GI And liver Flashcards
DNA hepatitis
B
Unenveloped hepatitis
A and E
IV hepatitis
BCD
Hep A diagnosis
Serum IgM ABs
Hep B diagnosis
HBsAg
AB to HBcAg
PCR for HBV DNA
Hep C diagnosis
3rd gen ELISA for AB detection
PCR for HCV RNA
Hep D Diagnosis
IgM and IgG ABs
Serum RNA
HDAg in liver
Hep E diagnosis
IgG and IgM ABs serum
PCR for RNA
Serology carrier hep B
HBsAg present
HBeAg not present
Anti HBeAB present
Normal transaminases
Low/ undetectable HBV DNA
Liver bx no inflamation or necrosis
UC
spreads prox from rectum
broad based shallow ulcers, mucosa only
no strictures
multiple pseudopolyps
toxic megacolon
Crohns
skip lesions
cobblestone
transmural
rik calcium oxalate stones
strictures, deep ulcers
non caseating granulomas
coeliac
tissue transglutaminase and gliadin blood tests
diffuse enteritis with flattened villi
assoc dermatitis herpetiform
Whipple disease
assoc HLA B27
tropherma whippeli infection
lamina propria SI laden macrophages
diarrhoea, statorrhoea, fever weight loss, migratory arthritis, brain involvement
Blood tests liver
hepatocyte - ALT AST LDH
bile canaliculi - ALP GGT
Scar formation liver
collagen release by stellate (Ida cells)
Cirrhosis morphology
proliferating hepatocyte surrounded by on going fibrosis
- fibrous septae
- parenchymal nodules
- disruption architecture
Acute liver failue
80% function lost
80% die without transplant
acute illness assoc encephalopathy and coagulopathy
within 26 weeks initial illness
absence pre existing liver disease
Ascites
85% due to cirrhosis
low protein fluid
amount of lymph thoracic cavity exceeds thoracic duct capacity
Mortality acute on chronic hepatic failure
50%
HBV % acute and chronic
65% subclinical
25% acute
10% chronic
HCV % chronic
80%, main cause IVDU
HIV % with hepatitis
10% HBV
25% HCV
Chronic hepatitis morphology
mononuclear portal infiltration
hepB ground glass hepatocytes
hepC lymphoid aggregates and bile duct injury
Type 1 autoimmune hepatitis
middle aged/ old
ANA and anti smooth muscle actin ABs
plasma cells as infiltrate
Type 2 autoimmune hepatitis
kids/ teenagers
anti liver kidney microsome 1 antibodies
plasma cells as infiltrate
Hepatic cancer associations
hepatocellular adenoma - OCC and anabolic steroids
HCC - ETOH
angiosarcoma - vinyl chloride
Stages alcoholic liver disease
- steatosis (reversible) fatty change and perivenular fibrosis
- hepatitis (reversible) hepatocyte swelling, mallory bodies, neutropilic infiltrate
- fibrosis and cirrhosis (non reversible) extensive fibrsosis with hyperplastic nodules
NAFLD
> 5% hepatocytes invlved
less mallory bodies and more mononuclear cells tan ETOH
80% isolated fatty liver, 20% NASH which is progressive
Unconjugated bilirubin
insoluble in water
highly albumin bound
unbound crosses BBB and icteric sclera
increased unbound in haaemolytic disease or when drugs displace
Causes unconjugated bilirubinaemia
neonatal jaundice
criggler najar
gillbert syndrome
Biliary atresia
conjugated
fetal/ perinatal (more common)
obstruction biliary tree viral/ autoimmune
hepatic or common bile duct
Primary biliary cirrhosis
autoimmune cholangiopathy
destruction small medium bile ducts
female in 50s
assoc sjorgens
95% AMA
dx bx
Primary sclering cholangitis
autoimmune cholangiopathy
intra and extrahepatic bile ducts with dilation and preserved segments
male 30s
assoc IBD
65% ANCA
radiology strictures and beading large bile ducts
Gallstone types
cholesterol - most common, radiolucent unless contain calcium carbonate
pigment - insoluble calcium salts and unconjugated bilirubin
brown infected and radiolucent
black sterile and radioopaque
Morphology chronic cholecystitis
suserosal fibrosis
outpouchings epithelium
porxelein gallbladder
hydrops gallbladder end stage
Cirrhosis collagen
TI and III normally in portal tracts and around veins - deosited in lobules, neovascularisation
TIV in space of disse
Pathogenesis acute pancreatitis
pancreatic duct obstruction
primary acinar cell injury
defective intrracellular release proenzymes
Main cause acute panreatitis
80% alcohol and gallstones
Hereditory pancreatitis
assoc 25% of pacreatitis
40% risk cancer
CFTR
SPINK1
Blood tests pancreatitis (timing)
amylase in 24h
lipase in 72-96h
decreased Ca2+
10% glycosuria
Cause and mortality chronic pancreatitis
Mainly alcohol
TGFbeta and PDGF fibrogenic factors
25y mortality 50%
Autoimmune pancreatitis
IgG4 secreting plasma cells in pancreas
responsive to steroid therapy
similar symptoms to cancer
Chronic hepatitis
Symptoms/biochemical/serological evidence for > 6m
Hepatitis carrier
Harbours and can transmit
No symptoms
Virus causing ischaemic gut
CMV
