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Rezi FC > Ciroza > Flashcards

Ciroza Flashcards

1
Q

Alte cauze de ciroza

A

Ciroza biliara secundara = CBS
Colangita biliara primitiva = CBP
Hemocromatoza ereditara
Boala Wilson
Deficit de alfa1-antitripsina (A1AT)
FC
Glicogenozele
Galactozemia
Idiopatica (criptogenica)
Sindromul Budd-Chiari
Boala veno-ocluziva
Congestia venoasa hepatica
Medicamente - metotrexat (MTX)
Hepatita autoimuna
Alte virusuri

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2
Q

Consecintele afectarii cronice hepatice

A

Inflamatie
Necroza
Angiogeneza
Depunere de matrice extracelulara

! Toate duc la fibroza

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3
Q

Investigatii pentru evaluarea severitatii cirozei

A

Functia hepatica - albumina serica, PT
Biochimie hepatica - transaminaze, FA
Electroliti - Na
Creatinina
Biomarkeri - ELF (fibroza hepatica)

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4
Q

Gradul fibrozei - scorul ELF (enhanced liver fibrosis)

A
  • < 7.7 = absenta/usoara
  • 7.7-9.8 = moderata
  • > 9.8 = severa
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5
Q

Investigatii pentru a determina tipul cirozei

A

Markeri virali
Autoanticorpi serici
Ig serice
Fe, feritina, CTLF
Cu, ceruloplasmina
Alfa1-antitripsina
Markeri genetici

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6
Q

Imagistica in ciroza

A

Ecografie abdominala
Fibroscan = elastografie tranzitorie unidimensionala
CT
IRM
Endoscopie

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7
Q

Ce poate identifica IHC pe fragmentul de biopsie hepatica?

A

Ducte biliare
Structuri angiogenice
Virusuri
Markeri oncogeni

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8
Q

Coloratii utilizate pe fragmentele de biopsie hepatica

A

H&E
Giemsa
Rosu picrosirius

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9
Q

Coloratie pentru colagen

A

Rosu picrosirius
* Pentru evaluarea morfometrica a fibrozei (cuantifica colagenul)

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10
Q

Factori de prognostic nefavorabil in ciroza - analize

A
  • Alb < 28 g/L (2.8 g/dL)
  • Na < 125 mmoli/L
  • PT > 6s peste N
  • Cr > 130 mcmoli/L (1.5 mg/dL)
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11
Q

Factori de prognostic nefavorabil in ciroza - clinica

A

Icter persistent
hTA persistenta
Ficat mic
Ascita
Hemoragie din varice
Complicatii neuropsihiatrice
Esecul terapiei
Etiologia

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12
Q

Ce parametri se iau in considerare la calcularea clasei Child?

A

Ascita
Encefalopatia
Bilirubina
Albumina
PT

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13
Q

Pe ce parametri se concentreaza clasa Child si scorul MELD?

A

Bilirubina
Creatinina
INR

! Sunt predictori ai mortalitatii la cei cu necesar de transplant hepatic

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14
Q

Caracteristici ACLF

A

Insuficienta organica
Rata mare de mortalitate
Aparitia la varste tinere
Etiologie alcoolica
Nivel mare de inflamatie sistemica
Prevalenta mai mare a anumitor factori precipitanti (infectii bacteriene, exces de alcool)

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15
Q

Dispozitive de asistare a ficatului

A

Dispozitive biologice care contin hepatocite
Dispozitived de detoxifiere
Sisteme artificiale de sustinere a ficatului

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16
Q

Cauzele afectarii functiei de bariera intestinala in bolile hepatice avansate

A

Modificarea motilitatii intestinale
Cresterea permeabilitatii intestinale
Suprimarea functiilor imunologice intestinale

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17
Q

Indicatii transplant hepatic

A
  1. Boli hepatice acute - IHA de orice cauza
  2. Boli hepatice cronice
  3. Colangita biliara primitiva - prurit intratabil/bilirubina > 100
  4. Hepatita B cronica
  5. Hepatita C cronica
  6. Hepatita autoimuna
  7. Boala hepatica alcoolica
  8. Tulburari metabolice primare - Wilson, hemocromatoza ereditara, deficit de A1AT
  9. Ciroza NASH
  10. Altele - CSP, polichistoza hepatica, oxaluria primara
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18
Q

Contraindicatii absolute transplant hepatic

A

Sepsis activ (alt teritoriu decat arborele hepatobiliar)
Cancere extrahepatice
Metastaze hepatice (exceptie neuroendocrine)
Lipsa angajamentului pshiologic al pacientului

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19
Q

Pregatirea pentru interventia de transplant

A

Confirmare diagnostic
Imagistica ecografica + sectionala
Studiu radiologic al circulatiei hepatice arteriale + al arborelui biliar
Evaluarea starii cardiorespiratorii + renale

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20
Q

Durata conservarii ficatului pentru transplant

A

20h

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21
Q

Durata operatiei de transplant hepatic

A

8h

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22
Q

Terapii imunosupresoare post-transplant hepatic

A

Tacrolimus +/- AZT/MMF
Sirolimus
Ciclosporina microemulsificata
Steroizi

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23
Q

Rejet acut/celular de grefa - aspect HP

A

Infiltrat pleomorf portal - dominat de eozinofile
Leziuni de cai biliare
Endotelita vaselor de sange

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24
Q

Supravietuire dupa transplant hepatic electiv

A

90% - 1 an
70-85% - 5 ani

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25
Q

Boli cu recurenta ridicata post-transplant hepatic

A

CHC
Ciroza VHC
CSP

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26
Q

Prevalenta CBP

A

7.5/100.000

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27
Q

Denumire alternativa CBP

A

Colangita cronica distructiva non-supurativa

28
Q

Clinica CBP

A

Prurit - cel mai precoce simptom
Fatigabilitate - frecvent invalidanta
Icter
Hepatomegalie
Xantelasma pigmentara palpebrala
Depuneri de colesterol in pliurile tegumentare ale mainilor

29
Q

Manifestari autoimune in CBP

A

Sjogren
Tioridita
Sclerodermie

30
Q

Alte manifestari asociate cu CBP

A

ATR
GNM
Boala celiaca
Pneumonie interstitiala

31
Q

Investigatii CBP

A

Anticorpi mitocondriali - AMA M2 > 1:160 (pot fi prezenti si altii nespecifici = ANA, ASMA)
FA crescuta - adesea singura anomalie
Cho crescut
IgM foarte mare
Ecografie - modificari difuze de arhitectura hepatica
Biopsie hepatica

32
Q

Aspect biopsie in CBP

A

Modificari timpurii (majoritatea in zona 1)
* Infiltrat portal limfoplasmocitar
* Granuloame (40% cazuri)

Modificari tardive
* Deteriorarea si rarefierea ductelor biliare mici
* Proliferare ductulara
* Fibroza tractelor portale
* Ciroza

33
Q

In ce boli se observa granuloame hepatice pe biopsie?

A

CBP
Reactii medicamentoase
Sarcoidoza
TB
Bruceloza
Schistosomiaza
Parazitoze - strongiloidoza

34
Q

Caracteristici colangita autoimuna

A

Histologie de CBP
Serologie de hepatita autoimuna
Raspunde la steroizi + AZT

35
Q

Tratament CBP

A

Acid ursodezoxicolic (10-15 mg/kg) - in boala precoce; alternativa = acid obeticholic
Steroizii - preferabil nu
Suplimentare vitamine liposolubile
Bifosfonati - pentru osteoporoza
Colestiramina (da indigestie) - pentru prurit
Alte medicamente pentru prurit
* Rifampicina
* Naloxona
* Naltrexona

Pruritul intratabil se amelioreaza cu plasmafereza/MARS (sistem molecular recirculant absorbant)
Transplant hepatic - esecul terapiei medicale

36
Q

Complicatii CBP

A

Complicatiile cirozei
Osteoporoza
Osteomalacie - mai rar
Polineuropatie - mai rar

37
Q

Efecte benefice AB + BB neselective in ciroza

A

Blocheaza translocatia bacteriana
Reduc presiunea portala
Reduc hemoragia variceala
Reduc PBS

38
Q

Ce inseamna ciroza in stadiu final?

A

Chid C
MELD 20+
UKELD 49+

39
Q

Mortalitate donatori LDH

A

1:200 -> 1:400

40
Q

Cauze CSP secundara

A

HIV
Cryptosporidioza
Consum de ketamina

41
Q

Cauze de CBS

A

Stenoze de CBP
Calculi biliari
Colangita sclerozanta

42
Q

Moduri de evidentiere arbore biliar

A

Ecografie
MRCP
ERCP - uneori
Colangiografie transhepatica percutana - evidentierea CBIH cand abordarea endoscopica este dificila

43
Q

Factori care influenteaza cursul bolii in HCE

A

Genul
Aportul alimentar de Fe
Hepatotoxicele asociate (mai ales alcool)
Genotipuri

44
Q

Triada clasica in HCE

A

Hiperpigmentare cutanata
Hmegalie
DZ

Doar in cazuri de supraincarcare importanta de Fe

45
Q

Utilitatea biopsiei hepatice in HCE

A

Stabilirea dimensiunii lezarii tisulare
Evaluarea fierului tisular
Masurarea concentratiei hepatice de Fe

46
Q

Ce concentratie hepatica de Fe sugereaza HC?

A

> 180 mcmoli/g de greutate uscata a fragmentului biopsiat

47
Q

Ce inseamna supraincarcare hepatica cu Fe relevanta clinic?

A

> 60 mcmoli/g de ficat

48
Q

Manifestari neurologice in boala Wilson

A

Dizartrie
Tremor
Miscari involuntare
Dementa

49
Q

RA grave la penicilamina

A

Modificari ale pielii
Eruptii cutanate
Leziuni renale
Leucopenie

50
Q

Complicatii si efecte ale cirozei

A

HTP
Hemoragie GI
Ascita
EPS
CHC
Bacteriemii, infectii
IR
Sindrom hepatopulmonar

51
Q

Cauze de HTP

A

Prehepatica - tromboza v porta

Posthepatica
* ICD (rar)
* Pericardita constrictiva
* Obstructie VCI

Hepatica
a) Presinusoidala
* Schistosomiaza
* Sarcoidoza
* CBP

b) Sinusoidala
* Ciroza (ex. alcoolica)
* Transformare nodulara partiala
* FHC

c) Postsinusoidala
* BVO
* Budd-Chiari

52
Q

Principalele locuri de aparitie a colateralelor port-sistemice

A

JEG
Rect
Vena renala stanga
Retroperitoneu
Diafragm
Perete abdominal anterior (vena ombilicala)

53
Q

Cauze de HTP extrahepatica prin tromboza venei porte

A

Anomalii venoase portale congenitale
Sepsis neonatal de vena ombilicala
Afectiuni protrombotice mostenite
* Factor V Leiden
* Boli mieloproliferative +/- mutatii JAK2

54
Q

Cauze intrahepatice de HTP

A

Ciroza - cea mai frecventa
Schistosomiaza
Alte cauze
* FHC
* Hiperplazia nodulara regenerativa
* Transformarea nodulara partiala

55
Q

Complicatii tamponament cu balon

A

Pneumonie de aspiratie
Ulceratia mucoasei
Ruptura esofagiana

56
Q

Avantaje stent Danis

A

Nu afecteaza deglutitia
Nu poate fi indepartat de pacientii necooperanti
Permite investigatiile post-endoscopice

57
Q

Complicatii bandare varice esofagiene

A

Ulceratii esofagiene
Mediastinita
Stenoze (mai rar)

58
Q

Factori precipitanti ascita

A

Continuarea consumului excesiv de alcool
Infectie/sepsis
CHC
Tromboza de vene splanhnice

59
Q

Cauze de gradient albumina ser/ascita > 11 g/L

A

HTP - ciroza
Sindrom Budd-Chiari
BVO
Obstructia fluxului hepatic de iesire
Insuficienta tricuspidiana (IT)
ICD
Pericardita constrictiva

60
Q

Cauze de gradient albumina ser-ascita < 11 g/L

A

Carcinomatoza peritoneala
TB peritoneala
Pancreatita
Sindrom nefrotic

61
Q

Cauza de ascita serocitrina

A

Cancer - cea mai frecventa
Ciroza
Infectii
* TB
* Perforatie intraabdominala cu orice bacterie (E. coli de ex)
* Spontan (ciroza - PBS)
Sindrom Budd-Chiari - proteine multe in lichid
Pancreatita CRONICA
ICC
Pericardita constrictiva
Hipoproteinemie (sindrom nefrotic)
Sindrom Meigs (tumora ovariana)

62
Q

Cauze de ascita chiloasa

A

Ciroza
Obstructia canalului limfatic principal - carcinoame - prezenti chilomicroni in lichid

63
Q

Cauze de ascita hemoragica

A

Cancer
SEU rupta
Traumatism abdominal
Pancreatita ACUTA

64
Q

Dezavantaje diuretice de ansa

A

HipoNa
HipoK
Depletie volemica

65
Q

Bacterii frecvent implicate in PBS

A

E. coli
Klebsiella
Enterococi

Rezi FC (29 decks)

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