Clinical- Liver Disorders Flashcards
What are true liver function testing for
- Cholestrol
- Albumin
- PT/INR
What is a nonhepatic source of bilirubin
RBCs
What is a nonhepatic source of AST
Skeletal muscle, cardiac muscle, RBCs
What is a nonhepatic source of ALT
- Skeletal muscle
- cardiac muscle
- Kidneys
What is the nonhepatic source of LDH
Heart, RBC
What is a nonhepatic source of alkaline phosphatase
Bone, first trimester placenta, kidneys, intestines
Which amino transferase is more specific for liver injury
ALT
What are the characteristic symptoms of hepatitis A
Anorexia, nausea, vomiting, malaise, eversion to smoking
What are the lab values for Hep A
- Very high ALT/AST
- elevated bilirubin and alkaline phosphatase
- Antibodies to hep A (anti-HAV)
What is the antibody that is mostly used in the diagnosis of acute hepatitis A
-IgM anti HAV
Which conditions are associated with HBV infections
Glomerulonephritis, serum sickness, polyarteritis nodosa
What are the lab values seen in HBV infection
Highly elevated ALT/AST
-normal alkaline phosphatase and bilirubin
When is the HBV surface antigen present
Infection, whether acute or chronic
What are antibodies to HBV surface antigen present
When immune, so if cleared a prior infection, or immunization
When are IgM against HBV core antigen present
Window period, acute and chronic infection
When are IgG against HBV core protein antigen present
Chronic infection and if had a prior infection
When is the HBV e antigen present
Only sure acute and chronic infection as it is a sign of viral replication
What is the HBV DNA present.
Acute and chronic infection, as it means the virus is present
What are some complications with Hepatitis C infection
Cirrhosis, HCC, mixed cyroglobulemia, lichen planus, autoimmune thyroiditis, decreased cholesterol levels
Which hepatitis infection is associated with polyarteritis nodosa
HBV
Which hepatitis infection is assocaited with mixed cyroglobulemia
HCV
What diagnostic method is used to check for presenc eor absence of fibrosis in chronic hepatitis
Serum FibroSure or ultrasound
Which drugs can elicit toxic hepatitis
- Isoniazid
- Sulfonamides
- Acetometaphen
What is the treatment/therapy for acetaminophen poisoning
Sulfhydryl compounds (N acetlycystine aka NAC)
*Use Rumack Matthew Nomogram
What is fulminant hepatitis
Massive hepatic necrosis with impaired consciousness occuring within 8 weeks of the onset of illness
What are the findings in the case of fulminant hepatitis
Rapidly shrinking liver
Rapid rising bili
Prolonged PT
Hepatic failure encepephalopathy
What is a Maddrey’s discrimination function and what is the value with a poor prognosis
Looks as liver function:
-PT and bilirubin are involved
Values >32 are poor prognosis
Before giving glucose to a recovering alcoholic, what must absolutely be given first and what is the consequence if you do not
Folic acid, otherwise my lead to Wernicke-Korsakoff syndrome
What are som of the history factors that may lead to increase risk for PBC
-Smoking, UTI, Hormone replacement, hair dye
What are the clinical manifestations for PBC
-Pruritus, xanthelasma (cholesterol deposits in the eyelid), asymptomatic elevation of alkaline phosphatase
What is the antibody normally present in patients with autoimmune hepatitis
Antismooth muscle
What is the treatment for autoimmune hepatitis
Glucocorticoids
What are the common associations with hemochromatosis
Hepatic issues
Cardiac issues
Hypogonadism
Arthritis
Patients with hemochromatosis are at an increased risk of infection with with organisms
- Vibrio vulnificus
- Listeria monocytogenes
- Yersinia enterocolitica
What are the laboratory findings in a patients with hemochromatosis
Elevated plasma iron greater than 45% transferrin
What is the treatment for hemochromatosis
Cheating agent deferoxamine
What is the genetic mutation in Wilson’s disease
ATP7B
What condition is considered for the following things in a young child:
- Hepatitis
- Splenomegaly with hypersplenism
- Coombs- negative hemolytic anemia
- portal hypertension
- neuro abnormalities
Wilson disease
What is the cause of nutmeg liver
Right sided heart failure
In Budd chair I syndrome, what is the prominent in the liver
Prominent caudate liver lobe
What is the diagnostic test to look for hepatic vein obstruction or Budd chairing syndrome
- Contrast enhanced ultrasound
- Color or Doppler ultrasoundography
What pattern in imaging can lead to diagnosis with Budd chair I or hepatic vein obstruction
Spider Webb pattern with caval webs
What can Budd chiari or hepatic vein obstruction lead to
Nutmeg liver
What can anti-alpha 1 trypsin lead to in the lower lobes
Panacinar emphysema
What are the hallmark lab findings in ischemic hepatitis
- Elevation of the serum aminotransferases
- Early rise in the serum lactate dehydrogenase (LDH)
The presence of jaundice in ischemic hepatitis is associated with which outcomes
Poor outcomes
When there is ischemic hepatitis and there is passive congestion of the liver, what reflex is present and what is the result
The hepatojugular reflex, with tricuspid regurgitation of the liver that can be pulsitile
What are the three non-cirrhosis causes of portal hypertension
Portal vein thrombosis
Portal vein obstruction
Schistosomiasis
Pyogenic liver abscesses seem to be associated with which increased risk
GI malignancy
What is the most common cause of hepatic abcess formation
Ascending cholangitis
Liver abscesses can be secondary to which conditions
Appendicitis and diverticulitis
Which organisms are the most frequently causing liver abscesses
Ecoli
Klebiella
Proteus vulgaris
Enterobactor aerogenes
Cavernous hemangiomas are commonly found in which patient population
Women on hormonal therapy
What is the characteristic of the vasculature on hepatocellular adenomas
Hypovascular
What is the protocol for focal modular hyperplasia and discontinuing the cause
The cause is seen in women with oral contraceptives leading to hepatocellular adenomas, but discontinuation is not necessary, just needs to be monitored
What condition can lead to Dupuytren’s contracture, aka bent finger with thickening of the skin on the palm and tenderness
Cirrhosis
During cirrhosis, what conditions are common due to vitamin deficiencies
Glossitis and cheliosis (swollen patches at the corner of the mouth )
