GI and Liver Flashcards
What type of injury can the liver recover from?
Acute injuries are usually recovrable
Wat can cause acute liver injury?
Viral (A,B,EBV) drugs alcohol vascular ubstruciton or congestion.
What can cause chronic liver failure?
alcohol Viral (B, C) autoimmune metabolic (iron, copper)
What are symptoms of acute liver injury?
Malaise nausea, anorexia, jaundice rarely confusion bleeding liver pain and hypoglycaemia
What are the presentation of chronic liver failure?
Ascites oedema, haematemesis (varicies, malaise, anorexia, wasting, easy bruising, itching hepatomegaly, abnormal LFTs rarely jaundice and confusion
What tests can gage liver function?
Serum bilirubin albumin prothrombin time as liver is involved in those pathways.
Serum liver enzymes like cholestatic alkaline phosphatase and gamma-GT hepatocellular transaminases give no index of liver function
What causes jaundice/
raised serum bilirubin
What are the types of jaundice?
Unconjugated prehepatic, from gilberts syndrome or haemolysis
Conjugated from cholestatic liver disease or bile obstruction so called post hepatic
What can be tested in liver tests?
Stools urine, itching and liver tests
What would be seen in urine stools LFT for prehepatic?
Normal urine normal stools and no itching and normal LFT
What wpuld be seen in urine stools LFT for hepatic or post hepatice?
Dark urine pale stools may itch and abnormal LFTs
What can cause liver disease?
Hepatitis (Viral, Drug, Immune, Alcohol) Ischaemia, Neoplasm congestion
What can cause obstruction of the bile duct?
Gallstones bile duct or Mirizzi, stricutre malignant or ischaemic inflammatory
What should you ask a patient with jaundice/
Dark urine pale stools itching? symptoms biliary pain rigors abdomen swelling weight loss, billlary disease intervention history, heart failure blod products autoimmune diseases and malignancy
drugs socual including sex IV drugs alcohol family history
What to test in pt with jaundice?
LFTs, Ultrasound for bile ducts, may need CT MR choliangiogram or endoscopic retrograde cholangiogram
What are gall stones made of?
70% choesterol 30% pigment+/- calcium,
What are risk factors for gall stones?
Femail fat fertile
What are symptoms of gallbladder gallstones?
Billary pain cholecystitis, myabe have obstructive jaundice no cholangitis or pancreatitis
What is the presentation of gall stones in the bile duct?
billary pain no cholcystitis, no obstructive jaundice no cholangitis and no pancreatitis
How can gall stonesbe managed/
Laproscopic cholecystectomy, bile acid disolution therapy, if in bile ducts ERCP with sphincterotomy and removal crushing or stent placemt or surgery
What the types of drug induced liver injury?
Hepatoceular where ALT is v high and ALT/ALK hos high
or cholestatic were it is ALK phosphatase> 2
When can drug induced liver injury happen/
Within 3 months of starting can happen after stopped, resolution within 3 months of stopping
What are the usual suspects for drug induced lier injury?
antibiotics, CNS drugs immunosupressants analgesics GI drugs suppliments
What is management of paracetamol induced fulminant hepatic falure?
N acetyl Cystine, Supportive to correct coagulationd defects fluid electrolytes and acid base balance renal failurem hypoglacaemia and encephalopathy