more liver Flashcards
What are the symptoms of acute hepatitis?
- Asymptomatic
- General malaise
- Myalgia
- GI upset
- Abdo pain (RUQ)
- Jaundice (pale stools, dark urine)
- Tender hepatomegaly
- Raised AST/ALT, bilirubin may be raised
List 4 infectious, non-viral causes of hepatitis
- spirochetes - leptospirosis
- mycobacteria - TB
- parasites - toxoplasma
- Bacteria - coxiella (Q fever)
List 6 non-infectious causes of hepatitis.
- Alcohol
- NAFLD
- Drugs/toxins
- Autoimmune
- Pregnancy
- Hereditary metabolic
How can chronic decompensated liver disease present?
- Jaundice
- Ascites
- Low albumin
- Coagulopathy
- Encephalopathy
What are the complications of chronic liver disease?
- HCC
2. portal HTN - varices and bleeding
What drugs are given for acute HBV infection?
Nucleotide analogues: Tenofovir and Entecavir
What phases of chronic HBV infection are treated?
- Immune clearance phase
2. Reactivation phase
How is chronic HBV treated?
- Pegylated interferon alpha 2a - 48 weekly injection
2. Nucleotide analogues - lifelong
What is the test for hepatitis D?
Hepatitis D antibody. If positive, test for HDV RNA
What is the treatment for hepatitis D?
Treat with pegylated interferon alpha
What is the test for hepatitis C?
HCV Ab - may be negative if very recent exposure
If positive, look for HCV RNA - indicates current infection
If HCV RNA positive, find HCV genotype (1 and 3 most common in UK)
What are the side effects of ribavarin?
- Haemolytic anaemia
- Dyspnoea
- Insomnia
- Anxiety
- Agitation
- Tiredness
What is the treatment for hepatitis C?
Directly Acting Antivirals (DAA), classes:
- NS5A
- NS5B
- Protease inhibitors
Combination of 2 drug classes
sometimes add ribavarin
How is Hepatitis C prevented?
- Screening blood products
- Universal precautions around handling bodily fluids
- Lifestyle modification - needle exchanges
- Treatment and cure of those who are infected (transmitters)
List 10 causes of cirrhosis.
- Chronic alcohol abuse
- NAFLD
- Hep B +/- D
- Hep C
- Primary biliary cirrhosis
- AI Hepatitis (high ALT)
- Hereditary haemochromatosis
- Wilson’s disease
- Drugs
- Alpha 1 antitrypsin deficiency
What are the 11 symptoms of cirrhosis?
- Leukonychia (due to hypoalbuminaemia)
- Clubbing
- Palmar erythema
- Dupuytren’s contracture
- Spider naevi
- Xanthelasma
- Loss of body hair
- Hepatomegaly
- Bruising
- Ankle swelling and oedema
- Abdominal pain due to ascites
How is cirrhosis diagnosed?
Gold standard = biopsy
LFTs
List 4 complications of liver cirrhosis.
- Coagulopathy (fall in CF 2, 7, 9, 10)
- Encephalopathy (asterixis, confusion, coma)
- Hypoalbuminaemia -> oedema
- Portal HTN
a. ascites
b. oesophageal varices
What is the treatment for cirrhosis?
Prevent further damage by treating cause - e.g. treating viral hepatitis or alcohol abstinence
If advanced, liver transplant may be required.
What are the symptoms of alcoholic hepatitis?
- Malaise
- Jaundice
- Anorexia
- Nausea
- Hepatomegaly
- Bleeding
- Ascites
- Macrocytic anaemia
What would you find on blood test for someone with alcoholic hepatitis?
- High AST and ALT (AST more than ALT)
- Macrocytic anaemia (high MCV)
- Leukocytosis
- Thrombocytopaenia
- High INR
- High urea
What drug would you give for alcohol withdrawal symptoms?
Chlordiazepoxide
How would you treat alcoholic liver disease?
Vitamin B and K and optimise nutrition
When would you give prednisolone for alcoholic liver disease?
If severe or if encephalopathy
What would you give a patient for alcohol cravings or anxiety?
Acamprosate or disulfiram
Define cirrhosis
Irreversible liver damage. Histologically, there is loss of normal hepatic architecture with fibrosis and nodular regeneration
List 4 complications of pancreatitis.
- Shock
- ARDS
- GI bleeding
- Pancreatic pseudocyst
- DM
- Malabsorption - steatorrhoea
What causes GORD?
Dysfunction of the LOS leads to gastro-oesophageal reflux of acid and stomach content.
What are the symptoms of GORD?
- heartburn
- water brash
- acid brash
- odynophagia
- nocturnal asthma
What are the alarm bell signs of GORD?
- dysphagia
- haematemesis
- weight loss
What are the associations for GORD?
- smoking
- alcohol
- obesity
- pregnancy
- hiatus hernia
- big meals
What are the differential diagnoses for GORD?
- CAD
- oesophagitis
- infections - candida
- duodenal ulcer
- non-ulcer dyspepsia
- gastric ulcers/cancers
What are the complications of GORD?
- oesophagitis
- Barrett’s oesophagus
- benign oesophageal stricture
- iron deficiency anaemia
How would you investigate for GORD?
Investigate if symptoms ongoing for >4wks, or alarm bell signs
- endoscopy, using Los Angeles classification
What is Barrett’s oesophagus?
Metaplasia of the distal oesophageal epithelium from squamous to columnar
What is Barrett’s oesophagus a precursor for?
Barrett’s oesophagus is pre-malignant for adenocarcinoma of the oesophagus
What is the treatment of GORD?
- lifestyle changes - lose weight stop smoking, drinking, eat >3hr before bed, raise bed height?
- antacids - magnesium trisilicate
- alginates (gaviscon)
- PPI - lansoprazole
- H2RA - cimetidine
- surgery: nissen fundoplication
What are the symptoms of peptic ulcer disease?
- Epigastric pain
- Bloating
- Belching
- Vomiting
- Weight loss (gastric ulcers)
What are the differential diagnoses for peptic ulcers?
- non-ulcer dyspepsia
- duodenal Crohn’s
What investigations would you do for peptic ulcers?
Non-invasive: - H. Pylori C Urea breath test, serology, faecal antigen test
Invasive: Endoscopy and biopsy
What is the treatment for peptic ulcer disease?
- Lifestyle mod
- H Pylori eradication
- NSAID discontinuation
- H2RA
What are the complications of peptic ulcer disease?
- bleeding
- perforation
- gastric duct obstruction ->N/V
What investigation would you do for bowel obstruction?
Abdominal XR plain film
What antibiotics would you give for appendicitis?
Metronidazole and cefuroxime
What are the differential diagnoses for appendicitis?
- Ectopic pregnancy
- Acute terminal Ilitis due to Crohn’s
- UTI
- Diverticulitis
- Perforated ulcer
- Food poisoning
