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GI - 2 > Chronic Liver Disease - part 2 > Flashcards

Chronic Liver Disease - part 2 Flashcards

1
Q

What does Right sided Heart Failure cause in the liver?

A

Passive congestion (nutmeg liver)

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2
Q

What labs will be elevated with Right sided Heart Failure that is affecting the liver?

A

Increased AST/ALT

Really INCREASED BNP

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3
Q

What is Ischemic Hepatitis?

A

“Shock liver” - hypoxic hepatitis due to fall in cardiac output (ex. MI)

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4
Q

What may protect against Ischemic Hepatitis?

A

Statin therapy

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5
Q

What labs will be elevated with Ischemic Hepatitis?

A

SUPER ELEVATED AST/ALT > 5000

Increased LDH

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6
Q

What sign will be present with the liver and heart failure?

A

Hepatojugular reflux

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7
Q

Cirrhosis is a complication of many liver disease. List the 3 most common.

A

Alcohol-Induced Liver Injury
NAFLD
Hepatitis C

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8
Q

How does Cirrhosis arise?

A
  • Liver injury
  • Inflammation
    = Fibrosis and regenerative nodules
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9
Q

What is the usually in the history with Cirrhosis?

A

Jaundice
Ascites - look pregnant
Encephalopathy - confusion

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10
Q

With Cirrhosis the physical exam shows the stigmata of Cirrhosis. The physical exam can be normal until?

A

End stage

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11
Q

List abdominal changes with Cirrhosis

A

Ascites
Caput medusae (abdominal vein dilation)
Umbilical hernia

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12
Q

List skin changes with Cirrhosis

A

Jaundice
Spider Angiomata (telangiectasias)
Gynecomastia in males

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13
Q

List hand/wrist changes with Cirrhosis

A

Asterixis
Dupuytren’s contracture
Nail changes

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14
Q

What causes the nail changes that are seen with Cirrhosis?

A

HYPOalbuminemia

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15
Q

List esophagus and mental changes with Cirrhosis

A

Esophageal varices
Vitamin deficiencies
Mental status changes

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16
Q

What are possible complications of Cirrhosis?

A

Hepatocellular carcinoma

Portal HTN - Ascites, variceal bleeding, SBP

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17
Q

With Cirrhosis what should you treat?

A

Underlying cause

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18
Q

With Cirrhosis, it can cause Hepatocellular carincoma, so you should monitor?

A

Alpha Fetoprotein (AFP) and US every 6 months

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19
Q

2 prognoses for Cirrhosis that are important for the transplant list?

A
  • Child - Turcotte - Pugh Score

- MELD

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20
Q

What scores for the Child-Turcotte-Pugh score with Cirrhosis are severe?

A

C

> 7

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21
Q

What scores for the MELD are severe with Cirrhosis?

22
Q

SAAG

A

Serum Albumin - Ascites Albumin

23
Q

Ascites can either be?

A

Portal HTN

Non-portal HTN

24
Q

SAAG > ____ is portal HTN Ascites

25
Q

SAAG < ____ is non-portal HTN Ascites

26
Q

Portal HTN Ascites likely causes?

A

Cirrhosis
CHF
Budd-Chiari Syndrome

27
Q

Ascites

A

Accumulation of fluid in peritoneal cavity

28
Q

Most common cause of Ascites?

A

Cirrhosis (portal HTN)

29
Q

What will be seen on physical exam with Ascites?

A

Increasing abdominal girth, larger tender liver

(+) shifting dullness

30
Q

What will an Abdominal US show with Ascites?

31
Q

When should an Abdominal paracentesis be performed with an Ascites patient?

A
  • new onset ascites
  • pts admitted to hospital for ascites
  • when ascites pts start to deteriorate
32
Q

What is the most important test to run on the Ascites fluid and why?

A

WBC

- PMN>250 == SBP

33
Q

SBP

A

Spontaneous (primary) Bacterial Peritonitis

34
Q

SBP is most common in patients with?

35
Q

What causes SBP?

A

Hematogenous spread of organisms to ascitic fluid because the liver cannot filter them

36
Q

Is a single organism usually isolated with SBP?

A

Yes - e. coli/cocci

37
Q

Signs of SBP?

A

Fever, Abdominal pain and signs of peritoneal irritation

- OR nonspecific manifestations

38
Q

PMN > _____ in peritoneal fluid classifies SBP

39
Q

What else should you perform on the peritoneal fluid with SBP besides WBC check?

A

Blood cultures because bacteremia is common

40
Q

What is the treatment for SBP?

A

Empirical antibiotic treatment

41
Q

Hepatic Encephalopathy

A

Alteration in mental status in presence of liver failure

- neurotoxins are not removed by the liver

42
Q

What will be increased with Hepatic Encephalopathy?

43
Q

What are a few precipitants to Hepatic Encephalopathy?

A

GI bleed
Constipation
Sepsis

44
Q

What is the treatment for Hepatic Encephalopathy?

A

Lactulose - causes diarrhea

- Remove precipitants and correct electrolytes

45
Q

What are the grades for Hepatic Encephalopathy?

A

1 - mild confusion
2 - drowsy
3 - stupor
4 - coma

46
Q

Who is at risk for Hepatocellular carcinoma?

A

Males with cirrhosis

47
Q

What will be increased with Hepatocellular carincoma?

A

Alpha Fetoprotein (AFP)

48
Q

In patients with known liver disease, you should screen for hepatocellular carcinoma.. how?

A

AFP and abdominal US every 6 months

49
Q

In patients with known liver disease, you should screen for hepatocellular carcinoma.. how?

A

AFP and abdominal US every 6 months

50
Q

What is the treatment for Hepatocellular carcinoma?

A

Surgery, ablation, liver transplant

GI - 2 (61 decks)

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