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Gastroenterology > Liver symptoms and viral hep > Flashcards

Liver symptoms and viral hep Flashcards

1
Q

Causes of pre-hepatic jaundice

A

Haemolytic anaemia

Ineffective erythropoiesis

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2
Q

Causes of hepatic jaundice

A 
Unconjugated
-CCF
-Hypothyroidism 
-Gilbert's, Crigler-Najjar
Conjugated 
-Excretion: Dubin johnson, rotor's 
-Vasc - Budd chiari
-Hepatic conditions (HH, Wilson, alpha1, hep A/B/C, CMV, EBV, toxins, HCC)
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3
Q

Causes of post hepatic jaundice

A 
Stones
Ca pancreas 
Drugs 
PBC/PSC
Biliary atresia, Caroli's disease
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4
Q

Drug causes prehepatic jaundice and hepatitis

A

Antimalarials

Hepatitis: paracetamol OD, valproate, statins, MOAIs

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5
Q

Drug causes of cholestasis

A

Penicillin, fluco, co-amox, erythro
Sulfonylurea
OCP
Chlorpromazine, prochlorperazine

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6
Q

Gilbert inheritance

A

Autosomal recessive

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7
Q

Liver biopsy shows pigment granules

A

Dubin-Johnson syndrome

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8
Q

Histology without pigmentation + recessive inheritance

A

Rotor syndrome

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9
Q

Ix finding in pre-hepatic jaundice:

urine, LFTs, other

A

Urine - raised urobilinogen, no bilirubin in urine
LFTs - raised LDH, AST
Other - Coombs, Hb electrophoresis

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10
Q

Ix in hepatic jaundice:

Urine, LFTs

A

Urine - raised urobilinogen, bilirubin in urine
LFTs
- AST : ALT (both raised, ratio >2 =EtOH)
-reduced liver funtion

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11
Q

Ix post hepatic jaundice:

Urine, LFTs, other

A 
Urine - raised bilirubin, no urobilinogen 
LFTs - raised AST, ALT, very raised ALP + GGT
Pale stools (low stercobilin due to low urobilinogen)
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12
Q

Signs of liver failure

A 
Jaundice 
Oedema + ascites 
Bruising/coagulopathy 
Encephalopathy (asterixis, constructional apraxia)
Fetor hepaticus 
Signs of cirrhosis
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13
Q

Complications of liver failure and their treatment

A

Bleeding - Vit k, platelets, FFP, blood
Sepsis - tazocin
Ascites (caused 2nd hypperaldosteronism) - Fluid+salt restrict, diuretic
Hypoglycaemia
Encephalopathy - lactulose + rifaximin (SBP from e.coli)
Seizures, cerebral oedema

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14
Q

Hepatotoxic drugs

A

Paracetamol, salicylate
Methotrexate
Isonizid, tetracycline

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15
Q

Paracetamol Kings college criteria

A

pH less than 7.3 24h after ingestion

  • PT over 100s
  • Cr>300
  • Grade 3 or 4 encephalopathy
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16
Q

Non-paracetamol Kings college criteria

A

PT>100s or 3/5 of:

  • Drug induced
  • Age less than 10 or over 40
  • > 1wk from jaundice to encephalopathy
  • PT>50s
  • Bilirubin >300
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17
Q

Complications of cirrhosis

A

Decompensation –> hepatic failure
SBP
Portal HTN
HCC risk

18
Q

Diagnose spontaneous bacterial pneumonitis

A

Asitic tap has neutrophil count >250

19
Q

Classification of cirrhosis

A

Child-Pugh A/B/C
BAPAE - Bilirubin, albumin, PT, ascites, encephalopathy
over 8 - risk of variceal bleed

20
Q

Rx liver failure

A

Good nutrition, stop alcohol, treat cause

21
Q

Portosystemic anastomoses location due to portal HTN

A

Oesophageal varices
Caput medusae
Haemorrhoids

22
Q

Encephalopathy classification

A

1 - Confused
2 - Drowsy: asterixis
3 - Supor: incoherent
4 - Coma: extensor plantars, unrousable

23
Q

Ix and Rx encephalopathy

A

Ix - Raised NH4 plasma

Rx - correct precipitants, avoid sedatives, lactulose

24
Q

Secondary hyperaldosteronism in ascites due to

A

Impaired aldosterone breakdown

Low albumin –> reduced plasma oncotic pressure

25
Q

Rx ascites

A

Daily weight
Fluid restrict and low sodium diet
spiro + furosemide

26
Q

LFT in alcoholism

A

AST:ALT over 2

Raised GGT

27
Q

Reduce craving for alcohol

A

Acamprosate, baclofen

28
Q

Aversion therapy in alcoholism

A

Disulfiram

29
Q

Most effective screening tool for harmful alcohol drinking and dependence
Action based on score

A

AUDIT
0-7: alcohol education
8-15: simple advice
16-19: simple advice + brief counselling + continued monitoring
20-40: referral to specialist for evaluation and treatment

30
Q

Acute Mx of alcohol withdrawal

A

BZD (chlordiazepoxide/diazepam)

Electrolyte + vitamin replenishment

31
Q

Chronic viral hep causes

A

Hep B/C/D

32
Q

Symptoms of acute HepA infection

A

Flu like prodrome:
Fever, malaise, anorexia
Arthralgia, abdo discomfort

33
Q

Rx and prevention of HepA

A

Supportive
Vaccine
Notifiable disease

34
Q

Hep virus most sexual transmission

A

Hep B

35
Q

HepB transmission through vaginal sex rate

A

40% efficient

36
Q

Chronicity rate/carrier status in HepB and HepC following acute infection

A

HepB - 10%

HepC - 80%

37
Q

Extrahepatic features seen HepB

A 
Urticaria or vascular rash 
Cryoglobulinaemia 
PAN 
GN
Arthritis
38
Q

Rx HepB acute and chronic

Prevent

A

Acute - supportive
Chronic - Peg alpha interferon/nucleoside analogue (tenofovir/lamivudine), control number not cure virus
Vaccination

39
Q

Rate of acute presentation in HepC

A

Rare symptomatic, 20%

40
Q

Rx HepC and prevent

A

No vaccine
Acute - Supportive
Chronic - PEGinterferon + ribavarin, virus can be eradicated

Gastroenterology (7 decks)

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