GI problems - liver Flashcards
what does it indicate when only GGT is high, alone
- usually indicates steatosis
i. e. fat deposits in liver
what does it indicate when GGT and ALP are high
- cholestasis e.g. biliary tree obstruction
what does it indicate when AST & ALT are high
hepatitis
steatosis causes
- alcohol
- non-alcoholic fatty liver disease
- metabolic syndrome e.g. diabetes, dyslipidemia, hypertension
causes of hepatocellular damage (hepatitis)
- viral hepatitis
- alcoholic hepatitis
- non-alcoholic hepatitis
- autoimmune hepatitis
- ischemic hepatitis
- drugs/herbal/natural supplements
viral hepatitis A
- transmission
- risk factors
- acute/chronic
transmission = fecal-oral
RF = travel
acute
signs of liver disease
- jaundice
- palmar erythema
- spider naevi
what does low albumin suggest
chronic / cirrhosis
what does prolonged PT suggest
acute liver failure
what does hypoglycaemia suggest
severe acute failure
what condition is low platelets often seen in
portal hypertension (hypersplenism)
describe alcoholic liver disease
- mix of steatosis & hepatitis
- hepatitis usually related to sudden or large volume exposure
- abstinence gives liver chance to recover
- chronic or repeated exposure -> cirrhosis
non-alcoholic fatty liver disease (NAFLD)
- similar pattern to alcoholic liver disease
- causative agent = metabolic syndrome (diabetes, dyslipidaemia, hypertension)
viral hepatitis B
- transmission
- risk factors
- acute/chronic
- blood
RF
- injecting drug use
- sexual transmission
- contaminated blood products
acute = only in adults chronic = only in neonate/child
viral hepatitis c
- transmission
- risk factors
- acute/chronic
blood
injecting drug use
acute/chronic
phases of chronic hep B
- immunotolerant
- no immune response -normal LFTs
- immune clearance
- important to have regular blood tests to identify periods of immune activation & liver damage, treat w/ antiviral drugs
- body controls virus
- no inflammation & virus suppressed
- immune escape & reactivation
phases of chronic hep B
- immunotolerant
- no inflammation or damage to liver
- immune clearance
- inflammatory response possibility of liver damage
- body controls virus
- no inflammation, virus suppressed, no liver damage
- immune escape & reactivation
- can reactive, inflammation, liver damage
describe hepatic encephalopathy, its symptoms and treatment
inability to metabolise NH3 by liver -> enters brain
- early = slight confusion, attention deficit, disturbed sleep
- severe = drowsiness, speech disturbance, personality changes
treated by lactulose
Acute vs chronic Hep B
acute
- adults
- HBcAB IgM present
chronic
- neonatal/child
- perinatal/vertical or horizontal
- requires tx
- no core antigen present
describe haemochromatosis
- hereditary autosomal recessive
- elevated ferritin and high iron saturation
- blood test: homozygous for C282Y
- mutation HFE gene
AST > 2x ALT
usually suggests alcoholic hepatitis
AST and ALT in thousands
- viral
- ischemia
- paracetamol
what is portal hypertension a sign of
cirrhosis
favoured diagnostic test for cirrhosis
- fibroscan (stiffness of liver)
treatment of portal hypertension
- low salt diet to reduce fluid retention
- start on diuretics to treat ascites
- protein supplements to improve nutrition and albumin
- advised to stop alcohol
describe spontaneous bacterial peritonitis
complication from cirrhosis (chronic liver disease) and ascites
spontaneous infection in peritoneal cavity
modes of transmission between acute and chronic
acute (adults)
- sexual
- parenteral e.g. IV
chronic (neonate/children)
- perinatal
- horizontal e.g. child to child
importance of HB core Ab IgM
if positive with HBsAg then it’s a recent infection (not in positive in chronic)
how do you classify the severity of cirrhosis
child pugh score (from A-C)
uses:
- bilirubin
- albumin
- PR
- degree of ascites
- degree of encephalopathy
complications of cirrhosis
portal hypertension
- ascites (-> SBP)
- variceal hemorrhage
liver insufficiency
- encephalopathy
- jaundice
complication of portal hypertension
- oesophageal varies
- hemorrhoids
- hypersplenism
- ascites
- caput medusae
