GI clinical Flashcards
What are causes of pre-hepatic jaundice?
Haemolysis
- Haemolytic anaemia
- Blood transfusions
- Haemolytic drugs
What type of billirubin is not reabsorbed in the terminal illeum?
Conjugated bilirubin (soluble)
What are causes of hepatic jaundice?
- Hepatitis
- Cirrhosis
- Hepatic carcinoma
- Gilbert’s syndrome
What are causes of post-hepatic jaundice
Extrahepatic causes - Calculous cholecystitis - Carcinoma of head of pancreas - Pancreatic oedema - Acalculous cholecystitis Intrahepatic causes - Swelling / fibrosis from cirrhosis
What is corvoirier’s sign?
Palpable gall bladder that is painless - sign of malignancy
What lab tests should be done when a patient has jaundice?
- FBC
- LFTs
- Bilirubin fractionation
What kind of jaundice is indicated when indirect bilirubin is increased and ALP and AST are normal?
Pre hepatic cause of jaundice (haemolysis)
What are possible causes of GI clubbing?
- Malabsorption (coeliac)
- Inflammatory bowel disease
- Lymphoma
- Cirrhosis
What is asterixis?
- Coarse flapping tremor
- Occurs with hepatic encephalopathy
What can cause koilonychia?
Hypochromic anemia, especially iron-deficiency anemia
What can cause hepatomegaly?
- Hepatitis
- Alcoholic liver disease
- Right heart failure
- Fatty infiltration
- Biliary tract obstruction
- Malignancy (metastatic/primary)
- Haematological disorders
What is Murphy’s sign indicative of?
- Gall bladder tenderness
- Acute cholecystitis
Courvoisier’s sign
- Painless jaundice and a palpable gallbladder
- Likely due to extrahepatic obstruction
- Could be due to pancreatic cancer and unlikely due to gallstones
What are the causes of splenomegaly?
- Haematological - haemolytic anaemia / leukaemias / polycythaemia ruba vera / lymphoma / myeloproliferative disease / myelofibrosis
- Infective (endocarditis, schisto, TB, malaria)
- Portal hypertension
- Rheumatological disorders - Rheumatoid arthritis / SLE (lupus)
- Rarer - sarcoidosis / amyloidosis / glycogen storagge disease
What are some of the causes of renal enlargement?
- Hydronephrosis (urine build-up)
- Polycystic kidney disease
- Renal cell carcinoma
- Neproblastoma (WIlm’s tumour) (children)
- Solitary cysts
What are some causes of ascites?
- Hepatic cirrhosis
- Intra-abdominal malignancy
- Nephrotic syndrome
- Cardiac failure
- Pancreatitis
- Constrictive pericarditis
What pathologies should you look for in male reproductive examination?
- Infection (epididymitis, orchitis, epididmyo-orchitis)
- Torsion
- Epididymal cysts
- Testicular tumours
- Indirect inguinal hernia
What enzyme has increased levels only in acue liver injury?
AST and ALT
What protein is decreased in patients who have had chronic liver disease or liver injury in the past?
Albumin
Which liver enzyme is found in not just the liver but may be found in the heart, muscle, idney and RBCs?
AST (ALT found predominantly just in the liver)
What other pathologies (other than hepatocellular and biliary) may cause increased AST levels?
- Rhabdomyolysis
- Acute MI
- Haemolysis
What is an AST level which is double that of ALT suggestive of?
Alcohol as the cause of liver disease.
- If ALT is greater than AST the liver disease is most likely not caused by alcohol
What does an AST:ALT ratio above 5 indicate?
Extrahepatic cause e.g:
- Rhabdomyolysis
- Acute MI
What is HELLP syndrome?
Complication of pregnancy
- Haemolysis (elevated LDH)
- Elevated liver enzymes (AST and ALT)
- Low platelets
