TeacherOfMedicine: hepatology

Showing posts with label hepatology. Show all posts

Saturday, 6 July 2019

Cholecystitis

Disease class: Gallbladder diseases

Types

Acalculous cholecystitis
cholecystitis, Acute

Alcoholic pancreatitis

Disease class: Pancreatitis

Tuesday, 2 July 2019

[Hepatology] Introduction

Hepatologists specialise in diseases of the pancreas, liver, gallbladder, and biliary tract.
There is significant overlap with gastroenterology and infectiology.

Etymology

Ancient Greek ἧπᾰρ, ἥπᾰτος (hêpar, hḗpatos) = liver
Ancient Greek λογία (logia) = study

History taking

Physical examination

Digestive system diseases

Common diseases:

Cholelithiasis (gallstones)

Cholecystolithiasis (stones in the gallbladder)
Choledocholithiasis (stones in the common bile duct)

Ascending cholangitis (inflammation of the common bile duct)
Acute cholecystitis (inflammation of the gallbladder)
Chronic liver disease
Liver cirrhosis

Primary Biliary Cholangitis (PBC)
Primary sclerosing cholangitis (PSC)

Hepatitis

Viral
Autoimmune
Alcoholic

Drug overdose
Liver cancer

Other diseases:

Hepatorenal syndrome
Metabolic disorders

Aflatoxin poisoning

[Gastroenterology] Introduction

Gastroenterologists specialise in diseases of the digestive system.

There is significant overlap with infectiology.

Subspecialties

Hepatology or hepatobiliary medicine: subspecialises in the liver, pancreas, gallbladder, and bile ducts
Proctology: concerns the rectum and anus

Etymology

Ancient Greek γαστήρ (gastḗr) = belly
Ancient Greek ἔντερον (énteron) = intestine
Ancient Greek λογία (logia) = study

History taking

Physical examination

Relevant symptoms

Digestive system diseases

Relevant diseases:

Gastroenteritis
Gastrointestinal bleeding
Gallstones
Coeliac disease
Inflammatory bowel disease
Functional abdominal pain

Irritable bowel syndrome

Hepatological disease

Cirrhosis

Esophageal motility disorder

Achalasia

Diverticulosis
Short bowel syndrome

Thursday, 13 June 2019

Alcoholic fatty liver

Disease class: Fatty liver

Kernicterus

Disease class: brain diseases, Metabolic

Kernicterus is a bilirubin-induced brain dysfunction.

Reye syndrome

Disease class: brain diseases, Metabolic

Disease class: Fatty liver

Tuesday, 9 April 2019

Aldosterone antagonists

Also known as

Mineralocorticoid antagonists
MRAs, MRCAs

Key examples

Spironolactone
Eplerenone

Common indications

Ascites and oedema due to liver cirrhosis: spironolactone is the first-line diuretic.
Chronic heart failure: of at least moderate severity or arising within 1 month of a myocardial infarction, usually as an addition to a β-blocker and an ACE inhibitor/angiotensin receptor blocker.
Primary hyperaldosteronism: for patients awaiting surgery or for whom surgery is not an option.

Mechanisms of action

Aldosterone is a mineralocorticoid that is produced in the adrenal cortex. It acts on mineralocorticoid receptors in the distal tubules of the kidney to increase the activity of luminal epithelial sodium channels (ENaC). This increases the reabsorption of sodium and water (which elevates blood pressure) with the by-product of increased potassium excretion.
Aldosterone antagonists inhibit the effect of aldosterone by competitively binding to the aldosterone receptor. This increases sodium and water excretion and potassium retention. Their effect is greatest in primary hyperaldosteronism or when circulating aldosterone is increased, e.g. in cirrhosis.

Important adverse effects

An important adverse effect of aldosterone antagonists is hyperkalaemia, which can lead to muscle weakness, arrhythmias and even cardiac arrest.
Spironolactone causes gynaecomastia, which can have a significant impact on patient adherence.
Aldosterone antagonists can cause liver impairment and jaundice and are a cause of Stevens–Johnson syndrome (a T cell-mediated hypersensitivity reaction) that causes a bullous skin eruption.

Warnings

Aldosterone antagonists are contraindicated in patients with severe renal impairment, hyperkalaemia and Addison’s disease (who are aldosterone deficient).
Aldosterone antagonists can cross the placenta during pregnancy and appear in breast milk so should be avoided where possible in pregnant or lactating women.

Important interactions

The combination of an aldosterone antagonist with other potassium-elevating drugs, including ACE inhibitors and angiotensin receptor blockers, increases the risk of hyperkalaemia.
Nevertheless, when supported by appropriate monitoring, this may be a beneficial combination in the context of heart failure.
Aldosterone antagonists should not be combined with potassium supplements except in specialist practice.