diseases of the liver Flashcards
cholestasis if isolated elevation of alk phos then consider
bone involvment
chronic hepatitis is what time from
over 3-6 months
what is anasarca and what is it from
full body swelling due to nephrotic syndrome or heart failure
ascites most common cause from
portal HTN from chronic liver disese
risk factors for chronic liver disedase
alcohol transfusions tattoos IVDU viral hepatitis
non portal HTN causes
infections
malignancy
inflammatory disorders
ductal disruption
risk factors for NAFLD
hispanics
people with psoriasis
cholecystecomy and heavy soft drink consumption
non alcoholic fatty liver cna lead to
CVD
cirrhosis
colorectal cancer
CKD
other causes of fatty liver
vinyl chloride
CCl4
yellow phosphorus
non alcoholic fatty liver disease symptoms labs etiology histology diagnose tx
usually asymptomatic
-mild RUQ discomfort, hepatomegaly
normal or increased transaminase and alk phos
obesity, DM, hypertriglyceridemia, metabolic syndrome
histo: NAFLD macrovesicular steatosis
- NAFLD–>NASH: macrovesicular steatosis and focal infiltration by PMNs and mallory hyalin
US to demonstrate macrovascular steatosis
liver bx diagnositc
tx: lifestyple modification
what is first step with pt with ascites
abdominal ultrasound
noninvasive
someone who comes in with abdominal pain with known ascites and a fever and altered mental status must rule out
spontaneous bacterial peritonitis
-this is the #1 differential in any cirrotic that comes in with ascites and showing decompensation
in person with liver cirrhosis that is severely malnourished maybe from alcohol is super at risk for ____ for cause of acites
what test preformed
TB
adenosine deaminase
with a chylous ascites what level test do you do
triglyceride level
how do you calculate SAAG
serum albumin - ascitic fluid albumin
what test looks for esophageal varices
esophagoduodenoscopy
EGD
pt with HCV and liver scarring
spontaneous bacterial peritonitis most common pathogens
E coli, or klebsiella pneumonia
or strep pneumo or viridans or engerococus
SBP in what pts
10-20% of known cirrhoti pts
presenting with decompensation–> worsening encephalopathy, fever, ab pain, worse renal function
PMN highly suggestive of bacterial peritonitis
PMN >250/mcL with >75% of all white cells
symptoms of hepatitis A
labs
treatment
anorexia malaise aversion to smoking mild RUQ acute increased aminotransferases--> eleevated alk phos and bilirubin self limited
HBV labs
increased aminotransferases–>elevated alk phos and bilirubin
where is chronic HBV endemic
asia and sub saharan africa
maternal transission
risk of what with chronic HBV
HCC
cirrhosis
endemic areas of HDV
africa
central asia
eastern europe
amazon region of brazil
in pt with anti hcv positivity what should you do with them
recommend ordering HCV RNA
what does anti-HCV in serum but negative HCV RNA mean
recovery from past infection
complications of CV
mixed cryoglobulinemia membranoproiferative GN increased risk for non-hodkin lymphoma cirrhosis and HCC decrease in serum cholesterol and LDL
HCV genotype 3 increases risk for
hepatic steatosis
hcv screening recommendations
people born between 1945 and 1965
HEV risk factors
those treated with tacrolimus for immunosuppression tend to get Hep E
africa
liver transplant pts
(a1-antitrypsin deficiency is #1 reason for child to get liver transplant)
HEV is spread how
waterborne
spread by swine
pets in home
consuming undercooked organ meats
treatment of HEV
what kind of virus
self limited
RNA hepevirus
fulminant acute liver failure
subfulminant
hepatic encephaolpathy w/in 8 wks after onset of acute liver disease. INR over 1.5
8w-6m after onset
leading causes of death in acute liver failure
cerebral edema and sepsis
treatment of acute liver failure
tylenol OD
supportive
corticosteroids of uncertain value
stress gastropathy prophylaxis
N-acetylcysteine in tyleono OD
tylenol OD treat with
important to get a ___ hr acetaminophen level
criticial ingestion treatment interval for max protection against severe hepatic injury is btwn ___ and __ hrs
N-acetylcysteine
4 hour acetaminophen level
0 and 8 hours
autoimmune hepatitis
most common in young mid age women \+ANA and or SM AB anti-LKM1 AST/ALT can be >1000 units/L billi increased
treatment autoimmune hepatitis
steroids and azathioprine
increased risk with autoimmune hepatitis
cirrhosis and HCC
drugs that cause hepatitis that histologicaly mimic autoimmune hepatitis are
nitrofurantoin minocyline ASA NSAIDs terbinafine TNF inhibitor isoniazid
what cant you give in a thymine deficient alcoholic before administering thymine (B1)
dextrose
will cause wernecke korsakoff
what gives you a megaloblastic anemia
folic acid and B12 deficiency
when do you get severe alcoholic hep with 50% mortality
when total bili over 10 mg/dL and PTT over 6 sec
susceptible to infections too
risk of alcoholic cirrhosis with
over 50g daily for over 10 years
what is the maddrey discriminant function
disease severity and mortality risk in pts with alcoholic hepatitis estimated by this (DF)
need PTT, and bilirubin
if value over or = to 32 then have high short term ortality and may benefit from treatment with gluocorticois
lower score doesn’t benefit
glasgow alcoholic hepatitis score
age bilirrub bun ptt peripheral wbc
score over 9 or =9 then survival benefit with glucocorticoids
hepatic encephalopathy grading:
somnolence to semistupor, responive to verbal stimuli
confusion
gross disorientation, bizarre behavior
grade 3
hepatic enceph alopathy grading: trivial lack of awareness shortened attention span impaired performance of addition euprhoia or anxiety
grade 1
hepatic encephalopathy grading:
lethargy or apathy min disorientation for time or place subtle personalitiy change inapprop behavior impaired performance of subtraction
grade 2
hepatic encephalopathy grading:
coma
grade 4
cirrhosis labs
macrocytic andemia decreased wbc infection SP thrombocytopenia prolonged PTT modes elevation in AST (ALT) and alk phos and total bili decrease albumin increased risk DM vitamin D deficiency--> osteoporosis
cirrhosis imaging
lUS contrasted CT or MRI, biopsy fibrosure liver iopsy egd
criteria in child pugh score
APE AB
ascites
bilirubin
encephalopathy
albumin
ptt
