Gastro important

Question 1

drugs that can cause drug induced liver injury

Answer 1

Paracetamol
Antibiotics (Augmentin, flucloxacillin, erythromycin, septrin, TB drugs)
CNS drugs (Chlorpromazine, Carbamazepine, Valproate, Paroxetine)
Immunosuppressants
Analgesics (Diclofenac)
Gastrointestinal drugs (PPIs)
Dietary supplements

Question 2

Drugs apparently not involved in DILI

Answer 2

NSAIDs other than Diclofenac
Beta blockers
Hormone replacement therapy (HRT)
ACE inhibitors
Thiazides
Calcium channel blockers

Question 3

Paracetamol overdose treatment

Answer 3

N acetyl cysteine

Question 4

Hep A transmission + diagnosis

Answer 4

contaminated food/water

Anti-HAV IgM shows acute infection. Usually full recovery

Question 5

Hep B transmission

Answer 5

mother-child during birth, sexual contact, sharing needles

Question 6

histological findings of liver cirrhosis

Answer 6

regenerative nodules surrounded with fibrotic tissue and collagen

Question 7

causes of liver cirrhosis

Answer 7

• alcohol abuse
• hep B/C
• Haemachromatosis, Wilson’s, Alpha-1-Antitrypsin deficiency
• Budd-chiari
• Primary billiary cholangitis, primary schlerosing cholangitis, autoimmune hep,
• Drugs such as amiodarone, methyldopa, methotrexate

Question 8

liver cirrhosis symptoms

Answer 8

late symptoms incude jaundice, priritus, ascites, confusion (due to hepatic encephalopathy- complication of cirrhosis), easy bruising (reduced clotting factor production)

Question 9

diagnosis of cirrhosis

Answer 9

liver biopsy = confirms
Elevated AST>ALT,
low platelets + low WBC

Question 10

what is Primary biliary cholangitis?

Answer 10

Autoimmune disease where T cells attack the cells lining the bile duct, leading to bile leaking between the cells into the interstitial space and then into blood and other liver cells –> leads to inflammation of the bile ducts and eventually cirrhosis

Question 11

antibodies associated with primary biliary cholangitis

Answer 11

AMA (antimitochondrial antibodies)

Question 12

presentation of primary biliary cholangitis

Answer 12

• patients often asymptomatic and then increased ALP is incidentally found
• Jaundice (bile and conjugated bilirubin leak into blood)
• skin pigmentation
• Xanthelasma
• Xanthoma
• Priritus
  Lethary/sleepiness/pruiritus
• May have joint pain and arthropathy (may be connected to other autoimmune disorders like RA!)

Question 13

investigations for primary billiary cholangitis

Answer 13

• Anti-michondrial antibodies (AMA)

- Increased ALP and GGT

Question 14

treatment for primary billiary cholangitis

Answer 14

• symptomatic: codeine phosphate for diarrhoea, osteoporosis prevention, colestyramine (relives pruritus by binding to cholesterol so it can be excreted more easily)
• fat soluble vitamin prophylaxis (A,D,K)
• monitoring and possible liver transplant

Question 15

alcohol withdrawal treatment

Answer 15

Chlordiazepoxide

Question 16

treatment for alcoholic hepatitis

Answer 16

• stop drinking + treat withdrawal
• corticosteroids
• Vit D and thiamine

Question 17

what is haemochromatosis

Answer 17

inherited disorder where increased intestinal absorption of
iron leads to iron deposition in joints, liver, heart,
pancreas, pituitary glands, adrenals and skin

Question 18

symptoms of haemochromatosis

Answer 18

• “bronze” skin pigmentation
• erectile dysfunction/fatigue/arthralgia (esp of hands) in early disease
• hepatomegaly, cirrhosis
• could have heart failure or hypogonadism as secondary consequences to deposition

Question 19

haemachromatosis diagnosis

Answer 19

• high transferrin saturation (>50%)
• raised ferritin and iron
• low total iron binding capacity (TIBC)
• liver biopsy- PERL’S STAIN diagnostic
• genetic testing shows C282Y and H63D mutations

Question 20

Haemachromatosis treatment

Answer 20

• venesection first line
• deferoxamine second line (binds to free iron in the blood and makes it easier to excrete in urine - decreases iron load in blood)

Question 21

symptoms Wilson’s disease + transporting agent causing the disorder?

Answer 21

• liver disease- hepatitis, cirrhosis etc
• mood/personality changes
• reduced memory/delusions
• KAYSER-FLEISHER RINGS around Iris

disorder of transporting ATPase called ATP7B

Question 22

Treatment of Wilson’s disease

Answer 22

• PENICILLAMINE- copper chelating agent (binds to copper, making it easier to excrete in the urine)
• zinc + ammonium tetrathiomolybdate- reduces copper reabsorption in urine so more copper can be excreted
• liver transplant

Question 23

diseases caused by A1AT deficiency

Answer 23

• emphysema in lung (most common condition in adults)

- cirrhosis and hepatocellular carcinoma in liver

Question 24

investigations for A1AT deficiency

Answer 24

• serum A1AT low
• on biopsy: PAS (periodic acid schiff) positive
• phenotyping

Question 25

treatment of A1AT deficiency

Answer 25

- IV A1AT pooled from human plasma - smoking cessation - liver/lung transplant

Question 26

liver failure presentation

Answer 26

- jaundice - liver flap - fetor hepaticus (breath smells sweet) - constructional apraxia (inability to copy 3D drawings)

Question 27

liver failure causes

Answer 27

- Drugs: paracetamol, halothane, isoniazid - alcohol - viral hep A/B - acute fatty liver of pregnancy

Question 28

liver failure investigations

Answer 28

- raised prothombin time and INR