Clinical stuff Flashcards
how to tell a spider angioma
it is blanchable, often seen on face and trunk…seen when estrogen is elevate (e.g. cirrhosis and pregnancy)
what are stigmata of liver disease?
spider angioma xanthalasma palmar erythema pruritus jaundice Terry Nails Leukonychia Dupuytren's
ascites/varices/caput medusa/hemmrhoids/splenomegaly –> portal hypertension
gynecomastia hepatic encephalopathy (confusion, asterixis) fetor hepaticus (mousy, sweet-ish breath)
What is an acute phase reactant?
a blood protein whose levels increase during inflammation (e.g. CRP, ceruloplasmin, fibrinogen, ferritin, A1AT) ***note that albumin goes down.
how is bilirubin toxic
cerebral toxicity
why do you have to be careful giving warfarin, sulfonamides, anti-inflammatories to newborns with jaundice?
because they bind albumin at the same site. they’ll displace bilirubin and can precipitate bilirubin toxicity
what is alpha-fetoprotein a marker for?
HCC, gonadal cancers…also elevated in pregnancy
what is clonorchis, where is it and what does it predispose to
a liver fluke found in the far east, cholangiocarcinoma
why can platelets be low in splenomegaly?
they are sequestered in the spleen
when would you maybe hear a bruit over the liver?
in alcoholic hepatitis
what is the AST:ALT ratio in alcoholic hepatitis vs. viral hepatitis?
2: 1 AST:ALT in alcoholic
1: 2 in viral
nephrotic range protein
3 mg/mg creatinine
what is metabolic syndrome?
some combination of : abdominal obesity high triglycerides high HDL Cho high blood pressure high fasting glucose (pre-diabetic)
increased echogenicity in the liver means…
fatty liver
What is the clinical picture of decompensated cirrhosis?
Some combiniation of:
ascites, bleeding esophageal/gastric varices, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome
Labs: hypoalbunemia, coagulopathy, hyperbilirubinemia
if someone has ascites w/o peripheral edema, how much fluid can you mobilize per day before you start depleting the intravascular volume?
0.5 L…furosemide or spironlactone
When do you start seeing coagulopathy in liver failure? (at what loss of function….)
90% loss of function
What are the common locations of portacaval anastomoses?
“the gut, butt and caput”
esophagus
rectal
paraumbilical
retroperitoneal
What is TIPS?
transjugular intrahepatic portosystemic shunt (a shunt placed between the portal vein and the venous outflow to relieve some pressure)
How to differentiate between an acute and chronic liver failure
look at the albumin…half life is 21 days
what are the alcohol intake guidelines in canada for men and women?
Both: not more than 2 a day
Men: not more than 14/wk
Women: not more than 9/wk
What is a triphasic CT scan?
A scan is done early and late arterial phase, and venous phase.
What is a Child-Pugh score?
A tool to determine the severity of liver disease. Includes bilirubin, INR, hepatic encephalopathy, ascites, albumin
most common malignant neoplasm of the oral cavity?
squamous cell carcinoma.
also a site for mets
leukoplakia should be considered ____ until proven otherwise
pre-cancerous
