Cirrhosis

Question 1

Wilson Disease

sx?dx?tx?

Answer 1

Cu depo in: Basal ganglia(chorea), Liver(cirrhosis), eyes(Keiser fischer rings)

dx: increased ceruoplasma, urine Cu, biopsy!
Tx: Penicillamine or transplant

Question 2

Hemochromatosis

sx?dx?tx?

Answer 2

increased Fe absorption causing overload = Bronze diabetes, hyperpigmentation + cirrhosis, joint pain, ED or Amenorrhea, Cardiomyopathy
Dx: elevated serum transferiritin & ferritin, Biopsy
Tx: Deferoxamine, Pheobotomy
*transplant wont fix!

Question 3

A1-AT Def

Answer 3

mutat in a1at transporter = COPD + Cirrhosis
Dx: PAS + Macrophages
Tx: transplant

Question 4

Primary Sclerosing Cholangitis

sx?dx?tx?

Answer 4

Extrahepatic = SOBs = mean, not subtle!
==> Dudes w/puritis, jaundice, 30-50yo, assoc IBD + UC
Dx: ANCA, MRCP(beads on string), ERCP(onion skin)
Tx: transplant or ursodeoxycholic acid
**DO NOT STENT

Question 5

PBC

sx?dx?tx?

Answer 5

Intrahepatic = bitches = subtle
==>female, jaundice, puritis, 30-50yo
Dx: imaging will be normal, only dx w/biopsy
Tx: transplant

Question 6

How do you Dx HCC? how do u screen?

Answer 6

Any1 w/cirrhosis = RUQ U/S + AFP q6months

Dx w/ Triple Phase CT

Question 7

How do you treat Spontaneous Bacterial Peritonitis(SBP)?

Answer 7

w/Cirrhotics fluid in ab can be nitus for bacteria tx based on bac levels durign paracentesis:

1-2 bact: Ceftriaxone & FQ
Multi bac: Ceftriaxone, FQ, Metro & exlap = prob GI perf!

Question 8

How do you determine ascites from portal HTN bs ascites from other shit? cut offs?

Answer 8

Serum Albumin - Ascities Albumin(SAAG)

SAAG>/= 1.1 == portal HTN
SAAG= 1.1 ==TB, Infection or Malignancy

Question 9

6 things that get fucked up with cirrhosis

Answer 9

1. dec clearance of bilirubin = jaundice
2. accum of bile = puritis
3. increase resistance = Portal HTN = Varicies
4. dec coag factors = bleeding
5. inc ammonia = hepatic encephalopathy
6. estrogen excess

Question 10

How do you treat Hepatic Encephalopathy?

Answer 10

lactulose, Zn, Rifaximin

Question 11

Pt 43 yo m w/ erectile dysfunction, fatigue, + brown skin pigmentation over face + arms, elevated ALT & AST. + fasting glucose of 130 dx?

Answer 11

Hereditary Hemochromotosis

Question 12

When would you see AST & ALT in the thousands? Vs when would you see it in the hundreds?

Answer 12

If you see numbers in the thousands it’s most likely tocsin induced, ischemic or ACUTE viral hepatitis. In the hundreds you should think about alcoholic or other disease

Question 13

Y-glutamyltransferase(GGT) and ferritin up or down in alcoholic hep?

Answer 13

Both these would be elevated in alcoholic liver disease. GGT is an enzyme present in the liver. And ferritin is an acute phase reactants

Question 14

How long do u tx autoimmune hepatitis? How?

Answer 14

2 year w/ prednisone or azothioprine

Question 15

Post exposure prophylaxis wth hep A

Answer 15

<1 or >40 = IgG

1-40 = HAVaccine