CMS midterm key Flashcards
liver cirrhosis
irreversible, scar tissue replaces liver tissue
NASH is
> 5% hepatic steatosis PLUS hepatocellular injury and inflammation, with or without fibrosis
fat accumulation and ballooning degeneration
causes of NAFLD
obesity
T2D
dyslipidemia/hypertriglyceridemia
findings in liver disease
palpable liver edge, spider angioma, captut medusa, palmar erythema, gynceomastia, ascites, portal hypertesnion
bad AST/ALT ratio
> 1 in advanced fibrosis and cirrhosis
imaging for liver disease
ultrasonogrpahy
NASH can only be diagnosed by
liver biopsy and histology
obesity BMI, WC, Waist to hip
BMI >30
Waist circumference
females >35 inches
males >40 inches
Waist to hip
males >1
females >0.85
gold standard for assessing body fat
dual energy x ray absorptometry DXA
% obesity in north america
30%
primary vs secondary obesity
primary: increase calories and decrease activity [95% of cases]
secondary: genes, medications, medical conditions
gestational diabetes testing ; what and when
2 step oral glucose challenge at 24 weeks
pre eclampsia? at what week in gestation?
hypertension (140/90) and proteinuria and/ or end-organ dysfunction at 20 weeks gestation
(thrombocytopenia, increased ALT and AST, increased creatinine
if there is hypertension before 20 weeks gestation it is not pre eclampsia it is
chronic hypertension
need to be 20 weeks for pre eclampsia and have proteinuria
how much weight to gain in pregnancy if obese BMI >30
5-9kg/11-20lbs which is 0.2kg/0.5lbs per week
and gain in 2nd and 3rd trimester
menopause
non pathologic, estrogen deficient
obstructive sleep apnea and obesity
neck circumference> 40 cm
diagnose with polysomnography
NAFLD in obesity? how much weight loss?
NAFLD is 80-90% of obese adults
3-5% weight loss for steatosis
7-10% weight loss for NASH
lifestyle or meds or surgery for obesity?
BMI >30 or >25 with 2 risk factors= lifestyle modifications
BMI >35 or >27 with 2 risk factors = lifestyle and medications
BMI >40 or >35 with 2 risk factors= weight loss surgery (get lots of markers for vitamins and bones and what not every 6-12 months)
5 As of obesity
ask
assess
advise
agree
assist
idiopathic T1D
no pancreatic beta cell autoimmune… only like 5% of cases
screening for T1D
no
screening for T2D
yes- if asymptomatic with BMI >25 or risk factors (A1C>5.7, impaired fasting glucose, impaired glucose tolerance)
screen for T2d in kids
insufficient evidences; only if overweight and have 2 risk factors