HPB IM Flashcards
Clinical presentation of Wilson’s Disease?
Liver disease e.g. hepatosplenomegaly, jaundice, cirrhosis etc etc.
Affects eyes = Kayser-Fleischer rings, sunflower cataracts
Affects CNS.
Characteristic combination is hepatitis/cirrhosis + dementia + parkinsonism
In which type of hepatitis is LDH raised?
In ischemic hepatitis
Liver toxicity from which drug can cause AST and ALT to rise into the thousands?
Paracetamol overdose
Which hepatitis viruses cause acute liver damage?
Hep A
Hep B
Hep E
Which hepatitis viruses cause chronic hepatitis?
Hep B 70%
Hep C 20%
NASH 10%
NCEP ATP 3 definition for Metabolic Syndrome?
Diagnosed if 3 or more criteria met.
1. Waist circumference >40M or >35W (inches)
2. BP 130/85
3. Fasting Triglyceride >1.7mmol/L
4. Fasting HDL <1.03M or <1.29W
5. Fasting glucose >6.1mmol/L
Why is Octreotide (Somatostatin) used for variceal bleeding?
It reduces bloodflow to portal system without major ADRs.
How does UBGIT affect urea levels?
Urea levels rise significantly out of proportion to creatinine in UBGIT
Difference between Primary Biliary Cholangitis vs PSC?
PBC is progressive destruction of intralobular BD.
PSC is progressive chronic inflammation of both intra and extrahepatic BD.
Normal liver size?
13cm for men
10cm for women
If ever had Hep B, which antibody will be positive?
What about for vaxxed pt?
Past infection = Anti-HbC +ve
Vaxxed = anti-HbsAg
In infection, Anti-HBc IgM is first Ab produced
Criteria for Metabolic-associated fatty liver disease?
Detection of steatosis via liver histo/biomarkers/imaging
AND 1/3 of obesity, T2DM, evidence of metabolic dysfunction e.g. increased wasit circumference, abnormal lipid/glycaemic profile
Prevalence of Hep B in SG?
3-5%
If Hep B positive, how often to screen for Hep B?
every 6 months - 1 year.
AFP/LFT + cross-sectional imaging (US)
Risk of perforation and bleeding in OGD and colonoscopy?
Perforation =0.01% for OGD
0.3% for colonoscopy
Risk of bleeding 2% in colono
Alternatives for colonoscopy?
- CT Colonography
- Barium enema (phased out)
When to stop iron tablets, blood thinners and hypoglycaemics before colonoscopy?
Iron tablets 5 days before
Blood thinners 3-7d before depending on drug. E.g. stop epixaban 3d before
Diabetic meds stop on the morning of scope
hypoglycaemics dangerous cuz risk of hypoglycemia while under sedation
Causes of splenomegaly?
Increased degradation of defective RBCs - hemolytic anemia (thalassemia, spherocytosis, early sickle cell disease), polycythemia vera
Infection (immune response)
Portal HTN (liver cirrhosis or venous obstruction)
Hodgkin lymphoma/leukemia/mets
RA/SLE/Vasculitis/Connective tissue disease
Causes of transaminitis?
EBV, CMV
Genetic: Haemochromatosis, Wilson’s, a-1-antitrypsin deficiency
Hemolysis, bone, muscle
Congestive hepatopathy
Viral hepatitis
NASH
ALD
FLD
ERCP
Ascites + Cirrhosis + Variceal bleeding etc. raises risk of?
Spontaneous bacterial peritonitis.
Test with SAAG.
where is ALT found?
Liver
Bone
Placenta
Where is AST found?
Liver
Blood
Lungs
Brain
Kidneys
Muscles
What is Budd Chiari syndrome?
Rare thromboembolic disorder of hepatic veins/IVC causing obstruction of hepatic vein outflow, hence post-sinusoidal portal HTN
What happens to VLDL, LDL, IDL and CRL in nephrotic syndrome?
They rise due to impaired clearance
Commonest pathogen for liver abscess?
Klebsiella commonest in SG