Gastrointestinal - Chronic Liver Disease Flashcards
what is cirrhosis?
irreversible liver damage
features of liver disease?
oedema ascites spider naevi gynecomastia jaundice bleeding bruising palmar erythema clubbing spleno/hepatomegaly
what features of liver disease are caused by hyper-oestrogenism?
gynecomastia
palmar erythma
why does hepatic encephalopathy result in liver disease?
ammonia builds up
brain processes it to glutamate
osmotic imbalance and cerebral oedema results
what stage of liver disease is reversible?
fibrosis
pathology of alcoholic liver disease?
increased release and synthesis of fatty acids in hepatocytes
alcohol metabolism products build up and cause injury
increased collagen synthesis by fibroblasts
who gets NASH?
non drinkers
DM
obsese
hyperlipidaemia
causes of cirrhosis?
alcohol Hep B/C NASH PBC/PSC haemachromatosis wilsons alpha 1 antitrypsin
what drugs can cause cirrhosis?
MTX
amiodarone
Ix for chronic liver disease?
LFTs FBC coag transient elastography upper GI scope
Tx for chronic liver disease?
thiamine Vit K Ca spironolactone paracentesis lactulose (if encephalopathy) transplant
why does portal hypertension result?
increased resistance to portal flow alongside increased portal venous inflow
anastamoses between portal venous and systemic venous enlarge
where are sites of portal venous and systemic venous anastamoses?
oesophagus
umbilical
retroperitoneal
haemorrhoidal
why does ascites occur in chronic liver disease?
portal hypertension results in arterial HYPOtension
RAAS system is upregulated (retains Na and H20 to increase BP)
hypoalbuminaemia can also occur
tx for ascites?
diet spironolactone fluid restrict drainage TIPS
what cell does hepatocellular carcinoma arise from?
hepatocytes
what does carcinoma mean?
arising from epithelial tissue
risk factors for hepatocellular carcinoma?
cirrhosis
male
hepatitis B
alcohol
what blood test can be used to monitor for hepatocellular carcinoma? what is this normally made from?
AFP
fetuses liver and yolk sac
Ix for varices?
endoscopy FBC coag LFTs U+Es creatinine
Tx for varices?
propranolol
ligation
TIPS
vit K
if varices are bleeding, what Tx is given?
Vit K/FFP/platelets blood transfusion terlipressin PPI ligation balloon tamponade
how is hereditary hemochromatosis inherited?
autosomal recessive
what happens in hereditary hemochromatosis?
increased intestinal iron absorption
due to decreased hepcidic which keeps iron in macrophages usually
features of hereditary hemochromatosis
tired athralgia impotence liver disease grey skin cardiomyopathy 'bronze diabetes'
what can protect women from early presentation in hereditary hemochromatosis?
mentruation
Ix for hereditary hemochromatosis and results?
LFTs ferritin (high) transferrin saturation (high) BM HFE test MRI echo
Tx for hereditary hemochromatosis?
venesection
monitor LFTs/BM
what happens in wilson’s disease?
too much copper
usually incorporated by liver into caeruloplasmin
transported to liver but not excreted by bile, so accumulates in organs
features of wilson’s disease?
hepatitis tremor dysarthria worsening memory kayser fleischer rings blue nails arthritis
Ix for wilson’s disease?
urinary copper LFTs serum copper serum caeruloplasmin MRI liver biopsy
Tx for wilson’s disease?
diet
penicillamine
transplant if failure occurs
what can cause an acute upper GI bleed?
ruptured varices
peptic ulcer
wallory weiss
oesophageal rupture
features of oesophageal rupture?
chest pain
hypotension
tachycardia
subcutaneous emphysema
for H pylori, what Ix can be done?
C13 breath test
rapid urease test (urea + biopsy)
what type of ulcer is relieved by eating?
duodenal
blood results in alcoholics?
macrocytic anaemia thrombocytopenia hyponatraemia hypoalbuminaemia prolonged PT
