GI 2 Flashcards
Most common causes of cirrhosis?
In W. world = alcohol
Worldwide = Hep B & C
What are the two main types of cirrhosis?
Micronodular - uniform small nodules, often following alcoholic hepatits
Macronodular - variable size nodules, usually after chronic viral hepatitis
What features would indicate DECOMPENSATED cirrhosis?
- hepatic encephalopathy
- ascites
- variceal haemorrhage (–> haematemesis)
General clinical features of cirrhosis (seen in compensated and decompensated)?
jaundice
fever
loss of body hair
What is fetor hepaticus
Distinctive musty sweet breath odour found in decompensated cirrhosis.
When would you see Serum alpha fetoprotein (AFP) ?
usually only high in fetus but can increase with chronic liver disease and if >200ng/mol = strongly suggestive of HCC!
How would you assess severity and prognosis in Cirrhosis?
CHILD-PUGH classification - 5 factors - encephalopathy - ascites - prothrombin time - serum bilirubin - serum albumin Or MELD score = serum bilirubin, creatinine and INR
What is PBC?
= primary biliary cirrhosis –> chronic disorder with progressive destruction of intrahepatic bile ducts causing cholestasis and eventually cirrhosis.
what is the only specific Ab in PBC?
M2 Ab ( an AMA) = anti-mitochondrial antibody
If pt has high serum ALP, high IgG and a positive AMA Ab test, what is the most likely diagnosis?
Primary biliary cirrhosis
Mx of PBC?
lifelong ursodeoxycholic acid = a naturally occurring bile acid (slows progression)
then supplements for malabsorption and transplant after disease progression.
Cardinal sign of alcoholic hepatitis?
rapid onset jaundice
What is characteristic histological appearance of alcoholic hepatitis?
steatosis with ballooned hepatocytes, often containing amorphic eosinophilic material called MALLORY BODIES
What would liver biochem show in alcoholic hepatitis
rise in AST & ALT with DISPROPORTIONATE RISE IN AST
marked increase in serum bilirubin
low albumin
prolong prothrombin time
A bile duct bx shows bile duct carcinomas, what condition would this likely indicate?
PBC (autoimmune attack of bile ducts)
Clinical presentation of Haemochromatosis?
classic triad of: micronocular cirrhosis, DM, and skin pigmentation
others = signs of iron loading in organs
Mx of haemochromatosis?
Venesection
chelation with deferoxamine
(surveillance for HCC development and genotyping of 1st degree relatives)
What is caeruloplasmin?
= main copper carrying protein in the blood
Where does copper accumulate in Wilsons disease?
cornea, basal ganglia, liver, kidney, joints
signs of liver failure? (5)
jaundice hepatic encephalopathy asterixis (flap) fetor hepaticus constructional apraxia (+ signs of chronic liver disease)
What is Budd Chiari syndrome?
= thrombosis of the portal vein
Caused by: pregnancy, polycythemia vera and OCP
Signs of ascites?
jaundice/other liver disease symps abdo distension puddle sign shifting dullness fullness in flanks fluid thrill pleural effusion and oedema maybe
How do intestinal tumours present?
Abdo pain, anorexia, anaemia and diarrhoea.
in what condition do you see a 100% lifetime risk of CRC?
Familial adenomatous polyposis.
Give some examples of hepatotoxic drugs
paracetamol, MTX, isoniazid, azathioprine, oestrogen, tetracycline
