What are some causes of cirrhosis?
- alcohol
- hepatitis B, C, D
- NAFLD
- Haemochromatosis
- PSC, PBC
- Wilson’s
- drugs: MTX, amiodarone
What are the investigations in cirrhosis? (For monitoring and etiology?)
Bloods: LFT, albumin, FBC, creat, coags Imaging: U/S, CT abdo, fibroscan Hepatitis serology Anti-mitochondrial Ab: PBC ANA, smooth muscle Ab, Anti-LKM1 pANCA: PSC in assoc with UC Iron studies Caeruloplasmin Alpha-1 AT CMV Ascitic tap Liver biopsy
What are the components of Childs-Pugh classification?
Bili, albumin, ascites, encephalopathy, nutrition
Treatment for hepatitis C?
Genotype 1a/b: sufosbovir + daclatasvir 2: sufosbovir + ribavarin 3: sufosbovir + daclatasvir 4,5,6: sufosbovir + PEG-IFN + ribavarin
12 weeks of treatment naive
12-24 if treatment experienced, cirrhosis
What are the criteria for listing for liver transplant?
End stage CLD with decompensation:
- Childs > 6 (I.e B or C)
- variceal bleeding
- SBP
- encephalopathy
- MELD >10 (INR, Bili, creat)
What are the CI to liver transplant?
- hepatorenal syndrome
- coagulopathy
- metastatic malignancy
- sepsis
- cholangiocarcinoma
- HIV
- hepatopulmonary syndrome
What are the causes of Hepatomegaly?
- mets
- alcoholic liver disease
- haem: CML
- fatty liver disease
- RHF
- haemochromatosis
- amyloidosis
What are some causes of splenomegaly?
- CML, leukemia
- portal HTN
- RA, SLE
- infiltrative: sarcoidosis, amyloidosis
- myoproliferative disorders: essential thrombocythemia, polycythemia
What are causes of hepatosplenomegaly?
- chronic liver disease with portal HTN
- haem: myeloproliferative disease, lymphoma, leukaemia
- infective: acute hepatitis, EBV, CMV
- infiltrative: sarcoidosis, amyloidosis
- SLE
What are clinical features of hemochromatosis?
- cirrhosis
- bronze pigmentation
- arthropathy of 2nd, 3rd MCP
- dilated cardiomyopathy
- glycosuria (“bronze diabetes”)
What are the peripheral signs if chronic liver disease?
- clubbing
- leuconychia
- palmar erythema
- dupuytren contracture
- jaundice, scleralicterus
- spider naevi
- gynecomastia
What are signs of decompensated chronic liver disease?
- hepatic flap
- encephalopathy
- variceal bleeding
- ascites
How to distinguish a spleen from kidney?
- no palpable upper border of spleen
- spleen moves inferomedially on inspiration
- spleen not ballotable
- splenic notch
- dull to percussion over splenic mass
What are the differences between UC and CD?
UC: - colon only - mucosal inflammation - usually acute onset CD: - anywhere in GI tract - transmural inflammation - usually indolent onset
What are extra colonic features of ulcerative colitis?
- arthritis
- ankylosing spondylitis
- uveitis
- oral ulcers
- anaemia
- liver: PSC
- bowel cancer
- skin: erythema nodosum, pyoderma gangrenosum
What are the causes of cirrhosis?
- Alcohol
- Viral hepatitis
- NASH
- Drugs: MTX, Isoniazid
- Autoimmune hepatitis
- Haemochromatosis and Wilson’s
- PSC
- PBC
What is approach to management of chronic liver disease/cirrhosis?
Hepatocellular failure: - diet - ascites: diuretics, low salt diet, paracentesis - encephalopathy: treat infection, give lactulose Portal HTN: - band varices, propanolol - TIPS procedure Transplant
What are findings on colonoscopy in CD vs UC?
CD: cobblestone appearance, skip lesions
UC: continuous, crypt abscesses
What investigations for inflammatory bowel disease?
- bloods: FBC, ESR/CRP, pANCA, nutritional, LFT
- stool culture
- AXR, CT
- Colonoscopy
How would you manage CD?
GENERAL: - stop smoking LOW RISK DISEASE: - colonic disease: 5ASA - SB disease: oral budesonide - if refractory, add AZA HIGH RISK DISEASE: - steroid+AZA or MTX - if no response, add infliximab - if no response to infliximab, add adalimumab SURGERY: - indicated if: fistula with abscess, intestinal obstruction
How would you manage UC?
- PO or PR 5ASA
- PO or PR Steroid
- severe: cyclosporin
- Maintenance: AZA, 6MP
- surgery is curative: though liver, ank spond, pyoderma still happen
What are indications for colectomy in UC?
- severe disease not responding within 7-10 days
- perforation, bleeding
- high risk of carcinoma(high grade dysplasia)
How to monitor for CRC recurrence?
- CEA q3-6m
- CT C/A/P yearly
- colonoscopy every 3 years
What is you differential for jaundice?
Pre hepatic: hemolytic anemia
Hepatic: hepatitis, CLD
Post hepatic: obstructive jaundice, PBC, gallstones, cholangitis
