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RBF > GI problems - liver > Flashcards

GI problems - liver Flashcards

1
Q

what does it indicate when only GGT is high, alone

A
  • usually indicates steatosis

i. e. fat deposits in liver

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2
Q

what does it indicate when GGT and ALP are high

A
  • cholestasis e.g. biliary tree obstruction
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3
Q

what does it indicate when AST & ALT are high

A

hepatitis

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4
Q

steatosis causes

A
  • alcohol
  • non-alcoholic fatty liver disease
    • metabolic syndrome e.g. diabetes, dyslipidemia, hypertension
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5
Q

causes of hepatocellular damage (hepatitis)

A
  • viral hepatitis
  • alcoholic hepatitis
  • non-alcoholic hepatitis
  • autoimmune hepatitis
  • ischemic hepatitis
  • drugs/herbal/natural supplements
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6
Q

viral hepatitis A

  • transmission
  • risk factors
  • acute/chronic
A

transmission = fecal-oral

RF = travel

acute

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7
Q

signs of liver disease

A
  • jaundice
  • palmar erythema
  • spider naevi
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8
Q

what does low albumin suggest

A

chronic / cirrhosis

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9
Q

what does prolonged PT suggest

A

acute liver failure

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10
Q

what does hypoglycaemia suggest

A

severe acute failure

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11
Q

what condition is low platelets often seen in

A

portal hypertension (hypersplenism)

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12
Q

describe alcoholic liver disease

A
  • mix of steatosis & hepatitis
  • hepatitis usually related to sudden or large volume exposure
  • abstinence gives liver chance to recover
  • chronic or repeated exposure -> cirrhosis
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13
Q

non-alcoholic fatty liver disease (NAFLD)

A
  • similar pattern to alcoholic liver disease

- causative agent = metabolic syndrome (diabetes, dyslipidaemia, hypertension)

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14
Q

viral hepatitis B

  • transmission
  • risk factors
  • acute/chronic
A
  • blood

RF

  • injecting drug use
  • sexual transmission
  • contaminated blood products
acute = only in adults
chronic = only in neonate/child
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15
Q

viral hepatitis c

  • transmission
  • risk factors
  • acute/chronic
A

blood

injecting drug use

acute/chronic

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16
Q

phases of chronic hep B

A
  1. immunotolerant
    • no immune response -normal LFTs
  2. immune clearance
    • important to have regular blood tests to identify periods of immune activation & liver damage, treat w/ antiviral drugs
  3. body controls virus
    • no inflammation & virus suppressed
  4. immune escape & reactivation
17
Q

phases of chronic hep B

A
  1. immunotolerant
    • no inflammation or damage to liver
  2. immune clearance
    • inflammatory response possibility of liver damage
  3. body controls virus
    • no inflammation, virus suppressed, no liver damage
  4. immune escape & reactivation
    • can reactive, inflammation, liver damage
18
Q

describe hepatic encephalopathy, its symptoms and treatment

A

inability to metabolise NH3 by liver -> enters brain

  • early = slight confusion, attention deficit, disturbed sleep
    • severe = drowsiness, speech disturbance, personality changes

treated by lactulose

19
Q

Acute vs chronic Hep B

A

acute

  • adults
  • HBcAB IgM present

chronic

  • neonatal/child
  • perinatal/vertical or horizontal
  • requires tx
  • no core antigen present
20
Q

describe haemochromatosis

A
  • hereditary autosomal recessive
  • elevated ferritin and high iron saturation
  • blood test: homozygous for C282Y
  • mutation HFE gene
21
Q

AST > 2x ALT

A

usually suggests alcoholic hepatitis

22
Q

AST and ALT in thousands

A
  • viral
  • ischemia
  • paracetamol
23
Q

what is portal hypertension a sign of

A

cirrhosis

24
Q

favoured diagnostic test for cirrhosis

A
  • fibroscan (stiffness of liver)
25
Q

treatment of portal hypertension

A
  • low salt diet to reduce fluid retention
  • start on diuretics to treat ascites
  • protein supplements to improve nutrition and albumin
  • advised to stop alcohol
26
Q

describe spontaneous bacterial peritonitis

A

complication from cirrhosis (chronic liver disease) and ascites

spontaneous infection in peritoneal cavity

27
Q

modes of transmission between acute and chronic

A

acute (adults)

  • sexual
  • parenteral e.g. IV

chronic (neonate/children)

  • perinatal
  • horizontal e.g. child to child
28
Q

importance of HB core Ab IgM

A

if positive with HBsAg then it’s a recent infection (not in positive in chronic)

29
Q

how do you classify the severity of cirrhosis

A

child pugh score (from A-C)

uses:

  • bilirubin
  • albumin
  • PR
  • degree of ascites
  • degree of encephalopathy
30
Q

complications of cirrhosis

A

portal hypertension

  • ascites (-> SBP)
  • variceal hemorrhage

liver insufficiency

  • encephalopathy
  • jaundice
31
Q

complication of portal hypertension

A
  • oesophageal varies
  • hemorrhoids
  • hypersplenism
  • ascites
  • caput medusae

RBF (35 decks)

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