Jaundice, HSM, Ascites, Autoimmune Hepatology Flashcards
(54 cards)
What are causes of hepatomegaly
3 C’s and 3 I’s
C - cirrhosis (early)
C - cancer (craggy)
C - congestion (portal hypertension 2 to RHF or cirrhosis)
I - infection (HBV HCV / CMV / EBV / malaria)
I - immune - (hepatitis / PSC / PBC)
I - infiltration with amyloid / sarcoid / haem malignancy / haemochromatosis
What should you do if abnormal LFT and what is 1st line imaging / other imaging [4]
Liver screen
USS = 1st line to show duct dilatation / mets
MRCP - MRI
ERCP if removing i.e. cholangitis / pancreatitis
What is in a liver screen [8]
Hep B,C,E EBV, CMV, HIV Auto-immune / Ab / Ig Serum copper - for Wilson disease Ferritin and transferrin - Haemochromatosis A1-anti-trypsin Glucose Lipids
How do you investigate hepatomegaly [6]
LFT’s
If abnormal = liver screen
FBC - liver disease cause BM suppression / MCV alcohol
U+E - hepatorenal syndrome / malnourishment
CLotting / albumin
CRP
Imaging
What is 1st line imaging
USS to show mets / stone / cirrhosis
What is hepatorenal syndrome
Liver disease affects kidney
High mortality
What are causes of splenomegaly [7]
Infection - Lyme’s, meningitis, sepsis, Glandular fever, TB
DIC
Malignancy - lyphhoma / leukaemia / myeloma
Sjogren / SLE / RA / vasculitis/ Sarcoid
Portal hypertension
IE, Rheumatic fever
Amyloid
What are causes of massive splenomegaly [4]
Malaria
CML
Myelofibrosis
Leishmaniasis
What is important in history of splenomegaly [7]
Fever - infection / TB / malignancy / sarcoid
Lymphadenopathy - glandular / malignancy
Ascites - portal / malignancy
Arthritis / vasculitis/ RA / sjogre / SLE / lyme
Weight loss - malignancy / TB
Purpura - meningitis / DIC /sepsis
Murmur - IE / rheumatic
What can cause abdominal distension 5 F’s
Flatus Fat Fluid Faeces Fetus
What are differential of ascites? [6]
Malignancy Infection - TB Decreased albumin CCF Pancreatitis / cancer Portal hypertension - cirrhosis / IVC / portal vein thrombosis
How do you investigate differentials for ascites [7]
FBC + film U+E, LFT, CRP Ca tumour marker - Ca19-19 (pancreas) TB USS CT, MRI
What are RF for jaundice [7]
BBV - Blood transfusion, IVDA, Piercing / tattoo, STI, Foreign travel
Alcohol
FH
Drugs
What causes mass in RIF [8]
Appendicitis Caecal cancer Crohn's disease Intussception TB Kidney malformation / transplant Undescended testis
What can obstructive jaundice be further classified into [2]
Calcular
Malignant
Calcular causes of obstructive jaundice features [4]
F>M
Biliary colic
No weight loss
Fluctuates
Malignant causes of obstructive jaundice features [4]
M>F
Painless
Weight loss
Progressive
Ascitic fluid investigations, biochemistry [7]
Tap: MC&S and AFB, cytology, albumin, LDH, glucose, protein
Ascitic fluid investigations: SAAG
What does it mean if SAAG >1.1g/dL and what does it mean if <1.1 [4]
Serum ascites albumin gradient (SAAG): serum albumin – ascites albumin
o SAAG >1.1g/dL: portal HTN (transudates)
o SAAG <1.1g/dL: other causes (peritoneal or visceral neoplasia, inflammation (pancreatitis), nephrotic syndrome, TB peritonitis) (exudates)
Management of ascites [4]
daily weights (aim for <0.5kg/d) & restrict Na intake fluid restriction (<1.5L/d) therapeutic paracentesis (with 100mL 20% albumin per L drained to reduce post paracentesis circulatory dysfunction) TIPSS transjugular intrahepatic portosystemic shunt
Spontaneous bacterial peritonitis
Ax [4]
Symptoms [3]
Ix [2]
Ax: ascites becomes infected with E. coli, Klebsiella or strep
Sy/Si: ascites, abdo pain, fever
Ix: paracentesis (neutrophil count >250 cells/uL and MC&S tends to show E. coli)
Spontaneous bacterial peritonitis
Mx
Cx
Prevention
Mx: IV CEFOTAXIME
Cx: hepatorenal syndrome 30%
Pre: prophylactic CIPROFLOXACIN if ascites and protein <15g/L
What is PBC
Chronic autoimmune granulomatous attack on bile duct INSIDE liver
Leads to cholestasis
Cirrhosis / portal hypertension
What causes PBC
Autoimmune
Genetic
Environment
M rule
- Middle age
- IgM
- Anti mitochondrial Ab
