Gastroenterology Flashcards
management of Hep C
Interferon (weekly, do not use if cirrohsis),
Ribavirin (guanosine analogue, CI in pregnancy, side effect; haemolytic anaemia)
Direct acting antiviral Telaprevir and Boceprevir, if resistance, discontinue
Nucleotide polymerae inhibitor Sofosbuvir)
Surveilance HCC
Non pharmacology: hep A and B vaccination
Surgery: Transplant
risk factors for Hep C
IVDU, transfusion before 90, exposure to blood products before 90, Ethnic group, health care worker, Children of Hep C AB , iatrogenic , Tattoos, prisoners, low socialeconomic status, sexual behaviour
Treatment contraindications
significant psychiatric illness Non compliance Alcohol intake >7 standard/week Decompensated cirrhosis unable to tolerate low HB certain autoimmune diseases solid organ transplant
treatment efficacy
virological - loss HCV RNA
Biochemical - normal ALT
Histological - reduction inflammation/fibrosis
EndEndo fo points of treatment
End of treatment response
Sustained virological response, (HCV RNA negative for 6 months after end of treatment)
What are the causes of cirrhosis
Viral infection
Alcohol/NASH/NAFLD
autoimmune : primary billiary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis
metabolic: haemachromatosis, wilson disesae, antitrypsin deficiency
Drugs: isoniazid, amiodarone, phenytoin
what are signs of alcohol misuse?
cachexia tremor parotid enlargement dupuytren's contracture cerebellar syndrome peripheral neuropathy myopathy
what are the severity of hepatic encephalopathy
grade 1: insomnia/reversal of day-night sleep pattern
grade 2: lethargy/disorientation
grade 3: confusion/somnolescence
grade 4: coma
what are the most common causes of ascites in developed country
cirrhosis malignancy right heart failure TB pancreatitis
How do you classify transudative and exudative ascites
SA-AG: >11g/L transudate
SA-AG <11g/L exudate
causes of heaptosplenomegaly
chronic liver disease with portal hypertension
myeloproliferative disease, lymphoma, leukemia, pernicious anamia
infeciton: acute viral hepatitis, glandular fever
infiltration- amyloidosis, sarcoidosis
connective tissue disease- systemic lupus erythematosus
acromegaly
thyrotoxicosis
differential diagnosis in liver plapation
- Massive
malignancy, alcoholic liver iwth fatty infiltration, myeloproliferative, right heart failure, hepatocellular carcinoma - moderate
the above, haemochromatosis, haematological disease - CML
fatty liver - obesity, diabetes mellitus - mild
the above, hepatitis, cirrhosis, billary obstruction, granulomatosis disorders, amyloidosis, HIV infeciton, ischaemia
Alcohol withdrawl drugs:
disulfiram 100 mg orally, once daily initially for 1 to 2 weeks, increase as required and as tolerated up to 300 mg daily.
acamprosate (patient less than 60 kg) 666 mg orally, in the morning, 333 mg at midday and 333 mg at night
or acamprosate (patient 60 kg or more) 666 mg orally, 3 times daily.
naltrexone 50 mg orally, once daily.
Chemo for colon cancer
oxaliplatin, 5-FU, bevacizumab, cetuximab
what are the causes and clinical mainesfation of the Budd chiatri syndrome
characterized by obstruciton to hepatic venous outflow, most commonly due to the thrombosis, may occure at the level of the hepatic venules, the hepatic veins, or the inferior vena cava. this cuases venous stasis, congestion, and damage to hepatic parenchymal cells
underlying cuases: 75% patients
includes myeloproliferative disorders, thrombophilias, paroxysmal nocturnal haemoglobinuria
either present with jaundice and hepatic encephalopahty, more commonly with subacute onset of abdominal pain and hepatomegaly
diagnosis is usually by doppler ultrasound of the hepatic vein
treatment involves anticoagulation and the medical management of ascites, unless encephalopahty or liver failure are present, in which case thrombolysis, angioplasty or liver transplantation
