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1. Clin Med III > 2- Alcoholic liver disease & Liver CA > Flashcards

2- Alcoholic liver disease & Liver CA Flashcards

1
Q

What are the 3 main patterns of injury associated w/ ALD?

A

Fatty liver, alcoholic hepatitis, chronic hepatitis w/ fibrosis or cirrhosis

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2
Q

What classifies a “heavy drinker”?

A

60 g/d x 2 wks

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3
Q

What is the relationship b/w alcohol consumption and risk of liver injury?

A

Dose dependent (not linear)

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4
Q

The following are risk factors for what?

  • Increased alcohol consumption
  • Beer or spirits > wine
  • Drinking outside of meal times
  • > 1 drink/ day in F or > 2 drinks/day in M
  • Pattern of consumption
  • Increased BMI
  • Genetics
  • CLD
  • Smoking
A

RF for ALD

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5
Q

How is binge drinking defined?

A

4 drinks over 2 hrs in F VS 5 drinks over 2 hrs in M

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6
Q

What is classified as “safe drinking”?

A

1 drink/day in F VS 2 drinks/day in M

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7
Q

What disease is a due to an accumulation of fat in cytoplasm of liver cells?

A

Fatty liver (hepatic steatosis)

**Mallory-Denk bodies + neutophilic lobar inflammation

Clinical dx w/ liver biopsy confirmation

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8
Q

How does a pt w/ fatty liver typically present?

A

Asymptomatic and self limited

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9
Q

Is fatty liver disease reversible if a pt stops drinking?

A

Yes

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10
Q

In what time frame can you expect to see reversal of the ALD if Pt stops drinking?

A

4-6 wks

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11
Q

If pt w/ fatty liver disease continues to drink what is the disease progression?

A

Alcohol hepatitis + cirrhosis

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12
Q

What is the tx for pt w/ FLD?

A

Lifestyle mod (weight loss and exercise) and alcohol cessation

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13
Q

What disease is defined as inflammation of the liver characterized by necrosis and fibrotic scaring?

A

Alcohol hepatitis (AH)

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14
Q

What is the biggest RF for AH?

A

Chronic or current heavy alcoholic consumption

(>2 drinks/day for women vs > 3 drinks/day men x 5 yrs)

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15
Q

What will increase a pt w/ AH risk for permanent liver damage?

A

Continued alcohol abuse

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16
Q

AH presents on a spectrum of mild to severe. What might you find on exam for a pt w/ severe AH?

A 
Jaundice
Hepatic encephalopathy
Hepatosplenomegaly w/ liver TTP
Edema (scrotal or LE)
Ascites
Variceal bleeding
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17
Q

What are the lab findings for pt w/ AH?

A

Leukocytosis, macrocytosis, thrombocytopenia,

AST/ALT ≥ 1.5 (AST 2-6 ULN), hyponatremia, hypokalemia, elevated: bili (>3), PT/INR, GTP + low albumin + folate

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18
Q

What will histology show for pt w/ AH?

A

Mallory-Denk Bodies

Neutophillic lobular inflammation

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19
Q

What is probable AH?

A

Clinically dx w/o confounding factors

*confounding factors: Pt denies ETOH abuse, hx of ischemic hepatitis (drug abuse), atypical labs

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20
Q

What is possible AH?

A

Clinically dx w/ confounding factors

*confounding factors: denies ETOH abuse, hx of ischemic hepatitis (drug abuse), atypical labs, hx metabolic liver disease (Wilson’s)

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21
Q

What does the “model for end stage liver disease” (MELD) calculate?

A

Mortality rate in 90 days

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22
Q

What dose Maddrey’s discriminant function (mDF) calculate?

A

MDF ≥ 32 predicts 30-50% mortality @ 28 days

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23
Q

What does the Lille Model calculate?

A

Response to steroids

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24
Q

What is the tx for severe AH (MELD score > 20, mDF ≥ 32)

A
  • Hospitalize
  • 40 mg prednisolone +/- IV n-acetylcysteine (if steroids determined appropriate by Lille model)
  • Stop BB
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25
Q

What is the single MOST important factor for survival in all pts w/ AH and ALD

A

Cessation + complete abstinence of alcohol

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26
Q

What disease is failure of the liver to detoxify noxious agents of gut origin, because of hepatocellular dysfunction and portosystemic shunting resulting in pairment of brain function?

A

Hepatic encephalopathy

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27
Q

What is the best known neurotoxin that can precipitate HE?

A

Ammonia

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28
Q

What are the sx of Grade I HE?

A

Changes in behavior, mild confusion, slurred speech, disordered sleep pattern (encephalopathy)

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29
Q

What are the sx of Grade II HE?

A

Lethargy, moderate confusion

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30
Q

What are the sx of Grade III HE?

A

Marked confusion (stupor), incoherent speech, sleepy but can arouse

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31
Q

What are the sx of Grade IV HE?

A

Coma, unresponsive to pain

32
Q

What is Asterixisis? What disease is it a sx of?

A

Visible tremor when UE in flexion in shoulders in wrists.

Hepatic encephalopathy

33
Q

What is the Stroop test used to evaluated in pts w/ HE?

A

Cognitive screening tool used to evaluated psychomotor speed and cognitive flexibility

34
Q

Variceal bleeding, ascites, and jaundice are sx of what?

A

Severe alcoholic hepatitis (≥ 32 or MELD > 20)

35
Q

What is the tx for AH?

A

TX alcohol withdrawal
Diuretics (lasix, Spironolactone)/ Sodium restricted diet
TX Hepatic encephalopathy: Lactulose, Rifaximin
Steroids if severe

36
Q

What is the next step if pt w/ AH is not responsive to steroid tx by day 7?

A

D/C => Liver transplant

37
Q

What liver pathology is characterized by widespread destruction and regeneration of liver disease w/ marked increased in fibrotic connective tissue?

A

Cirrhosis

38
Q

What is compensated cirrhosis and how does it present?

A

Portal pressure < 10

Splenomegaly

39
Q

What is the median survival for compensated cirrhosis?

A

12 yrs

40
Q

What is decompensated cirrhosis? How does it present?

A 
Increased portal pressure w/ decreased liver function resulting in porto-systemic shunting
Esophageal and rectal varices
Dilated abdominal veins (caput medusae)
Jaundice
Encephalopathy
41
Q

What is the median survival decompensated cirrhosis?

A

2 yrs

42
Q

If compensated cirrhosis is left untx, it will progress to what?

A

Decompensated cirrhosis

43
Q

Portal hypertension is associated with what liver pathology?

A

AH and decompensation cirrhosis

44
Q

What is portal HTN?

A

Increased pressure w/in the portal venous system

45
Q

What are the 3 possible sites of obstruction to flow in the portal venous system?

A
  1. Pre-hepatic: portal vein thrombosis
  2. Intrahepatic: cirrhosis
  3. Post-hepatic: CHF, pericarditis
46
Q

What is the tx for cirrhosis?

A

TX/ prevent complications of portal HTN and cirrhosis

  • Variceal surveillance (EGD)
  • Hepatocellular CA surveillance (US q 6 mos + AFP)
  • BB prophylaxis to prevent variceal bleeding (avoid if SBP < 90)
47
Q

What is the tx for ascites?

A
  • Low NA diet
  • Diuretics (Lasix, Spironolactone)
  • Fluid restriction ONLY if NA M 125
48
Q

What is TIPS procedure? When it is done?

A

Transjugular intrachepatic portosystemic shunt

Reduces ascites, variceal hemorrhage, improves QoL - 75% success rate

49
Q

What is given to pts that have > 5 L removed in a therapeutic paracentesis for ascites? Why?

A

6-8 g of albumin for each liter drained to prevent kidney injury

50
Q

When is liver transplant considered?

A

Pt w/ decompensated cirrhosis, MELD ≥ 15

51
Q

What is required for pt to be eligible for liver transplant

A

Abstinence from alcohol before and after transplant

52
Q

What is the prognosis for pt w/ alcoholic fatty liver disease?

A

Complete resolution in 4-6 weeks IF alcohol is stopped

53
Q

What is the prognosis for alcoholic hepatitis?

A

Based on severity.

Need to d/c ETOH before disease becomes irreversible

54
Q

What is the prognosis for alcoholic cirrhosis?

A

If pt continues to drink, 4 yrs survival < 20%

55
Q

All pts w/ cirrhosis should be screen for esophageal varices w/ what?

A

EGD

56
Q

All pts w/ cirrhosis should be screen q 6 mos with what imaging and AFP?

A

Abd US

57
Q

Spontaneous bacterial peritonitis is a complication of what?

A

Cirrhosis

58
Q

What is the dx criteria for heptarenal syndrome?

A
  1. Decompensated liver disease/liver failure
  2. Absence of shock
  3. Renal impairment
  4. No improvement w/ correction of volume status + albumin x ≥ 2 days
  5. Absence of other AKI causes
59
Q

Labs for pt w/ hepatorenal syndrome will show what?

A

Azotemia (increased BUN)

60
Q

What is hepatorenal syndrome?

A

Functional renal failure in the setting of decompensated liver disease/liver failure

61
Q

How is Type 1 hepatorenal syndrome defined?

A

Rapid + progressive renal failure w/ severe multi-organ failure

  • survival ≤ 4 wks
  • ≥ 2x increase in serum Cr (>2.5) in less than 2 wks
62
Q

How is Type 2 hepatorenal syndrome defined (less severe than Type 1)?

A

Associated w/ refractory ascites- Median survival 6 mos

63
Q

What is used to prevent HRS?

A
  • IV albumin if > 5 L drained in paracentesis
  • EGD surveillance + BB to protect against GI bleeding
  • ABX prophylaxis for SBP
64
Q

What is NOT used in the prevents on HRS?

A

NSAIDs or supplements

65
Q

When should ABX prophylaxis be given for SBP? What is typically given?

A 
Bactrim DS or Cipro 500 mg QD if pt w/ 
- Previous dx of SBO
- Ascetic protein < 1.5
IV Ceftriaxone if pt w/ 
- Variceal bleed x 3-7 days
66
Q

What imaging findings are associated w/ a benign liver lesion that don’t require any intervention?

A

Cavernous hemangioma < 4cm
Focal nodular hyperplasia
Simple ASX cyst
Focal fatty change/sparring

67
Q

What imaging findings are associated w/ a benign liver lesion that require intervention/GI referral?

A

Adenoma (associated w/ OCP)
Liver abscess
Inflammatory pseudotumor
Atypical/complex cyst

68
Q

What are malignant liver lesions?

A 
Metastases
Lymphoma
Primary liver neoplasms
- HCC
- Cholangiocarcinoma
- Rare tumors (cystadenocarcinoma, angiosarcoma)
69
Q

What malignant liver lesion arises from the parenchymal cells?

A

Hepatocellular carcinoma (HCC)

70
Q

What malignant liver lesion arises from the biliary duct cells?

A

Cholangiocharcinomas

71
Q

What is the most common form of liver cancer?

A

Hepatocellular carcinoma

72
Q

If cirrhotic or non-cirrhotic Hep B pt presents w/ liver imaging on lesion. What should you be suspicious for?

A

HCC
*Screen all cirrhosis pts.
Pts w/ Hep B screen q 6 most + AFP

73
Q

What are the sx of HCC?

A

Unintentional weight loss, sudden onset ascites, elevated AFP

74
Q

How is HCC dx?

A

CT
*If non-diagnostic then triphasic MRI w/ gadolinium contrast
Liver biopsy is diagnostic BUT risk of tumor seeding

75
Q

Who do you screen for HCC?

A

All pts at high risk for liver CA

76
Q

If pt w/ known cirrhosis is found to have 2 cm solid liver lesion. What is your next step?

A

Triphasic CT scan

77
Q

Is coffee good for the liver?

A

YES

1. Clin Med III (29 decks)

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