Disorders of the Liver Flashcards
Formula for Maddrey Discriminant Function Score
4.6 x (Patient PT - Control PT + Total Bilirubin in mg/dL)
Components of the Model for End-Stage Liver Disease (MELD) Score
Total bilirubin, creatinine, and INR
Most commonly implicated antibiotic in drug-induced liver disease
Amoxicillin-clavulanate
Most specific histologic criteria for autoimmune hepatitis
Interface hepatitis with lymphocytes and plasma cells in portal, periportal, or lobular areas
Absolute indications for treatment of autoimmune hepatitis (4)
(1) AST >10x, (2) AST >2x with gamma-globulin >2x, (3) bridging or confluent necrosis on biopsy, (4) symptoms: fever, nausea, vomiting, jaundice
Risk factors for progressive hepatic fibrosis in nonalcoholic fatty liver disease (4)
(1) Age >50, (2) BMI >28, (3) serum triglyceride levels >150 mg/dL, (4) ALT >2x
Most common screening test for Wilson disease
Serum ceruloplasmin
Kayser-Fleischer rings in Wilson syndrome indicate copper deposition in this layer of the cornea
Descemet membrane
Pathognomonic finding on liver biopsy in primary biliary cirrhosis characterized by focal duct obliteration with granuloma formation
Florid duct lesion
Gold standard for diagnosis of primary sclerosing cholangitis
Cholangiography
Pathologic hallmark of primary sclerosing cholangitis
Fibro-obliterative cholangiopathy
Portal vein pressure at which clinically significant portal hypertension occurs
8-10 mmHg
normal: 3-5 mmHg
Target heart rate when using nonselective beta-blockers for prophylaxis against variceal bleeding
Reduction in resting HR of 25% or 55-60/min
Frequency of surveillance endoscopy in patients with negative screening endoscopy for esophageal varices
Every 2-3 years
Most effective secondary prophylaxis for variceal hemorrhage
Nonselective beta-blockers plus endoscopic variceal band ligation
Most frequent complication of portal hypertension
Ascites
Definition of rapidly progressive reduction in renal function in type I hepatorenal syndrome
Doubling of the initial serum creatinine to greater than 2.5 mg/dL (221 umol/L) or a 50% reduction of the initial 24-h creatinine clearance to <20 mL/min/1.73 m2 in less than 2 weeks
Type of hepatorenal syndrome commonly associated with refractory ascites
Type II hepatorenal syndrome
Most effective treatment for hepatorenal syndrome
Liver transplantation
Diagnostic finding in hepatopulmonary syndrome on contrast-enhanced echocardiography
Microbubble visualization within the left atrium after 3-6 cardiac cycles
Confirmatory test for portopulmonary hypertension
Right heart catheterization
Hemodynamic criteria for portopulmonary hypertension (3)
(1) Mean PAP 25 mmHg or greater, (2) pulmonary vascular resistance 240 dynes/s/cm-5 or greater, and (3) PA occlusion pressure <15 mmHg
Portopulmonary hypertension has a poor prognosis when mean pulmonary artery pressures exceed this level
35 mmHg
not candidates for transplantation due to increased risk for perioperative death
Third leading cause of cancer-related death worldwide
Hepatocellular cancer
Most widely available and least expensive imaging modality for hepatocellular cancer
Ultrasound
Recommended interval for surveillance for hepatocellular cancer in patients with negative initial imaging
6 months
Most effective therapy for early-stage hepatocellular cancer
Liver transplantation
Group of fulminant hepatic failure with the best overall prognosis
Hyperacute liver failure (failure within 1 week)
Duration of acute liver failure
1 to 4 weeks (hyperacute if within 1 week, subacute if between 4-12 weeks)
Preferred therapeutic approach to a large symptomatic simple hepatic cyst
Laparoscopic fenestration
Benign liver lesion with a characteristic “central scar” on CT or MRI
Focal nodular hyperplasia
Benign liver lesion associated with the use of oral contraceptives
Hepatic adenoma
Indications for surgical resection of hepatic adenomas (2)
(1) Greater than 5 cm, (2) pregnancy is being considered
Pregnancy-related liver disease associated with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency
Acute fatty liver of pregnancy
