GI Flashcards
Liver cirrhosis causes
- Alcohol related liver disease
- NAFLD
- Hep B
- Hep C
- Autoimmine hep
Non-invasive liver screen
- USS liver
- Hep B+C
- Autoantibodies
- Immunoglobulins
- Caeruloplasmin
- Alpha 1 antitrypsin
- Ferritin and transferrin
4 key features of decompensated liver disease
- Ascites
- Hepatic encephalopathy
- Oesophageal varices bleeding
- Jaundice
what causes ascites
- Fluid in peritoneal cavity
- Increased pressure in portal system causes fluid to leak out of capillaries
- Drop in circulating volume causes reduced BP in kidneys
- Renin released therefore increased aldosterone = reabsorption of fluid and sodium in kidneys
- cirrhosis = most common cause
2 types of ascites
- transudate <25
- exudate = more protein >25
what causes transudative ascites
- HF
- malnutrition
- ## portal HTN
what causes exudative ascites
- malignancy
- TB
- pancreatic ascites
- budd chiari
Mx ascites
- low na diet
- aldosterone antagonist = spiro
- paracentesis (drain)
- Abx proph = cipro or norfloxacin
Hepatic encephalopathy caused by
- build up of neurotoxic substances that affect the brain e.g. ammonia
S+S hep enceph
Acutely
- reduced cosnciousness
- confusion
Chronically
- personality change
Mx hep enceph
- lactulose
- abx to reduce bacteria producing ammonia (rifaximin)
- nutrition support
Metabolic functions of liver and what goes wrong
- Gluconeogenesis (using lactate)
- Glycogen metabolism
Failure: - Hypoglycaemia
- High lactate
Synthetic functions of liver and what goes wrong
- Vit K dependent clotting factors
- Albumin
- TPO
Failure: - increased PT/INR
- Ascites
- thrombocytopenia
Excretion/detoxification functions of liver and what goes wrong
- toxins/drugs
- ammonia
Failure: - build up of liver excreted drugs
- High ammonia –> hepatic encephalopathy
blood findings in decompensated cirrhosis
Raised:
- Bili
- ALT
- AST
- ALP
- low albumin
- High PT
1st line investigation for fibrosis in NAFLD
- Enhanced liver fibrosis blood test
ELF resuts
- 10.51 or more = advanced fibrosis
- <10.51 unlikely advanced fibrosis
USS findings in cirrhosis
- Nodularity
- corkscrew hepatic arteries
- enlarged portal vein with reduced flow
- ascites
- splenomegaly
5 factos in child pugh score
- albumin
- bilirubin
- clotting (INR)
- dilation (ascites)
- encephalopahty
Mx cirrhosis
- treat underlying
- MELD score 6m to assess severity
- monitor complications (USS and AF every 6m)
- manage complications
- transplant
4 features decompensated liver disease
ascites
hepatic encephalopathy
oesophageal varices bleeding
yellow
= consider transplantation when decompensated
prophylaxis of bleeding in stable oesophageal varices
- non-selective BB = propranolol
- ligation
Mx bleeding oesophagela varices
- ABCDE
- major haemorrhage protocol
- coagulopathy treated woth FFP
- vasopressin analogues = terlipressin
- broad spectrum abx
- urgent endoscopy with ligation
SBP S+S
- fever
- abdo pain
- deranged bloods
- ileus
- hypotension
SBP common organisms
- E coli
- Klebsiella pneumoniae
SBP Ix
diagnostic aspiration = raised neutrophil count
Mx SBP
- Culture ascitic fluid pre abx
- IV broad spectrum abx
- ceftriaxone or cefotaxime
- IV human albumin
how many units per week
14
blood resuts in alchohol related liver disease
- increased MCV
- increased ALT and AST
- AST:ALT >1.5
- raised GGT
CAGE questions
Cut down
Annoyed
Guilty
Eye opener
time in withdrawal for hall, seizures and DT
- 12-24 hrs = hallucinations
- 24-48hrs = seizures
- 24-72hrs delerium tremens
Mx withdrawal in hospital
- chlordiazepoxide reducing regime
- Pabrinex then thiamine
wernickes encephalopathy
- confusion
- oculomotor distirbance
- ataxia
korsakoff sx
- memory impairement = retrograde and anterograde
- behaviour changes
Hep A - TTVT and sx
- Type = RNA
- Transmission = faeco-oral
- Vaccine available
- supportive Tx
- Can cause cholestasis with pruritus,jaundice, dar wee and pale stool
- Dx based on IgM
Hep B TTVT
- Type = DNA
- Transmission = blood/fluids
- Vaccine available
- Tx = supportive/antiviral
Hep C TTVT
- Type = RNA
- Transmit = blood/body fluids
- No vaccine
- Direct acting AV tx
Hep D TTVT
- Type = RNA
- Transmitted with Hep B
- NO vaccine
- Tx = pegylated interferon alpha
Hep E TTVT
- Type = RNA
- Transmit = faeco-oral
- No vaccine
- tx supportive
S+S hepatitis
- abdo pain
- fatigue
- flu like
- pruritus
- N+V
- Jaundice
LFTs in hepatitis
- AST and ALT high
- Less of a rise in ALP
HBsAg
active infection
HBeAg
high infectivity
HBcAB
past or current infection
HBsAB
vaccination or past/current infection
type 1 autoimmune hep
- WOmen in late 40s/50s
- Around or after menopause
- fatigue, liver disease features
type 2 autoimmune hep
- young girls
- acute hep
- high transaminases
- jaundice
autoantibodies in type 1
ANA
Anti-actin
Anti SLA/LP
autoantibodies i tyoe 2
Anti LKM1
anti LC1
key histology findings in AH
- Interface hepatitis
- Plasma cell infiltration
Mx AH
- high dose steroids
inheritance of haemochromatosis
- autosomal recessive
- affects HFE gene on csome 6
- leads to iron overload
S+S haemochromatosis
- chronic tiredness
- joint pain
- bronze skin
- testicular atrophy
- erectile dysfunction
- amenorrhoea
- cognitive
- hepatomegaly
initial ix for HH
serum ferritin
other ix HH
- transferrin saturation
- genetic test
- liver biopsy with perls stain
- mri
mx HH
- venesection
- monitor ferritin
inheritance of wilsons
autosomal recessive
- wilson diesase protein on csome 13
- copper accumulation
S+S wilsons
- teens
- chronic hepatitis
- tremor, dysarthria, dystonia
- parkinsonism
- deression
- kayser-fleischer rings
- haemolytic anaemia
Ix wilsons
- serum caeruloplasmin low
- 24hr urine copper assay
- biopsy
mx wilsons
- copper chelation with penicillamine or trientine
inheritance of alpha 1 antitrypsin
autosomal co-dominant
- csome 14
presentation of primary biliary cholangitis
- white woman 40-60
- fatigue
- pruritus
- GI sx
- pale greasy stool
- jaundice
- dark urine
what is pbc
autoimmune damage to small bile ducts inside the liver
PBC S+S
- Similar PSC
- Raised cholesterol = xanthelasma
autoantibodies in PBC
- AMA = key
- ANA
ALP also raised
Mx PBC
- ursodeoxycholic acid
- cholestyramine (maybe check)
what is primary sclerosing cholangitis
- sclerosis and inflammation of biliary tree
- associated with UC
primary sclerosing cholangitis S+S
- RUQ pain
- itching
- fatigue
- jaundice
- hepato and splenomegaly
Ix and Mxfor PSC
- MRCP
- raised ALP first
- bilirubin raised next
- Mx = ERCP
what can psc cause
- cholangiocarcinoma
- cirrhosis
screening for Ca in cirrhosis
- every 6 months
- USS
- alpha fetoprotein
S+S liver cancer
- weight loss
- abdo pain
- anorexia
- N+V
- jaundice
- Pruritus
- mass on palp
key presenting feature in cholangiocarcinoma
- obstructive jaundice = pale stool, dark wee, itching
tumour marker for cholangiocarcinoma
- CA19-9
contraindication for liver transplant
- significant co-morbidities
- current illicit drug use
- continuing alcohol misuse
- untreated HIV
- current or prev cncer
lining of stomach
columnar epithelial lining
red flag features in gord
- dysphagia
- > 55
- weight loss
- upper ando pain
- reflux
- tx resistant dyspepsia
- N+V
- mass
- anaemia
- high platelets
GORD patho
- acid from stomach flows through lower oesophageal sphincter
- irritates lining of oesophagus
oesophagus lining
squamoue epithelial lining
Ix GORD
- endoscopy
Mx GORD
- lifestyle changes
- med review
- antacids
- PPI
- Histamine H2 receptos antagonists
- laparoscopic fundoplication
H pylori type of bacteria
gram negative aerobic bacteria
- produces ammonium hydroxide
h pylori ix
- stool antigen
- urea breath test
- antibody test
- rapid urease test
triple therapy for h pylori
- PPI = omeprazole
- amoxicillin
- clarithromycin
7 days
barrets oesophagus
- lower oesophageal epithelium changes from squamous to columnar epithelium
tx barrets
- endoscopic monitoring
- PPI
- endoscopic ablation