Medicine

Aspartate Aminotransferase AST found in?

Liver, Heart, Muscle, RBCs, Pancreas, Kidney, Brain

AST high in?

Very high (Liver dmg, Tumour necrosis)

High (chronic liver damage, alcohol abuse, cholestasis, heart dmg, hemolysis, kidney dmg, muscle injury, heat stroke, pulm: embolism, high consumption of vitamin A.

ALT

More specific for liver.

AST:ALT>0.8 Alcohol related liver dmg, NAFLD, HCV

Found in Kidneys, Heart, Muscle

Alkaline Phosphatase (ALP)

Bone, Placenta, Intestine, Biliary tree, Liver

Drugs causing increased GGT

Phenytoin, Barbiturate, Rafimpicin, Alcohol (Ethanol), Griseofluvin, Valporate, Isotretinion, OC pills

Features of chronic liver insufficiency

Wrosening synthetic function

• Prolonged PT

• Reduced Albumin

Jaundice

Ascites

• SBP

• HR$

varices bleeding

Hepatic encephalopathy

Virus causing Hepatitis

CMV

Hepatitis A to E

Herpes Simplex

EBV

Rubella

Yellow Fever

Causes of COL

1. Alcohol

2. Viral (B, C)

3. NAFLD

4. Immune : primary sclerosing cholangitis, autoimmune liver disease

5. Biliary : primary biliary cirrhosis, secondary biliary cirrhosis, custic fibrosis

6. Genetic: Haemochromatosis, Wilson’s disease, alpha 1 antitrypsin def.

7. Cryptogenic

8. Chronic venous flow obstruction

9. Cardiac cirrhosis

10. Any chronic liver disease

CF of portal hypertension

Congestive splenomegaly

Collateral vs

Fetor hepaticus

Ascites

TCP, Leucopenia, Anemia

Causes of portal htn

Prehepatic presinusoidal

Intrahepatic presinusoidal

Sinusoidal

Intrahepatic postsinusoidal

Posthepatic postsinusoidal

Causes of ascites

High SAAG

COL, Cardiac failure

Hepatic vein obstruction

• Budd chiaris $

• Sinusoidal obs: $

Constrictive pericarditis

Low SAAG

Malignant disease

Acute pancreatitis

Lymphafic obsturction

Nephrotic $

Protein losing enteropathy

Severe Malnutrition

Hypothyroidism

Meig$

Child pugh parameters

• Bilirubin

• Albumin

• Prothrombin time

• Ascites

• HE

MELD Na parameters

Serum Creatinine

Serum bilirubin

INR

Sodium

Causes of peptic ulcer

H.pylori, smoking, NSAIDs

Carcinoid $

Vasodilation

Bronchospasm

Diarrhea

Cardiac (TR, PS)

Acute pancreatitis

Gall stone

Ethanol

Trauma

Steriod

Mumps

Autoimmune, Ascaris lumbricoides

Scorpion poison

Hypothermia , Hypercalcemia, Hypertriglycaemia

ERCP

Drugs (zidovudine, thiazide, frusemide, salfasalazine, steriods, azathioprine)

H pylori associated ds

PU

Gastritis

CA stomach

MALToma

Chronic pancreatitis

Toxic metabolites, (alcohol, smoking, Hyper Ca, CRF)

Idiopathic

Genetic (hereditary, cystic fibrosis)

Autoimmune

Recurrent

Obstruction (CA HOP, Sphincter of oddi stenosis)

Causes of esophagitis

GERD

Infective (candida, HSV, CMV)

Chemical (corrosive)

Eosinophilic

Drugs (bisphosphanate, steriods, potassium tablets, CCB, theophylline, nitrates, certain antibiotics like doxycycline, clindamycin)