GI 4 Flashcards
Hep A genetic spread does it cause liver failure cause smp ix treatment
RNA faeco-oral does not cause cirrhosis IVDU, uncooked pork, hygiene, MSM N/V/D, anorexia, fever, malaise, arthralgia, hepatosplenomegaly, jaundice, dark urine increased AST/ALT/bilirubin, Hep A IgM supportive
Hep B genetic spread symp treatment cx what can be given for high risk people
DNA
parental, sexual, maternal
asymp, like hep A, cirrhosis, cancer, liver failure
supportive, antivirals: lamivudine, entecavir, tenefovir
cancer, GN, cirrhosis, liver failure
vaccine
HepBsAG HepBanti s Hep B c AB Hep B AG Hep B DNA PCR
2-10 w after exposure. undetectable after 4-6 months once resolved. >=6m chronic
natural immunity indicating clearance - in vaccinated px
IgM within a few hours remains for 4-8 m. IgG in chronic
high infectious >=3m chronic
level of viral replication used to assess if give treatment and monitor response to it
Hep C genetics symptoms ix what can be useful for disease activity treatment cx
RNA, flavivirus
asympt, fatigue, arthralgia, jaundice
Hep C ABs, NAATs (PCR), viral genotyping
ALT
peg interferon and ribavirin and protease inhibitor
cirrhosis, chronic, cancer
Hep D genetics
what about this
RNA
depends on Hep B
Hep E genetics spread symptoms ix treatment cx
RNA, FO
acute and self limiting, jaundice, fatigue, nausea
increased aminotransferase in acute. AB. RNA
supportive. improve sanitation
liver failure
I hep in who
symp
ix
treatment
women on the pill
mild to hepatic failure
increases ESR, IgG. ANA pos SMA pos anti LKM pos. liver biosy
steroids, azithro, USDA, transplant
fulfilment failure acute failure subacute failure causes symp ix rx
encephalopathy 1w
2-4w
4-8w
hep, CMV, EBV, paracetamol, malignancy, alcohol
jaundice lethargy nausea anorexia
GTT, FBC, ABG, LFTs, virology, USS, biopsy
supportive, transplant
alcoholic liver stages 3
symp
ix
rx
fatty liver (steatosis) 2. alcoholic hep 3. cirrhosis
variable symp
decreased albumin LFTS. USS/CT - fatty infiltration
absitance - diazepam
NAFLD is what cause symp ix treatment
fatty infiltration of liver not due to alcohol
obesity
asymp till later stages
increase in ALP then AST. USS - echogenic. biopsy. ELF score after USS
lifestyle. transplant
NASH is what leading to what risk factors symp ix treatment
liver fat content > 12% leading to inflam and fibrosis obesity, htn, hyperlipidaemia asymp LFTs, HbA1c, liver biopsy remove causative factors
cirrhosis cause
symp
ix
prognosis
alcohol, NAFLD, hep B/C, PBC, AI, drugs like metho
spider naevia, jaundice, leukonychia, telengectasia, xanthalasma, dupytrens, clubbing, palmer erythema
LFTs, GBC, Yes, CRP, virology, USS, CT, transient elastography, acoustic radiation force > biopsy, ELF score in NAFLD
child pugh score
cirrhosis complications and some management
ascites Abd USS - spironolactone, paracentesis, TIPS encephalopathy - laxatives oesophageal varices - OGD liver cancer - abd US/CT/MRI malnutrition, vit D defic, coagulopathy
haemachromatosis genetics symp transferrin sat other ix treatment cx
AR mutation in HFE gene
fatigue, erectile dysfunction, arthralgia, bronze skin, DM, liver disease signs, CM, hypogonadism, hypothyroid
> 55% in men >50% in females. genetic. ferritin
venesection keep transferring sat <50% and ferratin <50mcg/L
desferrioxamine
avoid alcohol
liver cancer/failure
wilsons disease genetics onset children young adults symp ix rx
AR decreased caeruoplasmin -> high copper
10-25yp
liver dx
neurodx
hep, cirrhosis, neuro, speech, behave, dementia, chorea, kayser fletcher rings, haemolysis, blue nails
increased caerusplasmin, decreased serum copper, high urinary secretion
penicillamine / triestine hydrochoride
low copper diet
transplant
budd chiari syndrome is what cause symp ix treament
hepatic vein thrombosis
PVC, thrombophilia, preg, OCP
abdo pain sudden onset. severe ascites. tender hepatomegaly
increased ALT/AST/ALP/bili decreased albumin. USS CT/MRI - occlusion
thrombolyse, anticoagulants, angioplastiy, TIPS, transplant
PBC is what symp ix rx cx
interlobular bile ducts inflam - cirroses
itching, middle aged F, hyperpigemtation, RUQ pain, clubbing, fatigue, jaundice, osteoporosis
cholestatic LFTs, increased IgM, AMA pos, SMA, biopsy
cholestryramine for itch, USDA, transplant, bisphosphonae, pred, azithro
cancer, portan htn
hemangioma is what
USS
rx
benign
non cirrhotic patient s
well demarcated echogenic spot
no treatment
adenoma
benign women
storage disease
OCP
embolise surgery
carcinoma cause ix risk factors symp screen who treatment
chronic hep B worldwide. Hep c commonest in europe
increased AFP
liver cirrhosis, alpha 1 anti defic, hereditary tyrosinosis, glycogen storage disease, aflatoxin, OCP, anabolic steroids, male, DM
presents late. liver signs
high risk px USS +/- AFP
surgical resection. transplant. radiofreq ablation. transarterial chemo embolisation. sorafenib (multikinase inhibitor)
hepatic encephalopathy symptoms
prophylaxis treatment
GCS, liver flap, increased ammonia, triphasic slow waves on EEG
lactulose
rifaximin
