DIT 2 Flashcards
findings in PBC besides fatigue and itching
skin - hyperpigmentaiton, xerosis
xanthomas/xanehtelasma
cirrhosis, jaundice, Malays, steatorrea
two rheum markers PBC and lab findings
- antimitochondrial
- ANA
- elevated Alk phos/bili/cholesterol (later disease)
PSC associated with….
UC
lab markers PSC
pANCA
elevated alk phos
ANA NEGATIVE
PSC increases risk for…
cholangiocarcinoma
enzyme that conjugates bilirubin
UDPGT
adolescent patient, mild asymptomatic jaundice that following exercise…dx and deficiency
Gilbert
increased indirect bilirubin 2/2 mild UDPGT deficiency
neonate, severe neonatal jaundice, kernicterus, usually fatal
Crigler Najjar type 1 (evil) …severe UDPGT deficiency
milder form Crigler Najjar type 2 (presents in childhood/adolescence)
rx crigler najjar 2
phenobarbital (increases UDGPT)
extra hepatic manifestations Hep C
membranoproliferative glomeruloneph mixed cryoglobulinemia lymphoma porphyria cutanea tarda lichen planus DM
extra hepatic manifestations Hep B
membranous nephropathy
polyarteritis nodosa, aplastic anemia
which hepatitis increases risk for HCC
hep B > hep C
HbsAg
active infection
HbsAb
recovered or vaccinated
HbcAb
ANY HISTORY OF HAVING DISEASE
IgM - early
IgG- late
HbeAg
active viral replication, HIGH INFECTIVITY
HbeAb
low infectivity
- HbsAg -HbsAB +IgG HBcAb
active infection window period
+ HbsAg -HbsAb +IgG HbcAb, low high Hbv DNA
chronic infection (immune tolerance) high disease state, no damage
pathological development of alcoholic liver disease
steatosis (reversible) -> steatohepatitis -> cirrhosis (increased HCC risk)
overweight patient, chronically elevated LFTs, no inflammation on imaging, no hx of alcohol or hepatitis
NAFLD -> NASH
increased risk obesity, DM, metabolic syndrome, insulin resistance
rx NASH for T2DM
TZDs (i.e. pioglitazone)
improves LFTs and possible histology
hand findings in cirrhotic patient
DUPUYTREN CONTRACTURE
asterexis
palmar erythema
digital clubbing
patient with ascites, hepatomegaly, jaundice….acutely can have RUQ pain, hepatomegaly, RAPID DEVELOPMENT jaundice and ascities
think Budd Chari (thrombosis of hepatic vein or intrahepatic/suprahepatic portion of IVC)
best initial study for Budd Chiari
US
how to differentiate between portal hypertension ascites and something else?
SAAG
serum albumin - ascites albumin
SAAG >1.1 = portal hypertension
Causes of non-portal hypertension ascites
SAAG <1.1
high albumin in ascites - TB, pancreatitis, serositis, infection, heart failure,
low albumin - nephrotic syndrome
SAAG in SBP?
greater than 1.1
associated with portal HTN
dx SBP
ascites gram stain/culture neutrophil ?250 elevate ascites LDH SAAG>1.1 low ascites glucose
rx SBP
third generation cephalopo (cefotaxime, ceftriaxone)
albumin to maintain plasma volume and preserve renal function
manifestations hemocrhomatosis
bronze diabetes heart - dilated/restrictive cardiomyopathy liver - hepatomegaly, cirrhosis joints - arthralgia skin - hyperpigmentation pancreas - DM
rx hemochromatosis (2)
serial phlebotomy iron chelators (deferoxamine)
what test to get to screen for hemochromatosis
ferritin (will be elevated)
transferrin will be elevated too
test to get for Wilson’s
ceruloplasmin (will be low)
rx Wilson’s (4)
copper chelators (pencil amine + trientene) restrict dietary copper liver transplant zinc supplements (interfere with copper absorption)
difference between pathologies of Wilson’s and hemochromatosis
wilson - LESS SECRETION (of copper)
hemochromatosis - LESS ABSORPTION (of iron)
patient comes in with emphysema and cirrhosis
dx and mode of inheritance
a1 antitrypsin deficinecy
CODOMINANT
a1 antitrypsin leads to OVERactivity of what
elastase (too much destruction of elastic tissue)
anti smooth muscle abx
type 1 AIH
liver-kidney microsomal (LKM) antigens
type 2 autoimmune hepatitis
liver cytosol antigen
type 2 autoimmune hepatitis
young female with vague RUQ comes in, incidentally finds a liver mass on imaging
hepatic adenoma
MAIN RISK FACTOR: OCP USE!!!
main risk factor for hepatic adenoma
OCP use
MCC malignant liver mass
LIVER METS! NOT HCC (MCC primary liver tumor)
next step in patient with incidentally found liver mass with malignant features
ASSESS FOR OTHER CANCERS
CT chest, abd, pelvis
colonoscopy
risk factors for HCC
Hep B
Hep C
cirrhosis
aflatoxin (food infected with aspergillius)
what paraneoplastic syndromes can HCC cause (4)
EPO - polycythemia
VIP - watery diarrhea
PTHr P - hypercalcemia
hypoglycemia
What cancers can cause polycythemia (4)
"Potentially Really High Hct" pheochromocytoma RCC HCC hemangioblastoma
elevated AFP
HCC
