GI - Liver Disease Flashcards
A 32 year old woman returns from a holiday in India. She started getting diarrhoea after eating at a seafood restaurant on the last night. She is feverish, nauseous and is sore all over. The whites of her eyes are yellow.
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Hepatitis A
India Diarrhoea Seafood restaurant Feverish, nauseous Sore all over Yellow
Viral Hepatitis General Presentation
3 main signs and symptoms, apply to ALL hepatitits:
Fever
Jaundice
Raised ALT and AST
Hepatitis A and E
Faeco-oral hepatitis.
“The Vowels hit your Bowels”
Hep A:
Asymptomatic (usually)
Acute
(may be nausea and vomiting)
Hep E:
Enteric
Epidemics (water)
Expectant mothers
–> Management:
Supportive
Avoid alcohol
A 29 y/o male comes to the GP with fever, fatigue, joint pain and urticaria-like skin rash. He had unprotected anal sex a month ago. He comes back a week later for a blood test, which shows raised ALT and AST.
Now, he complains of feeling sick, RUQ pain and looks a bit yellow.
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Hepatitis B
Fever Fatigue Joint pain Urticaria like skin rash Anal sex ALT and AST Feeling sick RUQ pain Yellow
Hepatitis B summary
Initial infection - prodrome:
Flu-like symptoms (fever, myalgia, malaise)
Rash
Lymphadenopathy
--> Acute infection: Nausea Anorexia RUQ pain Jaundice
Outcome of infection:
90% Completely recover
10% Develop chronic infection
Hepatitis B Management
Acute: Symptom supportive
Chronic: Consider Peginterferon Alpha or Tonfovir
A 67 year old man is investigated under the two-week wait for jaundice, tender hepatomegaly, ascites and anorexia. His blood tests show a raised aFP. He mentions that he was diagnosed with hepatitis years ago. What virus(es) are likely?
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Hep B and C
Two week wait Jaundice Tender hepatomegaly Ascites Anorexia aFP
Hepatitis and Hepatocellular carcinoma
Hepatitis is the most common risk factor for developing HCC
Hep B:
The virus integrates into the host chromosome
Acts and an oncogene
Hep C:
Causes chronic inflammation
Mutations accumulate
Alpha-fetoprotein is marker of HCC!
Which hepatitis virus requires another virus to be present for it to successfully infect?
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Hep D
Hepatitis D needs the Hepatitis B surface antigen (HBsAg) to enter hepatocytes
Kayser-Fleischer Rings
Dark rings that appear to encircle the iris of the eye. Due to copper deposition in part of the cornea.
Wilson’s Disease Inheritance, Pathology, Presentation
Inheritance: Autosomal Recessive
Pathology: Copper incorporation into caeruloplasmin in hepatocytes and its excretion into bile is impaired, and so copper is deposited, firstly into liver, then basal ganglia
Presentation: Children with liver failure or young adults with CNS signs such as ataxia, tremor, dysarthria. Kayser-Fleischer Rings are pathogomonic.
A 56-year-old man, diagnosed with emphysema, presents with a one-month history of jaundice and ascites. Your registrar tells you that the man has had breathing problems for the majority of his life.
What is the most likely diagnosis?
Sickle Cell Disease COPD Epstein-Barr Virus Idiopathic Pulmonary Fibrosis Alpha-1 Antitrypsin Deficiency
Alpha-1 Antitrypsin Deficiency
Alpha-1 Antitrypsin Deficiency Inheritance, Pathology, Presentation
Inheritance: Autosomal Recessive
Pathology: A1AT is genetically mutated, leading to it being prevented from release from hepatocytes. This causes a loss of its protective function in the lungs against elastase, leading to emphysema and a build up in the liver leading to destruction and liver disease.
Presentation: Emphysema in a non-smoker from a young age with late onset liver sign and a few risk factors
Liver Failure stages
Healthy liver
Fatty liver
deposits of fat lead to liver enlargement
Liver fibrosis
scar tissue forms
Cirrhosis
growth of connective tissue destroys liver cells
A 63-year-old woman stumbles into A+E. She looks unwell with a flushed face. An F1 mentions that when she presented last week, examination of her upper limbs suggested a sensory polyneuropathy.
Cytomegalovirus Primary Biliary Cirrhosis Paracetomal Overdose Alcoholic Liver Disease Primary Sclerosis Cholangitis
Alcoholic liver disease
Stumbles into AandE
Flushed face
Presented last week
Sensory polyneuropathy
