25: Chronic Liver Dz And Cirrhosis Flashcards
Major complication associated with Hep B vs Hep C
Hep B: polyarteritis nodosa
Hep C: mixed cryoglobulinemia
Major lab + imaging to ID fibrosis due to cirrhosis
- Serum fibrosure lab
2. US elastography
Risk of an HBV positive mother transmitting to infant at time of delivery
90%
Leukopenia in alcoholics
Occasionally seen but resolves after cessation of drinking
CBC issues possibly seen in alcoholics
- high or low WBCs
- Anemia
- Folic acid deficiency
- Thrombocytopenia
Mallory (Mallory-Denk) bodies
Alcoholic hyaline seen on liver biopsy in alcoholic liver disease
What happens if you administer glucose without thiamine in alcohol-induced liver disease
Can precipitate Wernicke Korsakoff
Three major treatments for severe alcoholic hepatitis
- Steroids
- Pentoxifylline
- Liver transplant
Requirement for liver transplant for alcohol-induced liver disease
Must abstain from alcohol for 6mo to be considered
Three scores for severity of alcohol-induced liver disease + the score that indicates a poor prognosis
- Maddrey’s discrimination function (DF): 32
- Glasgow Alcoholic hepatitis score: 9
- MELD: model for end-stage liver disease: 21
Wernicke Korsakoff sx
AMS, ataxia, involuntary eye movements (nystagmus)
Korsakoff sx
Severe memory issues, confabulation
Treatment for Wernicke encephalopathy
Thiamine
Two things that protect against NAFLD
- physical activity
2. Coffee consumption
What is seen on liver biopsy in NAFLD
Macrovesicular steatosis +/- inflammation and fibrosis, PMN infiltrate, Mallory hyaline - indistinguishable from alcoholic steatohepatitis
Lung disease seen in a1 antitrypsin deficiency
Pan-acinar emphysema in lower lobes (smokers get emphysema in upper lobes)
Most commonly diagnosed inherited hepatic disorder in infants/children
A1 antitrypsin deficiency
PiM, PIS, PiZ and PiZZ phenotypes in a1AT deficiency
- PiM: normal, most common
- PIS: mildly reduced levels
- PiZ: severe reduction
- PiZZ: most severe reduction
What is iron stored as + where is it stored in hemochromatosis
Hemosiderin -> liver, panc, heart, adrenals, testes, pituitary, kidneys
Neurological manifestations in Wilson disease
Parkinson’s, tremor, ataxia, dysarthria, dysphagia, spasticity, migraines, insomnia, seizure
How to check for SBP?
Paracentesis
Two major scores to calculate for cirrhosis
- Child-Turcotte Pugh
2. MELD
What to order for MELD vs Child-Turcotte-Pugh
MELD: bili, creat, Na, INR
CTP: bili, INR, albumin, assess for encephalopathy and ascites
What two things should be monitored every 6 months in cirrhosis to monitor for HCC?
Alpha fetoprotein, US
Three treatments for NAFLD
- Weight reduction
- Exercise
- Control metabolic syndrome
Three pt populations that need paracentesis for ascites
- New onset ascites
- Pts admitted to hospital with ascites
- Known ascites deterioration
What level of PMN suggests SBP in ascites?
250 mcL
What does SAAG stand for?
Serum albumin- ascites gradient
Four things that increase severity of esophageal varices
- Size larger than 5mm
- Red wale markings
- Severity of liver disease
- Active alcohol abuse
Esophageal varices prevention drug
No selective beta-adrenergic blockers
Major treatment for esophageal varices
Band ligation
Treatment for hepatic encephalopathy + how it works
Lactulose -> colonic acidification and diarrhea
