GI problems 3 Flashcards
Symptoms of liver disease
- Jaundice - yellow eyes, skin
- palmar erythema
- spider navei
- ascities
- itchy skin
- clubbed fingers
What is elevated when there is hepatocellular pattern of liver disease
AST, ALT and billirubin
- also have low albumin
- normally test pr
Acute vs chronic pattern
- albumin low if chronic
- prothrombin - if acute
GGT alone elevated
GGT and ALP
AST ALT
- statosis - fat in liver cells
- cholestasis - obstrucive
- hepatitis, hepatocellular injury
Steatosis
fatty liver disease
- alcohol or non-alcohol
- non-aclohol - metabolic syndrome - diabetes, dyslipidaemia, hypertension increase BMI
Causes of Hepatitis
- Viral
- alcoholic
- non-alcoholic
- autoimmune
- ischaemic
- haemochromatosis
- drugs
What does it mena if have GGT and AST and ALT elevated?
- mixed
- both steatosis and hepatocellular injury
Non- alcoholic fatty liver disease
- can be caused by metabolic syndorme - high lipids, obesity, insulin resistance,diabetes
- get steatosis, and then get hepatitis lead to cirhosis
Causes of hepatitis (viral)
Hep A - fecal-oral (injestion of food or water) (aute)
Hep B, C - Blood or body fluids (drug use, sexual transmission)
Hep D - can only have this if have B
Hep E - fecal - oral (acute)
B, C, D - only ones that can be chronic
can also get EBV, CMV that can cause this
Autoimmune hepatitis
ischaemic
- due to immune reaction
- ischemci - due to cardiogenci, severe dehydration and blood loss - get redcue oxygen to liver
Haemochromatosis
Drugs
- inherited - autosomal ressevie
- increase iron absorpiton
- iron saturaiton and ferritin will be very high
Drugs - paracetamol overdose
-antidoe - N-acetylcysteinie
Liver tumours
-only really in people with risk factors for hepatocellular carcinoma
What are main causes for AST and ALT elevation
- viral
- ischaemia
- paracetamol
- can be if the ast and alt are in the thousands
If AST >2x ALT - alcoholic hepatitis
What tests do we do?
liver function tests blood tests -ultra sound - to look for gallstones, and also for bile ducts and steatosis -then do hepatitis test -iron studies -liver autoantibodies
igM and igG
igM increases in acute infaciton
igG increases if you have had previous exposure
what would we see with alcoholic hepatitis
- alcohol hisotyr
- ast/alt reverseal >2:1
- low albumin with clinical signs of chronic liver disease
- advised complete abstience
- lose weight
- long-term control of diabetes and dyslipidaemia
what can low platelet count mean?
-signof hypersplenism - protal hypertensio
what signs would we see in acute hepatitis B
- flu like ilness, vomiting, anorexia, tirdness
- high ALT, AST, ALP, GGT, bilirubin
- albumin low, prothrombin - high
- (3 differntials - viral, paracetamol, ischaemia)
Hep A - negative - never been exposed
Hep B - Surface antigen (HBsAg) - indicates current infection - positive
- surface antibodies are negative
- core antibodies (Hv core Ab igM) - positive
- igM - acute infection - suggest acute hep B
heo C negative
Hep B - acute and chornic
acute and chronci differnet
- perinatal - mtoehr tochild
- can also get tranmission - through childhood - blood/body fluid contact - nedemic
Sexual
Acute hep B vs chronic
-acute - adult transmistion - iv drug use, contaminated blood, sexual - can clear the infection
Chronci hep B - neonate or childhood transmission
-perinatal/vertical and horizontal - undeveolped immune sysetm
Vaccination
- Is person currently infectied - yest -surface antigen positiev (HbsAg)
- Acute vs chronic - acute - igM present
- Cleared infection- surface antigen negative , surface antibodies will be positive and igG postiive
vaccination - only anti-HBs
chronic hep B
- go through many different phases of infection
- varying periods of damage - no symptosm so need blood test to give treamtnet
complications of cirrhosis
- get portal hypertension - can lead to cirhosis, varaceal haemorrhage
- can also get liver insuficiency, and this can lead to encephalopathy and jaundice
why do you get ascites
- get cirrhosis
- get icnrease resistance to portal flow
- leads to portal hypertension
- increase hydrostatic pressure, decrease albumin
- also due to splanchnic vasodialtion, activation of adh, renin sodium and water retnesion
- leadin to ascities
hepatic encephalopathy
- get gut - makign ammonia, then get it sent to the liver, however with diseased liver youc annot metabolise it, then get portosystemic shunt, and this causes liver not to metabolsie it and get toxins affect the brain
- can give lactulose - to reduce hte absorpiton of ammonia- can increase excresion out gut
What can cause portal hypertension
- can get it with right sided heart failure
- portal vien thrombosis
- budd-chiari syndorme - clot in hepatic viens - increases pressure
