelating therapy (deferairox) can be used in severe cases or those who cannot tolerate venesections
- no cahnge to iron required
alcoholic liver disease, the AST:ALT ratio is often
2:1
Smoking and IBD
Protective against UC
Risk factor for chrohns and associated w more severe disease
Symptoms /signs of hepatic encephalopathy
- confusion, altered GCS (see below)
- asterixis: ‘liver flap’
- constructional apraxia: inability to draw a 5-pointed star
- raised ammonia level (not commonly measured anymore)
Treatment of hepatic encephalopathy
treat any underlying precipitating cause
lactulose first-line ? excretes ammonia
antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
Treament of a Mild-moderate (<4 or 4-6 stools/day) UC flare
For proctitis +/- left sided disease
- Topical (rectal) aminosalicylate
- if remission is not achieved within 4 weeks, add an oral aminosalicylate
- if remission still not achieved add topical or oral corticosteroid
For patients with extensive disease
- topical + high-dose oral aminosalicylate, +/- oral corticosteroid
Severe flares should be treated in hospital
Causes of acute liver failure
paracetamol overdose
alcohol
viral hepatitis (usually A or B)
acute fatty liver of pregnancy
Features of acute liver failure
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy - sweet breath
renal failure is common (‘hepatorenal syndrome’)
Management of ascites
- Reducing diet sodium
- Fluid restriction
- ALdosterone antagonists (spironalactone)
- drainagae if tense
- Prophylactic ABc - SBP (ciprofloxacin)
Haemachormatosis recieving weekly venesections, what tests should be done to monitor treatment
FBC
Tranfserrin saturation
serum ferritin
TRanfserrin - first marker to rise in haemochromatosis , showing amount
The main risk factor for developing HCC
Chronic Hep B
Liver cirrhosis (etoh, hepatitis, haemachormatosis and PBC)
Features of HCC
- Raised AFP
- Features of cirrhosis (jaundice, RUQ pain, ascites, organomegaly, pruitus, splenomegaly)
