Gastroenterology Flashcards
How can acute liver failure present?
Coagulopathy
Hepatic encephalopathy
Jaundice
Ascites
What are some causes of acute liver failure?
Alcoholic liver disease, fatty liver disease, autoimmune hepatitis
Infection: viral hepatitis, CMV
Drugs: paracetamol overdose, isoniazid
Vascular: Budd-Chiari syndromen
What investigations are done to investigate acute liver disease?
Bloods
Ascitic tap => MC&S
CXR
Doppler flow study of portal vein
What bloods are done in acute liver failure?
FBC - infection, GI bleed
U&Es - urea synthesised in liver, so can’t be used for measuring renal function in liver failure
LFT
Clotting - measures synthetic function of liver, raised PT/INR in liver failure
Hepatitis serology
Blood cultures
What is included in a liver screen?
LFTs Coagulation screen Hepatitis serology Epstein Barr Virus Cytomegalovirus Immunoglobulins Ferritin - haemochromatosis Serum copper - Wilson's disease
What LFT results would indicate hepatocellular injury?
Greater than 10 fold increase in ALT
Less than 3 fold increase in ALP
What LFT results would indicate cholestasis?
Greater than 3 fold increase in ALP, with a raised gamma GT
Less than 10 fold increase in ALT
What would a raised gamma GT indicate?
Alcohol use
Drugs such as phenytoin
ALP also raised => cholestasis (biliary epithelial damage/bile flow obstruction)
What would an isolated ALP rise indicate?
Present in bone therefore indicates bone pathology
Bone mets/primary bone cancer
Vit D deficiency
Recent fracture
What can cause an isolated rise in bilirubin?
Gilbert’s syndrome
Haemolysis
What do ALT/AST ratios indicate?
ALT > AST chronic liver disease
AST > ALT - cirrhosis, acute alcoholic hepatitis
What are complications of acute liver failure?
Cerebral oedema Ascites Bleeding Hypoglycaemia Encephalopathy
How does encephalopathy develop in acute liver failure?
Build up of nitrogenous waste, cleared by astrocytes => production of glutamate
Osmotic imbalance => cerebral oedema
How is hepatic encephalopathy treated?
Avoid sedatives, correct electrolyte imbalances
Lactulose
Rifaximin => abx, reduces ammonia forming bacteria
What are symptoms of ulcerative colitis?
Bloody diarrhoea Abdominal pain Urgency Tenesmus Acute attacks: fever, malaise
What are extra-intestinal features of UC?
Erythema nodosum Episcleritis Conjunctivitis Ankylosing spondylitis, sacroilitis Primary sclerosing cholangitis
What investigations are done for UC?
Bloods - FBC, U&Es, LFTs, CRP, iron studies
Stool culture
Faecal calprotectin
Flexible sigmoidoscopy with biopsies
How is mild UC defined?
<4 bowel movements pre day Small amount of PR bleed HR <90 Apyrexial No anaemia
How is moderate UC defined?
4 - 6 bowel movements a day
No anaemia
Apyrexial
How is severe UC defined?
>6 bowel movements a day Large amount of PR bleed Pyrexial Anaemic HR >90
What maintains remission in UC?
Mesalazine
What is the management for severe UC?
Admit
IV fluids
IV hydrocortisone/PR prednisolone
VTE prophylaxis
Rescue therapy - ciclosporin, tacrolimus, surgery
What are features of UC?
Continuous mucosal/sub-mucosal inflam, extends from rectum proximally
Crypt abscesses, pseudopolyps
What are acute complications of UC?
Toxic megacolon => risk of perforation
Severe exacerbations
