GI problems 3

Question 1

Symptoms of liver disease

Answer 1

• Jaundice - yellow eyes, skin
• palmar erythema
• spider navei
• ascities
• itchy skin
• clubbed fingers

Question 2

What is elevated when there is hepatocellular pattern of liver disease

Answer 2

AST, ALT and billirubin

• also have low albumin
• normally test pr

Question 3

Acute vs chronic pattern

Answer 3

• albumin low if chronic

- prothrombin - if acute

Question 4

GGT alone elevated

GGT and ALP

AST ALT

Answer 4

• statosis - fat in liver cells
• cholestasis - obstrucive
• hepatitis, hepatocellular injury

Question 5

Steatosis

Answer 5

fatty liver disease

• alcohol or non-alcohol
• non-aclohol - metabolic syndrome - diabetes, dyslipidaemia, hypertension increase BMI

Question 6

Causes of Hepatitis

Answer 6

• Viral
• alcoholic
• non-alcoholic
• autoimmune
• ischaemic
• haemochromatosis
• drugs

Question 7

What does it mena if have GGT and AST and ALT elevated?

Answer 7

• mixed

- both steatosis and hepatocellular injury

Question 8

Non- alcoholic fatty liver disease

Answer 8

• can be caused by metabolic syndorme - high lipids, obesity, insulin resistance,diabetes
• get steatosis, and then get hepatitis lead to cirhosis

Question 9

Causes of hepatitis (viral)

Answer 9

Hep A - fecal-oral (injestion of food or water) (aute)
Hep B, C - Blood or body fluids (drug use, sexual transmission)
Hep D - can only have this if have B
Hep E - fecal - oral (acute)

B, C, D - only ones that can be chronic

can also get EBV, CMV that can cause this

Question 10

Autoimmune hepatitis

ischaemic

Answer 10

• due to immune reaction

- ischemci - due to cardiogenci, severe dehydration and blood loss - get redcue oxygen to liver

Question 11

Haemochromatosis

Drugs

Answer 11

• inherited - autosomal ressevie
• increase iron absorpiton
• iron saturaiton and ferritin will be very high

Drugs - paracetamol overdose
-antidoe - N-acetylcysteinie

Question 12

Liver tumours

Answer 12

-only really in people with risk factors for hepatocellular carcinoma

Question 13

What are main causes for AST and ALT elevation

Answer 13

• viral
• ischaemia
• paracetamol
• can be if the ast and alt are in the thousands

If AST >2x ALT - alcoholic hepatitis

Question 14

What tests do we do?

Answer 14

liver function tests
blood tests 
-ultra sound - to look for gallstones, and also for bile ducts and steatosis
-then do hepatitis test
-iron studies
-liver autoantibodies

Question 15

igM and igG

Answer 15

igM increases in acute infaciton

igG increases if you have had previous exposure

Question 16

what would we see with alcoholic hepatitis

Answer 16

• alcohol hisotyr
• ast/alt reverseal >2:1
• low albumin with clinical signs of chronic liver disease
• advised complete abstience
• lose weight
• long-term control of diabetes and dyslipidaemia

Question 17

what can low platelet count mean?

Answer 17

-signof hypersplenism - protal hypertensio

Question 18

what signs would we see in acute hepatitis B

Answer 18

• flu like ilness, vomiting, anorexia, tirdness
• high ALT, AST, ALP, GGT, bilirubin
• albumin low, prothrombin - high
• (3 differntials - viral, paracetamol, ischaemia)

Hep A - negative - never been exposed

Hep B - Surface antigen (HBsAg) - indicates current infection - positive

• surface antibodies are negative
• core antibodies (Hv core Ab igM) - positive
• igM - acute infection - suggest acute hep B

heo C negative

Question 19

Hep B - acute and chornic

Answer 19

acute and chronci differnet

• perinatal - mtoehr tochild
• can also get tranmission - through childhood - blood/body fluid contact - nedemic

Sexual

Question 20

Acute hep B vs chronic

Answer 20

-acute - adult transmistion - iv drug use, contaminated blood, sexual - can clear the infection

Chronci hep B - neonate or childhood transmission
-perinatal/vertical and horizontal - undeveolped immune sysetm

Question 21

Vaccination

Answer 21

1. Is person currently infectied - yest -surface antigen positiev (HbsAg)
2. Acute vs chronic - acute - igM present
3. Cleared infection- surface antigen negative , surface antibodies will be positive and igG postiive

vaccination - only anti-HBs

Question 22

chronic hep B

Answer 22

• go through many different phases of infection

- varying periods of damage - no symptosm so need blood test to give treamtnet

Question 23

complications of cirrhosis

Answer 23

• get portal hypertension - can lead to cirhosis, varaceal haemorrhage
• can also get liver insuficiency, and this can lead to encephalopathy and jaundice

Question 24

why do you get ascites

Answer 24

• get cirrhosis
• get icnrease resistance to portal flow
• leads to portal hypertension
• increase hydrostatic pressure, decrease albumin
• also due to splanchnic vasodialtion, activation of adh, renin sodium and water retnesion
• leadin to ascities

Question 25

hepatic encephalopathy

Answer 25

- get gut - makign ammonia, then get it sent to the liver, however with diseased liver youc annot metabolise it, then get portosystemic shunt, and this causes liver not to metabolsie it and get toxins affect the brain - can give lactulose - to reduce hte absorpiton of ammonia- can increase excresion out gut

Question 26

What can cause portal hypertension

Answer 26

- can get it with right sided heart failure - portal vien thrombosis - budd-chiari syndorme - clot in hepatic viens - increases pressure