13 Feb 24 Flashcards
CF of alcoholic hepatitis
😵💫Jaundice , anorexia , fever
😵💫RUQ and epigastric pain
😵💫Abd distension due to ascites
😵💫Prox muscle weakness from muscle wasting if malnourished
😵💫Possible hepatic encephalopathy
Labs of alcoholic hepatitis
😵💫Elevated AST , ALT usually <300
😵💫AST/ALT >-2
😵💫Elevated GGT , bilirubin , INR
😵💫Leukocytosis , predominantly neutrophils
😵💫Decreased albumin if malnourished
Abd imaging may show fatty liver.
How to alcohol history can cause alcohol hepatitus
Heavy use > 7 drinks /day
Idiosyncratic hepatic cell injury causes
Isoniazid
Chlopromazine
Antiretroviral therapy
Impact of various drugs on liver
Cholestasis. Anabolic steroids
Fatty liver. Valproic acid
Hepatitis. Isoniazid
Toxic/fulminant. Acetaminophen
liver
Granulomatous changes. Allopurinol
Isoniazid induced liver injury Identify
Jaundice
Tender hepatomegaly
Elevated LFTs. (500s)
Panlobular mononuclear infiltration
Hepatic cell necrosis
GIT manifestations of sarcoidosis
Hepatospleenomegaly
Asymptomatic LFT abnormalities
Mild ALP elevations
Extrapulmonary sarcoidosis CF
Multisystem inflammatory granulomatous dx
Patchy infliltratiin by non caseating granulomas
CF :
AS
Hepatispleenomegaly
LFT elevations
Mix cholestatic and hepatocellular abnormalities
Hilar LAD
Hypercalcemia
DX of liver sarcoidosis
Liver , LYmph node biopsy
(Of most accessible lesion)
Whatis Lofgren syndrome
L. Lymph nOdes in hilum
F. Fever
GR miGRratory arthritis
E
N. Erythema nodosum
Autoimmune hepatitis CF
🤐A/S :
Identified by abnormal LFTs
🤐Symptomatic:
Fatigue , anorexia , nausea , jaundice
Can progress to fulminant Liver failure / cirrhosis
🤐 often associated with other autoimmune disorder (vitiligo, autoimmune thyroiditis , celiac dx )
Autoimmune hepatitis Labs
🥴Hepaticellular pattern (inc AST ALT)
20X the upper limit of normal
🥴Hypergammaglobulinemia
🥴elevated gamma gap >4g/dl
🥴Elevated autoantibodies
Anti sm ms
Anti liver /kidney microsomal type 1
Antinuclear (non specific)
Histology of autoimmune hepatitis
Portal and periportal lymphoplasmacytic inflitration
Ttt of autoimmune hepatitis
Prednisone +- azathioprine
Diagnostic requirements for Acute liver failure
⏳Severe Liver injury ( ALT , AST > 1000U/L)
⏳Signs of hepatic encephalopathy
(Confusion, asterixis)
⏳Synthetic liver dysfunction INR >- 1.5
👼🏼No underlying liver dx or cirrhosis should be present.
👼🏼Hepatic enceph differentiates ALF from acute hepatitis
Mechanism of liver failure due to acetaminophen
Overproduction of N-Acetyl-p-benzoquinone imine NAPQI which leads to hepatic necrosis
NAPQI is normally safely detoxified through glucoronidation in liver
But this pathway is overwhelmed in overdose.
Chronic alcohol use potentiates acetaminophen hepatotoxicity by depleting glutathione levels and impairs glucuronidation.
Antidote N acetylcysteine increases glutathione levels.
Labs of acetaminophen toxicity
Inc LFTs. (>1000)
Inc INR >1.5
Bilirubin is elevated (not as elevated as other causes of liver failure)
ElevatedRFTs
Most common causes of Acute liver failure
Drug toxicity
Acute viral hepatitis ( A B )
Worsening ALF due to acetaminophen
Features and indications of transplant
Rising serum Bilirubin
Rising PT >100s
Acute renal insuff Cr > 3.4
Grade 3 hepatic enceph (marked confusion and incoherence)
Cerebral edema (may lead to coma)
Signs of hyperestrogenism in CLd
Spider angiomata
Gynecomastia
Loss of sexual hair
Testicular atrophy
Palmar erythema
Cirrhosis and hyperestrinism
👶🏾Impaired hepatic metabolism of circulating estrogens
👶🏾Ciculating estrogens affect vascular dilation.
👶🏾Spider angiomata is central dilated arteriole surrounded by smaller radiating vessels
👶🏾 palmar erythema is also result of increased normal speckling of palm due to increased vasodilation esp at thenar /hypothenar eminences.
Hereditary hemochromatosis CF
Hyperpigmentation
Arthropathy
Hepatomegaly , cirrhosis , HCC
Diabetes Mellitus
Hypopituitarism , sec hypogonadism
Cardiomyopathy
Herediatry hemochromatosis Dx
Elevated Liver transaminases
Elevated Serum ferritin , transferrin saturation
HFE genetic mutations
Ttt:
Phelobotomy (urgent if ferritin > 1000ng/mL) without waiting for genetic test results.
HH labs
AR
Elevated LFTs
Elevated ferrtin
Elevated transferrin saturation
Serum iron /TIBC X 100
HFE genetic mutations
