Teaching clinic: 2 cases of cirrhosis HCV Flashcards
Cause of black formed stool
Bismuth: forms bismuth sulphate which is black
Fe supplement
Tarry stool location
Upper GI to proximal colon
Haematemesis is from where?
Large volume blood loss above duodenal jejunal junction (ligament of treitz): esophageal varices
Cause of cirrhosis in HK
HBV > HCV (found in 1989) > alcoholic liver disease > NASH
* Cryptogenic cirrhosis (mostly HBV but lost surface antigen)
* autoimmune hepatitis
* PBC
* Wilsons disease (young <30)
* Haemochromatosis (in thal patients without transfusion: iron will still be elevated but not to haemochromatosis level)
* Cardiac cirrhosis
- Pancytopenia due to hypersplenism
- Hyperuricemia: GI bleeding and reabsorption of blood due to increase in protein
- Subacute liver conditions: albumin may be low (25 days of half life)
Causes of high globulin in cirrhosis
- Portosystemic shunting
- Reduced antigen degradation by cirrhotic liver
- Cirrhotic liver will produce antigens. Antigenemia: increased plasma cells (produce globulin)
Reversed de titis ratio 2 causes?
alcoholic hepatitis: megamitochondriac
liver malignancy (primary/secondary): large enough to cause secondary necrosis of liver
ALT in cytosol, AST in mitochondrial
ALT is liver specific
Cause of increased AST
- Skeletal muscle
- Myocardial muscle: MI
- Hemolysis
Cause of elevated ALP
SOL such as Liver abscess
Cholestasis
polycystic liver: LFT normal
What enzyme inducers can cause increase in GGT?
- Rifampicin
- Antiepileptic drugs
Why is PT good for assessing liver function?
Relies on F5 and F7 which have short half life
Gardners line
- RLQ
- Umbilicus
- Left anterior axillary line
What is the chance of becoming a chronic hep B and C carrier in an adult?
Hep B: 0-2%
Hep C: 50-85%
Which genotype of HCV most important?
Pangenotyopic agents. most important is genotype 1
HK 25% is genotype 6
Hep C transmission
Reason for high chronicity in hep C
Will become chronic carrier
* Rapid mutation esp in envelop protein –> quasispecies in the host simultaneously (suppress one quaispecies others rise up)
* Immune pressure on dominant stain: coexistent strain emerges to escape immune attack
Clinical course of hep C
- Immune attack: neutralizing ab develop but are time limited and highly strain specific. Cell mediated responses cause liver damage.
- The disease: viremia peaks at pre or early acute phase
- Chronic hepatitis: fluctuating AST and ALT. Cirrhosis and HCC in 20-50 years