Hepatology Flashcards
What should you importantly exclude if a patient is jaundice?
Obstructive jaundice- IE is there a stone in the CBD, do they need an ERCP? or is there a tumour at the head of the pancreas that needs whippling. (stent etc) So ask about dark urine, pale stools.
What tests will give away a pre-hepatic jaundice?
FBC- is there a heamolytic anaemia?? Dip the urine also. DO haptoglobin (it binds free haem and would be decreased in a haemolytic picture)
What test do you do to differentiate between an immune haemolytic picture and a non-immune?
Do a coombs test, are they antibodies surrounding the RBCs?
Infective causes of hepatitis?
Heps, EBV, CMV, leptospirosis
Auto-immune cause of hepatitis?
Primary biliary cirrhosis
What blood picture would you see in PBC?
Isolated alk phos, and anti-mitochondrial antibodies.
In what condition do you have anti-smooth muscle antibodies?
Autoimmune hepatitis.
Which metabolic liver condition may mimic parkinsons?
Wilsons- build up of copper in basal ganglia.
Name 3 conditions haemachromatosis can cause?
Bronze diabetes, cardiomyopathy and liver cirrhosis.
When would you see an acute dramatic rise in AST?
In paracetamol overdose
Why does liver failure cause a hyponatraemia?
Nitrates are retained when the liver is damaged, causing vasodilation (splanchnic), primarily affecting the kidney mimicking pre-renal hypoperfusion. So the kidneys activate ACE and aldosterone (secondary hyperaldosteronism), salt is retained, you become adematous (ascites) and there is a relative hyper volaemic hyponatraemia. This is hepato-renal syndrome.
How do you acquire leptospirosis? (infective form of liver failure)
Rat urine, so people who work in abattoirs, sewage workers, farmers etc.
Tx for PBC?
Ursodeoxycholic acid is used to treat PBC
