Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med III Exam 2 > Alcoholic Liver Disease > Flashcards

Alcoholic Liver Disease Flashcards

1
Q

Leading cause of liver transplant in USA

A

ALD (replaced HCV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ALD?

A

damage to the liver function due to alcohol abuse; spectrum from steatosis to cirrhosis;
no distinct stages – many may be present at the same time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 stages of ALD

A
  1. Fatty liver (simple steatosis)
  2. Alcoholic Hepatitis
  3. Chronic hepatitis w/ fibrosis or cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk of developing ALD

A

Men >3 drinks per day > 5 years
Women >2 drinks per day >5 years

F>M
African Am > Hispanic > Caucasian
Obesity & excess body weight
Genetic factors 
Hep C + Alcohol = rapid liver disease progression
ALD + Smoking = HCC
Amount ingested (most important risk factor)
Type of alcohol (beer/spirits>wine)
Pattern of drinks (outside of meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most important risk factor

A

Amount of alcohol ingested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is fatty liver (hepatic steatosis)

A

accumulation of fat droplets in the cytoplasm of liver cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathophys of fatty liver

A

increase FFA from peripheral stores, increased triglyceride formation, decreased FA oxidation, reduced LPL released by liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sx of fatty liver

A

asymptomatic & self limited

may have hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx for fatty liver

A

MAY BE REVERSIBLE W/ ABSTINENCE AFTER ABOUT 4-6 WEEKS

STOP DRINKING **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is alcoholic hepatitis

A

inflammation of liver characterized by necrosis (death) and fibrotic scaring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sx of alcoholic hepatitis

A

usually asymptomatic or mild sx

symptomatic = advanced liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Severe sx w/ alcoholic hepatitis

A 
fever
leukocytosis
hepatic encephalopathy* (toxins)
spider angiomas 
jaundice 
hepatosplenomegaly w/ liver tenderness (scrotal or LE)
edema
ascites
variceal bleeding
oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Labs for alcoholic hepatitis

A

leukocytosis w/ left shift; microcytosis (MCV), thrombocytopenia (low platelets due to splenomegaly); MCV >100 think ETOH

ASH/ALT ratio >2
ALP mildly elevated
Bilirubin elevated
PT/INR elevated (can't make clotting factors)
low albumin
Hyponatremia, hypokalemia (fluid overload)
GTP elevated 
Folate (low)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AST: ALT >2

A

ALD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Histology for alcoholic hepatitis

A

alcoholic hyaline (Mallory)
fatty infiltration
neutrophil infiltration around clusters of necrotic hepatocytes
Mallory bodies! (hyaline clumps)
Fibrosis around hepatic venules (precursor to cirrhosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dx of ALD

A

liver bx REQUIRED when:

  • unclear hx of alcohol use and elevated LFT;
  • confounded by other risk factors
  • considering pharmacotherapy w/ steroid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hepatic encephalopathy

A

failure of liver to detox agents due to dysfunction –> ammonia builds up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Prognosis for HE

A

50% survival at 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tx for HE

A

treat previpitating factors (GI bleed, infection, sedating, meds, electrolyte abnormalities, constipation, renal failure)
LACTULOSE (increase BM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Signs of HE

A 
EEG changes
flapping tremor (asterxisis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Grades of HE

A

Grade I: change in behavior, mild confusion, slurred speech, disordered sleep pattern

Grade II: lethargy, moderate confusion; ASTERIXSIS

Grade III: marked confusion (stupor), incoherent speech, sleeping but can arouse

Grade IV: coma, unresponsive to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

tests for HE

A

Stroop Test (evaluate psychomotor speed and cognitive flexibility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Asterixis

A

tremor of hand when wrist is extended, resembles “flapping” – grade II HE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Overall labs for alcoholic hepatitis

A 
hx: 10+ drinks/day, recent jaundice
Exam: jaundice, enlarged liver
Bilirubin: high (>5)
AST/ALT: both elevated but <300
AST/ALT: >2
INR: elevated
Absolute neutrophil count: >7,700
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of AH

A

hospitilize if high mortalitiy

  • Model of end stage liver disease (MELD) >20
  • maddery discrimant factor (MDF) >32; start steroids?
  • lillie score* (labs over time) - used to determine if steroids should be continues!

D/C all alcohol use!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Test to determine if steroids should be continues

A

Lillie Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When to hospitilize for AH

A

MELD >20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tx for mild-severe AH

A

treat withdrawl/infection
Diuretics (lasix, spironolactone)

Severe disease (MDF >32, MELD >20)

  • consider steroid tx and d/c if not effect on day 7 using lillie score
  • liver transplant
29
Q

Cirrhosis: what is it?

A

widespread destruction and regeneration of liver tissue; increased fibrotic CT; regenerated liver tissue forms nodules & permanent alters to the strucutre; scarring and increased CT = impairement of liver function

necrosis and inflammatory cell infiltration

30
Q

Types of cirrhosis

A

compensated cirrhosis

decompensated

31
Q

Compensated cirrhosis

A

portal pressure <10 (~12 year survival); splenomegaly (thrombocytopenia, leukopenia, anemia, AST elevation)

32
Q

Uncompensated cirrhosis

A

increased portal pressure; decreased liver function (~2 year survival)

microvasculatore very distorted so alot of blood flow bypasses vascular scars
Results:
- portal HTN
- porto-systemic shunting
- impaired liver function
33
Q

Manifestations of decompensated cirrhosis

A 
ascites
esophageal &amp; rectal varices
splenomegaly (leukopenia, thrombocytopenia)
Dilated abdominal veins (caput medusa)
encephalopathy
Liver function failure: jaundice, HE

Fatigue/anorexia, weak, palmar erythma, parotid enlargement, Dupuytren’s contracture, jaundice, gynecomastic, muscle wasking; portal HTN signs, asterixis (HE)

34
Q

Manifestation of compensated cirrhosis

A

splenomegaly

35
Q

Obstruction sites for portal HTN

A

prehepatic: portal vein thrombosis
Intrahepatic: cirrhosis
Posthepatic: CHF, constrictive pericarditis

36
Q

Problem w/ portal HTN

A

increases collateral circulation

  • varices bleed
  • splenomegaly
  • ascites (increased hydrostatic pressure)
  • hepatic encephalopathy
37
Q

Increased pressure in peritoneal capillaries

A

Ascites

38
Q

Shunting of blood

A

Caput medusae
Hemorrhoids
Esophageal Varices
Encephalopathy (shunting ammonia)

39
Q

Splenomegaly causes

A

anemia/leukopenia
thrombocytopenia
bleeding

40
Q

Labs for cirrhosis

A

similar to alcoholic hepatitis
AST elevation (normal in compensated, clue to cirrhosis if elevated)
Anemia - AOCD, folate deficiency, suppression of hemaotopoeisis from ETOH, hemolysis, GI blood loss, splenomegaly
Thrombocytopenia
Coag abnormalities
Thrombocytopenia, leukopenia (splenomegalY)

41
Q

Tx for cirrhosis

A

treat complications

  • Variceal surveillance (EGD) +/- badning
  • HCC surveillance (US q 5 mo) +/- AFP
  • Beta-blocker for prevention of variceal bleeding (HR55-60 SPB<90); don’t need to continue EGD if goals met
42
Q

Goals VS for variceal bleeding prevention

A

BB
HR 55-60
SBP <90

43
Q

Tx for ascites

A

2g/d sodium
diuretics: lasix, spironolactone
Fluid restriction ONLY if sodium <125
Refractory: stop BB, therapeutic paracentisis (w/ albumin if >5-6 L drained)
TIPS (transjugular intrahepatic portosystemic shunt) - lowers portal pressure

Monitor CBC( 3-6 mo), electrolytes w/ diuretic use, renal funciton, PT/INR
HE (lactuose +/- rifaximin)
Liver tranplant (refer w/ decompensated cirrhosis + MELD >15) - requires 6 mo abstitence before can consider for tranplant
44
Q

How much albumin to give if receiving paracentiesis?

A

6-8 g albumin infused for each liter >5L removed to prevent kidney injury

45
Q

When to refer for liver transplant

A

Uncompensated + MELD >15

46
Q

Meds for HE

A

lactulose

+/- Rifaximin

47
Q

Complications of Cirrhosis

A

Portal HTN (caput, ascites, congestive splenomegaly, varices)
Spontaneous bacterial peritonitis (SBP)
HE
Hepatorenal syndrome

48
Q

Hepatorenal syndrome: what is it?

A

functional renal failure in setting of decompensated cirrhosis

49
Q

Types of hepatorenal syndrome

A

Type 1- Rapid & progressive w/ multi-organ failuer (~4 weeks survival)

Types 2: associated w/ refractory ascites (~6 mo survival)

50
Q

Dx criteria for HRS

A

cirrhosis w/ ascites
absence of shock
Renal impairment (Cr rise 0.3 mg/dL in 46 hours; 50% increase in baseline w/i 7 days)
No improvement w/ correction of volume + albumin x 2 days
Absence of other causes of AKI

51
Q

Features of HRS

A 
ascites
Cr >1.5
Azotemia (increase BUN)
Oliguria (<500 ml/d)
Hyponatremia (fluid overload)
Hypotension
52
Q

Prevention of HRS

A

albumin IV w/ large volume (>5L) paracentesis
Protect against GI bleed w/ EGD surveillance of BB
Do not use NSAIDs or supplements
SBP prophylaxis*

53
Q

When to use SBP prophylaxis

A

patients w/ previous dx SBP
patient that have had variceal bleed x 3-7 days
Patients w/ ascetic protein <1.5

54
Q

Prophylaxis for those that had previous SBP

A

Bactrim q d or Cipro 500 mg q daily

55
Q

Prophylaxis for those w/ variceal bleed

A

3-7 days IV ceftriaxone

56
Q

Categories of liver masses

A

benign require no further eval
benign w/ further investigation/therapy
Malignant requiring management

57
Q

Benign lesions

A

usually no intervention

  • Cavernous hemangioma <4 cm
  • focal nodular hyperplasia
  • simple cyst <4 cm & asymptomatic
  • focal fatty change/sparing
58
Q

Benign lesions requiring managment

A

Adenoma (associated w/ use of OCP)
Liver abscess (pyogenic, amebic)
Inflammatory pseudotumor
Atypical/complex cyst and large symptomatic simple cysts

  • refer to GI/hepatology
59
Q

associated w/ OCP

A

adenoma

60
Q

Types of malignant lesions

A 
Metastases
Lymphoma ("The great masquerader")
Primary neoplasm
- HCC
- cholangiocarcinoma (in bile duct)
- other rare (cystadenomcarcinoma, angiosarcoma)
61
Q

HCC

A

arise from parenchymal cells

62
Q

Cholangiocarcinomas

A

arise from biliary duct cells

63
Q

When to suspect HCC

A

cirrhotic patients OR patients w/ non-cirrhotic Hep B w/ liver lesion on imagin
M>F
any chronic liver disease increases risk (Hep C, AIH)

64
Q

At risk of HCC

A

cirrhotic patient w/ any liver disease (low platelet, US elastrography w/ kPA ?20)

Chronic Hep B (non-cirrhotic)

  • asian females >50
  • asian males >40
  • any age w/ FH of oHCC and personal dx of Hep B
  • afircans and Af Am black >20
  • screen w/ US q 6 months +/- AFP!!!!
65
Q

Screening for those w/ hep B to avoid HCC

A

US q 6 months +/- AFP

66
Q

Sx of HCC

A 
cachexia (wasting away)
weakness
Weight loss
sudden ascites
Eleveated LFT
Elevated AFP!!!!!!
67
Q

Dx of HCC

A
  1. ) Tri-phasic CT scan
  2. ) Tri-phasic MRI if CT is non-diagnostic)
  3. ) Liver bx = DIAGNOSTIC (low but finite risk of tumor seeding)
68
Q

When do you not bx for HCC

A

Imaging is typical

AFP elevated

69
Q

Management of HCC

A

resection rarely feasible due to background cirrhosis (non-cirrhotic HBV is feasible; cirrhotic HCC w/ normal bilirubin and no portal HTN)

Liver transplant for early stage (1 lesion up to 5cm, or 3 lesions up to 3cm AND no vascular invasion)

RFA for small tumors (3cm)
TACE/TARE (transarterial radioembolization), XRT (radiation) for large tumors

Advanced: systemic therapy for distant spread
End stage: symptomatic tx

Clin Med III Exam 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions