GI problems - liver

Question 1

what does it indicate when only GGT is high, alone

Answer 1

• usually indicates steatosis

i. e. fat deposits in liver

Question 2

what does it indicate when GGT and ALP are high

Answer 2

• cholestasis e.g. biliary tree obstruction

Question 3

what does it indicate when AST & ALT are high

Answer 3

hepatitis

Question 4

steatosis causes

Answer 4

• alcohol
• non-alcoholic fatty liver disease
  
  • metabolic syndrome e.g. diabetes, dyslipidemia, hypertension

Question 5

causes of hepatocellular damage (hepatitis)

Answer 5

• viral hepatitis
• alcoholic hepatitis
• non-alcoholic hepatitis
• autoimmune hepatitis
• ischemic hepatitis
• drugs/herbal/natural supplements

Question 6

viral hepatitis A

• transmission
• risk factors
• acute/chronic

Answer 6

transmission = fecal-oral

RF = travel

acute

Question 7

signs of liver disease

Answer 7

• jaundice
• palmar erythema
• spider naevi

Question 8

what does low albumin suggest

Answer 8

chronic / cirrhosis

Question 9

what does prolonged PT suggest

Answer 9

acute liver failure

Question 10

what does hypoglycaemia suggest

Answer 10

severe acute failure

Question 11

what condition is low platelets often seen in

Answer 11

portal hypertension (hypersplenism)

Question 12

describe alcoholic liver disease

Answer 12

• mix of steatosis & hepatitis
• hepatitis usually related to sudden or large volume exposure
• abstinence gives liver chance to recover
• chronic or repeated exposure -> cirrhosis

Question 13

non-alcoholic fatty liver disease (NAFLD)

Answer 13

• similar pattern to alcoholic liver disease

- causative agent = metabolic syndrome (diabetes, dyslipidaemia, hypertension)

Question 14

viral hepatitis B

• transmission
• risk factors
• acute/chronic

Answer 14

• blood

RF

• injecting drug use
• sexual transmission
• contaminated blood products

acute = only in adults
chronic = only in neonate/child

Question 15

viral hepatitis c

• transmission
• risk factors
• acute/chronic

Answer 15

blood

injecting drug use

acute/chronic

Question 16

phases of chronic hep B

Answer 16

1. immunotolerant
   
   • no immune response -normal LFTs
2. immune clearance
   
   • important to have regular blood tests to identify periods of immune activation & liver damage, treat w/ antiviral drugs
3. body controls virus
   
   • no inflammation & virus suppressed
4. immune escape & reactivation

Question 17

phases of chronic hep B

Answer 17

1. immunotolerant
   
   • no inflammation or damage to liver
2. immune clearance
   
   • inflammatory response possibility of liver damage
3. body controls virus
   
   • no inflammation, virus suppressed, no liver damage
4. immune escape & reactivation
   
   • can reactive, inflammation, liver damage

Question 18

describe hepatic encephalopathy, its symptoms and treatment

Answer 18

inability to metabolise NH3 by liver -> enters brain

• early = slight confusion, attention deficit, disturbed sleep
  
  • severe = drowsiness, speech disturbance, personality changes

treated by lactulose

Question 19

Acute vs chronic Hep B

Answer 19

acute

• adults
• HBcAB IgM present

chronic

• neonatal/child
• perinatal/vertical or horizontal
• requires tx
• no core antigen present

Question 20

describe haemochromatosis

Answer 20

• hereditary autosomal recessive
• elevated ferritin and high iron saturation
• blood test: homozygous for C282Y
• mutation HFE gene

Question 21

AST > 2x ALT

Answer 21

usually suggests alcoholic hepatitis

Question 22

AST and ALT in thousands

Answer 22

• viral
• ischemia
• paracetamol

Question 23

what is portal hypertension a sign of

Answer 23

cirrhosis

Question 24

favoured diagnostic test for cirrhosis

Answer 24

• fibroscan (stiffness of liver)

Question 25

treatment of portal hypertension

Answer 25

- low salt diet to reduce fluid retention - start on diuretics to treat ascites - protein supplements to improve nutrition and albumin - advised to stop alcohol

Question 26

describe spontaneous bacterial peritonitis

Answer 26

complication from cirrhosis (chronic liver disease) and ascites spontaneous infection in peritoneal cavity

Question 27

modes of transmission between acute and chronic

Answer 27

acute (adults) - sexual - parenteral e.g. IV chronic (neonate/children) - perinatal - horizontal e.g. child to child

Question 28

importance of HB core Ab IgM

Answer 28

if positive with HBsAg then it's a recent infection (not in positive in chronic)

Question 29

how do you classify the severity of cirrhosis

Answer 29

child pugh score (from A-C) uses: - bilirubin - albumin - PR - degree of ascites - degree of encephalopathy

Question 30

complications of cirrhosis

Answer 30

portal hypertension - ascites (-> SBP) - variceal hemorrhage liver insufficiency - encephalopathy - jaundice

Question 31

complication of portal hypertension

Answer 31

- oesophageal varies - hemorrhoids - hypersplenism - ascites - caput medusae