Gastrointestinal & Hepatobiliary dysfunction Flashcards
what is the function of the liver and what condition would it lead to if the liver is dysfunctional
metabolism of sugars, fats and proteins -> hypoglycemia, lerthargy, cachexia
production of proteins -> ascites
breakdown of toxins -> encephalopathy
bile production -> jaundice
clearance of medications -> drug toxicity
production of clotting factors -> coagulopathy
what causes hepatitis
excessive alcohol intake
drugs
non-alcoholic fatty liver disease (NAFLD)
autoimmune disorders (primary biliary cirrhosis, autoimmune hepatitis)
metabolic disorders (wilson disease, hemochromatosis)
what are the different types of hepatitis
hepatitis A and E:
- acute
- contaminated food and water
- acute illness
- self-limiting disease
- no long-term liver disease
- no risk of liver cirrhosis/cancer
hepatitis B and C:
- blood products/body fluids
- often asymptomatic and silent
- chronic long-term liver disease
- increased risk of liver cirrhosis
- increased risk of liver cancer
describe hepatitis A
- caused by eating infected food or water, including contaminated shellfish
- mild fever, fatigue, body aches, nausea and vomiting, jaunduce
- self-limiting disease - >95% will recover spontaneously and completely
describe hepatitis E
- caused by drinking contaminated water
- majority of patients develop an acute illness which resolves completely with no long-term liver disease
describe hepatitis B
- caused by exposure to infected blood and bodily fluids
- from infected mother to child during childbirth
- unprotected sexual intercourse with an infected person
- sharing syringes with an infected person (drug-abusers)
- contaminated, tattoo needles, razor, toothbrushes, acupuncture needles etc
- blood transfusion from contaminated donor
- acute hep B presents with lethargy, body aches, mild fever, jaundice and dark tea-coloured urine
- 90% of those who get acute hepB will recover fully
- chronic hep B is often silent, lifelong infection which increases the risk of developing liver cirrhosis, liver failure and liver cancer
- 90% of those who get hepB at childbirth/in childhood will develop chronic hepB
describe hepatitis C
- transmitted through unprotected sexual intercourse, sharing of contaminated needles and infected blood products
- major of patients develop chronic hepC, which increases the risk of liver cirrhosis and liver cancer
- most patients are not symptomatic and only diagnosed through routine blood tests
protect against hepatitis
HepA and E:
- practice good hygiene, especially after going to the toilet
- when travelling, avoid consuming tap water, especially in countries with poor sanitisation
- avoid consuming incompletely cooked/raw shellfish, especially if the source of the shellfish is dubious
- get vaccinated against hepA prior to traveling to places where hepA is common
Hep B and C:
- practice safe sex (using condom), especially if unsure of partner’s hepatitis status
- do not share razor, toothbrush, syringes needles
- only allow tattoos, acupuncture and piercings if the equipment is properly sanitized
- get vaccinated against hepB
what are the risk of hepatitis
hepA and E:
- minimal risk. >90% of patients recover completely with no long-term liver damage
- very rarely, a person may develop severe (fulminant) hep A/E which may develop into liver failure –> liver transplant is the only life-saving option
- no treatment or cure for hepA/E, most patients recover on their own
hepB and C
- patients with hepB and C may develop chronic hepatitis
- long term, intermittent, mild inflammation of liver which goes on over the years leading to progressive damage and scarring of the liver (liver cirrhosis)
- patients are often asymptomatic and are not aware of the ongoing liver damage till late in the course of the disease
risk of liver cancer
hepB carriers are 100x more likely to develop liver cancer compared to non-hepB carriers
further increased in
- males >40 years old and females >50 years old
- liver cirrhosis
- family history of liver cancer
- persistently high level of hepB virus in blood
- concurrent alcohol, smoking and obesity
what are some gallbladder disease
- cholelithiasis
- biliary colic
- cholecystitis
- choledocholithiasis
- cholangitis
what happens to the liver in cirrhosis
portal hypertension
- dilated veins in stomach (varices)
- enlarged spleen
- fluid accumulation in abdomen
failure of liver function
- low protein level
- easy bruising
- jaundice
- confusion
what are some complications of liver cirrhosis
- ascites
- varices
- jaundice
- liver cancer
- encephalopathy
what are the signs and symptoms of liver cirrhosis
ascites leg swelling spider naevi palmar erythema jaundice dark urine varices hematemesis malena encephalopathy liver cancer
treatment for liver cirrhosis
treatment of underlying cause of liver cirrhosis to prevent progression of disease
