Liver symptoms and viral hep Flashcards
(40 cards)
Causes of pre-hepatic jaundice
Haemolytic anaemia
Ineffective erythropoiesis
Causes of hepatic jaundice
Unconjugated -CCF -Hypothyroidism -Gilbert's, Crigler-Najjar Conjugated -Excretion: Dubin johnson, rotor's -Vasc - Budd chiari -Hepatic conditions (HH, Wilson, alpha1, hep A/B/C, CMV, EBV, toxins, HCC)
Causes of post hepatic jaundice
Stones Ca pancreas Drugs PBC/PSC Biliary atresia, Caroli's disease
Drug causes prehepatic jaundice and hepatitis
Antimalarials
Hepatitis: paracetamol OD, valproate, statins, MOAIs
Drug causes of cholestasis
Penicillin, fluco, co-amox, erythro
Sulfonylurea
OCP
Chlorpromazine, prochlorperazine
Gilbert inheritance
Autosomal recessive
Liver biopsy shows pigment granules
Dubin-Johnson syndrome
Histology without pigmentation + recessive inheritance
Rotor syndrome
Ix finding in pre-hepatic jaundice:
urine, LFTs, other
Urine - raised urobilinogen, no bilirubin in urine
LFTs - raised LDH, AST
Other - Coombs, Hb electrophoresis
Ix in hepatic jaundice:
Urine, LFTs
Urine - raised urobilinogen, bilirubin in urine
LFTs
- AST : ALT (both raised, ratio >2 =EtOH)
-reduced liver funtion
Ix post hepatic jaundice:
Urine, LFTs, other
Urine - raised bilirubin, no urobilinogen LFTs - raised AST, ALT, very raised ALP + GGT Pale stools (low stercobilin due to low urobilinogen)
Signs of liver failure
Jaundice Oedema + ascites Bruising/coagulopathy Encephalopathy (asterixis, constructional apraxia) Fetor hepaticus Signs of cirrhosis
Complications of liver failure and their treatment
Bleeding - Vit k, platelets, FFP, blood
Sepsis - tazocin
Ascites (caused 2nd hypperaldosteronism) - Fluid+salt restrict, diuretic
Hypoglycaemia
Encephalopathy - lactulose + rifaximin (SBP from e.coli)
Seizures, cerebral oedema
Hepatotoxic drugs
Paracetamol, salicylate
Methotrexate
Isonizid, tetracycline
Paracetamol Kings college criteria
pH less than 7.3 24h after ingestion
- PT over 100s
- Cr>300
- Grade 3 or 4 encephalopathy
Non-paracetamol Kings college criteria
PT>100s or 3/5 of:
- Drug induced
- Age less than 10 or over 40
- > 1wk from jaundice to encephalopathy
- PT>50s
- Bilirubin >300
Complications of cirrhosis
Decompensation –> hepatic failure
SBP
Portal HTN
HCC risk
Diagnose spontaneous bacterial pneumonitis
Asitic tap has neutrophil count >250
Classification of cirrhosis
Child-Pugh A/B/C
BAPAE - Bilirubin, albumin, PT, ascites, encephalopathy
over 8 - risk of variceal bleed
Rx liver failure
Good nutrition, stop alcohol, treat cause
Portosystemic anastomoses location due to portal HTN
Oesophageal varices
Caput medusae
Haemorrhoids
Encephalopathy classification
1 - Confused
2 - Drowsy: asterixis
3 - Supor: incoherent
4 - Coma: extensor plantars, unrousable
Ix and Rx encephalopathy
Ix - Raised NH4 plasma
Rx - correct precipitants, avoid sedatives, lactulose
Secondary hyperaldosteronism in ascites due to
Impaired aldosterone breakdown
Low albumin –> reduced plasma oncotic pressure
