12 Feb 24 Flashcards
Acute cellular transplant rejection
CF
🥸Happens within first 3 Mo after transplant
🥸Pts own immune system targets liver allograft
🥸AS pts to fever, malaise , lathargy
🥸Elevated LFTs
Liver biopsy findings of Acute cellular rejection
🥰Mixed Inflammatory infiltration of portal tracts involving eosinophils , neutrophils , lymphocyes.
🥰Interlobular bile duct destruction (nonsuppurative cholangitis)
🥰Endothelitis (lymphocytic subendothelial invasion of portal and hepatic veins) -Most reliable sign if ACR
Ttt of ACR
Increased immunosuppresion by high dose corticosteroids (to reverse)
Repeat transplant for refractory cases
Side effect of mycophenolate
Cytopenias
GIT adverse effects ( pain vomiting diarrhea)
Side effects of tacrolimus
Acute renal injury
Haptic adenoma RF
Young female on prolonged estrogen based OCPs
Pregnancy
Hepatic adenoma CF
🤡incidental finding often A/S
🤡solitary solid lesion on right liver lobe
Rupture;
🤡 sudden episodic RUQ pain
🤡 free abdominal fluid (blood)
🤡 signs of hemorrhagic shock
Hypotension tachycardia
Low grade fever
Mild leukocytosis
Peritoneal irritation from blood in abd cavity
Episodic RUQ pain with biliary obstruction labs
Ttt of hepatic adenoma
A/S or. < 5cm. Stop OCP
symptomatic or > 5cm. Surgical resection
Hepatic adenoma Complications
Malignant transformation (10%)
rupture and hemorrhagic shock
Hepatic adenoma imaging
Solitary solid lesion in Rt liver lobe
Multiple lesions occasionally occur
Ttt of ruptured hepatic adenoma
Circulatory support
Emergency surgery
Reye syndrome pathophys
🐑Aspirin use by child in viral infections
(Varicella , influenza)
🐏Microvesicular fat deposits in liver
🐏Cerebral edema
🦭imapired fatty acid metabolism due to mitrochondrial dysfunction leads to hepaticdysfunction causing ammonia accumulation and resultant astrocyte edema
Reye syndrome CF
🦍acute liver failure
Hepatomegaly without jaundice
🦍Rapidly prog encephalopathy
Vomiting , lethargy , seizure , coma
Scenario clues:
🐟Vomiting and confusion after recovery from viral illness
🐬Initial SS of raised ICP (vomiting lethargy) progress rapidly to seizures and coma and death.
Reye Syndrome Labs
Elevated AST , ALT and Ammonia
Elevated PT , Aptt , INR
Normal bilirubin or mild inc
Dec Glucose (from impaired liver synthesis)
Metabolic acidosis
Ttt of reye syndrome
Suppotive
Toxicmetabolic encephalopathy
Acute cerebral dysfunction/mental status changes in the absence of primary CNS pathology
Types of toxic metabolic encepahlopathy
Hypoxic ischemic encephalopathy;
Near drowning event
Choking
Reye syndrome
Aspirin for viral illness
Liver failure :
Viral / autoimmune hepatitis
Medicines (acetaminophen)
DKA :
Poorly controlled DM
Hyponatremia :
SIADH
Rapidly correction of hypernatremia
Aspirin Is C.I in children except in????
Kawasaki dx
Juvenile idiopathic arthritis
Surveillance for Cirrhosis pts
6 Monthly Abdominal USG
New Onset Ascites in pts with Cirrhosis
Causes
HCC (mostly AS hence we do screening USG). Or
Thrombus obstructing portal or hepatic veins.
Liver laceration trauma sites
RUQ
Right flank
Rt lower rib cage
Pt with BAT without peritonitis ….
Do FAST scan.
If posiive
Immediate laporotomy
If negative
CT scan abd pelvis
Which abd organs do not give peritoneal free fluids on BAT
Spleen , duodenum(contained bleed)
Pancreas (retroperitoneal)
Causes of severe neonatal Indirect hyperbilirubinemia
🦑Perinatal factors :
Prematurity
Exclusive BF
🦑Cephalhematoma
🦑Jaundice at age <24hrs
🦑ABO incompatibility
🦑Hereditary spherocytosis
🦑Sibling who received phototherapy
🦑East Asian ethnicity
