upper and lower GI (tougher) Flashcards
What antibodies are Primary Biliary Cholangitis associated with?
Anti-mitochondrial
What antibodies are associated with type 1 and type 2 autoimmune hepatitis?
Type 1- Anti-smooth, ANA antibodies
Type 2- anti-liver antibody
What is Hepatic Encepalopathy?
Characterised by excess absorption of ammonia and glutamine, confusion and abnormal behaviour. Due to excessive consumption of alcohol
What is the management and prophylactic treatment for hepatic encephalopathy?
1st line- IV lactulose
Prophyalctic- rifaximin
What is the bilirubin pathway?
-Jaundice is caused by high levels of bilirubin in the blood.
1) Red blood cells are haemolysed forming bilirubin.
2) Bilirubin is then transported to the liver and converts unconjugated bilirubin to conjugated bilirubin.
3) Conjugated bilirubin is more water soluble and can then is excreted by the bile ducts then through the kidneys. If there is disruption in this pathway it causes jaundice.
Is conjugated or unconjugated bilirubin water soluble?
conjugated- water soluble can be excreted
unconjugated- not water soluble
(*the liver conjugates- unconjugated bilirubin > conjugated bilirubin)
What is Pre-Hepatic Jaundice?
pre-hepatic-high levels unconjugated bilirubin, excess RBC haemolysis breakdown excess bilirubin
What is hepatic jaundice?
The liver itself becomes damaged, there is dysfunction of the hepatic cells. Therefore the liver is unable to convert unconjugated bilirubin to conjugated bilirubin.
-high unconjugated bilirubin
What is post hepatic jaundice?
Post-hepatic -high levels conjugated bilirubin, obstruction of the bile ducts
cholangiocarcinoma is assoicated with which type of surgical jaundice?
post hepatic jaundice- causes a post hepatic blockage in the biliary ducts
What are causes of pre-hepatic jaundice?
haemolytic anaemia (coombs test)
gilbert’s syndrome
What are common causes of hepatic jaundice?
hepatic cells dysfunction resulting in not all the bilirubin being conjugated for excretion
conditions damage liver
viral hepatitis- A > E
alcoholic liver disease
autoimmune hepatitis
hepatocellular carcinoma
What are causes of post hepatic jaundice?
bile duct blockage- gallstones
cholangiocarcinoma (formed from primary biliary sclerosis)-sclerosis- time hard
extra-mural mass
shoulder tip pain is associated with
acute cholecystitis
(and ectopic pregnancy)
what is the management of primary sclerosing cholangitis?
Management:
1st line- Ursodeoxycholic acid (Treat the pruritis, due to slow bilirubin movement)
2nd line- ERCP
What is the management of Ascending Cholangitis?
(*also known as acute cholangitis)
1st line- intravenous antibiotics
2nd line (more severe) endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction
What is the pathophysiological process of Viral Hepatitis?
b) what sub-type of liver enzymes are released, and which ones?
hepatitis virus enters blood stream and infects hepatocytes. This results in an immune mediated response.
Transaminases liver enzymes are releases- AST and ALT
-Elevated AST and ALT on LFTs
What is the ONLY DNA (double stranded) virus - for viral hepaitis?
Hepatitis B
(BEE different)
*rest are RNA single stranded viruses
What are only types of Viral Hepatitis you can be vaccinated for?
hepatitis A
hepatitis B
What type of viral hepatitis is transmitted between mother and baby?
hepatitis B (b-baby, beee different - only double stranded DNA virus)
what are the x2 main types of hepatitis transmitted ‘blood’
hepatitis b
hepatitis c
What is the form of transmission for each type of viral hepatitis?
hepatitis A- faecal oral (recent holiday abroad poor sanitation)
hepatitis B- mum- baby, blood borne, sharing needles
hepatitis C- blood borne
Hepatitis D
Hepatitis E- faecal oral route
Elevated AST and ALT (transaminases) are associated with?
viral hepatitis
What type of viral hepatitis are each these viral markers associated with?
antibodies- past takes time to make
antigens- more current and acute
surface- vaccinated surface arm antibody
Viral Markers: Hep B
Surface antigen (HBsAg) – active infection
E antigen (HBeAg) – a marker of viral replication and implies high infectivity
Core antibodies (HBcAb) – implies past or current infection
Surface antibody (HBsAb) – implies vaccination or past or current infection
