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GI II Final > Clinical Approach to the Hepatobiliary Patient: Chronic Liver Disease and Cirrhosis > Flashcards

Clinical Approach to the Hepatobiliary Patient: Chronic Liver Disease and Cirrhosis Flashcards

1
Q

what is the time frame for chronic liver disease?

A

at least 6 months

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2
Q

What are 2 ways you can identify the presence or absence of fibrosis (cirrhosis) in chronic hepatitis?

A

serum fibrosure (lab) and/or ultrasound elastography (imaging)

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3
Q

Where is HBV endemic?

A

sub-saharan africa and southeast asia

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4
Q

What 3 things is HBV associated with?

A

glomerulonephritis, serum sickness, and polyarteritis nodosa

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5
Q

What are people with chronic HBV at substantial risk for?

A

cirrhosis (portal HTN) and hepatocellular carcinoma

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6
Q

How do you make the diagnosis of chronic HCV?

A

HCV Ab+ HCV RNA in serum

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7
Q

What is the most sensitive indicator of HCV infection?

A

HCV RNA

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8
Q

What indicates recovery from prior HCV infection?

A

anti-HCV in serum without HCV RNA in serum

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9
Q

What are 3 complications associated with chronic HCV?

A

cirrhosis, hepatocellular carcinoma, pathogenic factor in mixed cryoglobulinemia

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10
Q

What is the most common form of autoimmune hepatitis?

A

Type 1: classic: anti-smooth muscle and/or antinuclear antibodies (ANA)

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11
Q

what is the typical manifestation of classic autoimmune hepatitis?

A

female, 30-50 yo, healthy appearing young woman with stigmata of cirrhosis

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12
Q

What are the extrahepatic manifestations associated with autoimmune hepatitis?

A

rash, arthralgias, keratoconjunctivitis sicca, thyroiditis, hemolytic anemia, nephritis, ulcerative colitis

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13
Q

How do you make the diagnosis of autoimmune hepatitis?

A

look for serologic abnormalities: type I: SMA; type 2: anti-LKM antibody

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14
Q

How would you treat autoimmune hepatitis?

A

glucocorticoids, azathioprine, monitor liver function tests monthly, liver transplant may be required

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15
Q

How does alcoholic hepatitis present?

A

asymptomatic–> severe liver failure with jaundice, ascites, GI bleeding, and encephalopathy

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16
Q

what would a liver biopsy look like in a patient with alcohol-induced liver disease?

A

Mallory bodies (alcoholic hyaline)

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17
Q

how do you treat alcohol-induced liver disease with hypoglycemia?

A

abstinence from alcohol; daily multivitamin, thiamine, folic acid, zinc; you need to give thiamine first before glucose

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18
Q

what are 3 different scores used to assess prognosis of alcohol-induced liver disease?

A

A Maddrey’s discriminant function (DF); Glasgow alcoholic hepatitis score; a model for end-stage liver disease (MELD)

19
Q

what are the principal causes of NAFLD?

A

metabolic syndrome (obesity, DM, hypertriglyceridemia)

20
Q

What protects against NAFLD?

A

physical activity and coffee consumption

21
Q

What is the liver biopsy like in a patient with NAFLD?

A

it is indistinguishable from that of alcoholic hepatitis

22
Q

how does alpha-1 anti-trypsin deficiency present in young? in smokers?

A

pulmonary emphysema in lower lobes; pulmonary emphysema of upper lobes

23
Q

How do you diagnose alpha-1 anti-trypsin deficiency?

A

check alpha-1 antitrypsin phenotype; Pi gene on chromosome 14

24
Q

What is the classic tetrad associated with hemochromatosis?

A

cirrhosis with hepatomegaly, abnormal skin pigmentation, diabetes mellitus, cardiac dysfunction

25
Q

Patients affected by hemochromatosis are at increased risk of infection with what?

A

yersinia enterocolitica, vibrio vulnificus, listeria monocytogenes, and siderophilic organisms

26
Q

how do you treat hemochromatosis?

A

phlebotomy or the chelating agent deferoxamine

27
Q

How do you make the diagnosis of wilson disease?

A

low serum ceruloplasmin

28
Q

How do you treat wilson disease?

A

oral penicillamine or liver transplant

29
Q

How does right heart failure affect the liver?

A

patients will have passive congestion of the liver (nutmeg liver)

30
Q

What is ischemic hepatitis?

A

ischemic hepatopathy, hypoxic hepatitis, shock liver; when there is an acute fall in cardiac output due to acute MI, arrhythmia, or septic or hemorrhagic shock

31
Q

What is the hallmark of ischemic hepatitis aka “shock liver”?

A

rapid and striking elevation of serum aminotransferase levels- often greater than 5000 units/L; early rapid rise in the serum lactate dehydrogenase (LDH) level

32
Q

What is fibrosure and how does it work?

A

it is a noninvasive blood test of biochemical markers that provides fibrosis staging and necroinflammatory grading; low excludes advanced fibrosis; high predicts advanced fibrosis

33
Q

How do you check/diagnose a spontaneous bacterial peritonitis in a patient with cirrhosis?

A

blood culture or paracentesis; check fluid for albumin, WBC with differential, culture and gram stain; if it is greater than 250 PMNs/mL think SBP

34
Q

How do you determine the prognosis of cirrhosis?

A

you always calculate Child-turcotte-Pugh score and MELD/MELD-Na score

35
Q

How do you screen for HCC?

A

alpha fetoprotein (AFP) and ultrasound every 6 months to screen for HCC

36
Q

What is the most common cause of ascites?

A

portal hypertension (chronic liver disease)

37
Q

How do you diagnose ascites?

A

abdominal ultrasound or abdominal paracentesis

38
Q

What are the routine studies done on ascitic fluid?

A

1) cell count 2) albumin and total protein 3) culture and gram stain

39
Q

What is primary spontaneous bacterial peritonitis?

A

it is most common among patients with cirrhosis; it is a hematogenous spread of organisms to ascitic fluid

40
Q

how do you treat spontaneous bacterial peritonitis?

A

appropriate empirical antibiotic treatment: a third generation cephalosporin or piperacillin/tazobactam

41
Q

What are the 4 risks of increased risk of bleeding from esophageal varices?

A

1) the size of the varices (larger than 5mm) 2) the presence at endoscopy of red wale markings 3) the severity of liver disease 4) active alcohol abuse

42
Q

How do you prevent rebleeding of esophageal varices?

A

nonselective beta-adrenergic blockers (propranolol, nadolol)

43
Q

How do you treat hepatic encephalopathy?

A

remove precipitants, correct electrolyte imbalances, lactulose

44
Q

How do you diagnose HCC?

A

a patient with known liver disease develops an abnormality on ultrasound or rising alpha fetoprotein (AFP)

GI II Final (16 decks)

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