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Clin Med 3 > E2: Alcohol Related And Liver Cancer > Flashcards

E2: Alcohol Related And Liver Cancer Flashcards

1
Q

What are the 3 patterns of injury associated with ALD?

A

1) fatty liver
2) Alcoholic hepatitis
3) Chronic hepatitis with fibrosis or cirrhosis

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2
Q

What are the risk factors for ALD?

A
  • Daily drinking above the threshold of 1/day (women) or 2/day for men
    • women develop more severe ALD at lower doses with shorter duration
  • Increased BMI
  • Genetic factors
  • Co-existing CLD
  • Smoking
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3
Q

Is fatty liver reversible?

A

Yes, reversible with abs intense from alcohol after about 4-6 weeks

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4
Q

What is the treatment of fatty liver?

A

Lifestyle modifications and alcohol cessation

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5
Q

What is alcohol related hepatitis?

A

-Inflammation of the liver characterized by necrosis and fibrotic scarring, most likely to occur in chronic or current heavy alcohol consumption

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6
Q

What are the clinical features of alcohol hepatitis?

A
  • fever, leukocytosis
  • hepatic encephalopathy
  • spider angiomas
  • jaundice
  • hepatosplenomegaly with liver tenderness
  • edema
  • ascites
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7
Q

What finding on liver histology is consistent with Alcoholic hepatitis?

A

Mallory Denk body and neutrophilic lobular inflammation

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8
Q

How is a definite diagnosis of alcoholic hepatitis made?

A

Clinical diagnosis with liver biopsy confirmation

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9
Q

What is the management of alcoholic hepatitis?

A
  • Hospitalize with severe AH
  • in severe AH, treat with steroids with patients that are eligible and without contraindications
  • Discontinue alcohol, complete abstinence is essential in all patients
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10
Q

What is the most important factor is improving survival for patients with alcoholic hepatitis?

A

Discontinue alcohol use

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11
Q

What is hepatic encephalopathy?

A

-Failure of the liver to detoxify noxious agents of gut origin because of hepato-cellular dysfunction and portosystemic shunting

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12
Q

What is the best known neurotoxin that can precipitate hepatic encephelopathy?

A

Ammonia

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13
Q

How is hepatic encephalopathy treated?

A

Lab tulles for acute overt hepatic encephalopathy and secondary prophylactic therapy for an indefinite period of time

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14
Q

What are are the symptoms of grade I HE?

A

Changes in behavior, mild confusion, slurred speech, disordered sleep pattern

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15
Q

What are the signs of grade II HE?

A

Lethargy, moderate confusion, asterixsis

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16
Q

What are the symptoms of grade III HE?

A

Marked confusion, incoherent speech, and sleeping but can arouse

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17
Q

What are the symptoms of Grade IV HE?

A

Coma and unresponsive to pain

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18
Q

What is a stroop test used for?

A

The stroop test is a brief cognitive screening tool that evaluates psychomotor speed and cognitive flexibility
-Able to diagnose minimal hepatic encephalpathy with excellent sensitivity and specificity

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19
Q

What medications are given to treat hepatic encephelopathy?

A

Lab tulles and rifaximin

20
Q

What does the Lillie model do?

A

Calculates the likelihood of patients response to steroids

21
Q

What does an Maddreys Discriminant function (MDF) ≥32 predict?

A

Predicts 30-50 mortality at 28 days

22
Q

What does the model for End stage liver disease (MELD) do?

A

Calculates mortality rate in 90 days

23
Q

What is cirrhosis?

A

-Widespread destruction and regeneration of liver tissue and a marked increase in fibrotic connective tissue

24
Q

What is compensated cirrhosis characterized by?

A
  • Portal pressure <10
  • Median survival ~ 12 years
  • Clinical manifestations splenomegaly, thrombocytopenia, leukopenia, anemia, and AST elevation
25
Q

What is decompensated cirrhosis characterized by?

A
  • Increased portal pressure, decreased Liver function
  • medial survival is ~2 years
  • portal HTN, Porto-systemic shunting
26
Q

What is portal Hypertension?

A
  • Increased pressure within the portal venous system, commonly seen in decompensated cirrhosis and acute alcoholic hepatitis
  • Increased pressure promotes collateral circulation
27
Q

What are the 3 possible sites of obstruction to flow in portal hypertension?

A
  • Pre-hepatic: portal vein thrombosis
  • Intrahepatic: Cirrhosis
  • Post hepatic: CHF,
28
Q

What is the treatment for ascites?

A
  • adherence to less then 2g sodium per day
  • Lasix or spironolactone
  • fluid restriction
29
Q

How much albumin do you need to replace when performing a paracentesis?

A

6-8 grams of albumin for each liter >5 removed to prevent kidney injury

30
Q

When should you refer for liver transplant if a patient has cirrhosis?

A

If decompensated cirrhosis or a MELD ≥15

31
Q

What is the prognosis for alcoholic fatty liver?

A

-Complete resolution may occur if alcohol is stopped for 4-6 weeks

32
Q

What is the prognosis for alcoholic hepatitis?

A

Prognosis depends on severity. Mild cases are often reversible. Need to discontinue alcohol

33
Q

What are the possible complications of cirrhosis?

A
  • Portal HTN
  • Spontaneous bacterial peritonitis
  • Hepatic encephalopathy
  • Hepatomegaly syndrome
34
Q

What is the diagnostic criteria of Hepatorenal syndrome?

A
  • Signs of decompensated liver disease
  • absence of shock
  • renal impairment
  • no improvement with correction of volume status and albumin for ≥ 2 days
  • absence of other causes of AKI
35
Q

What are the clinical features of hepatorenal syndrome?

A

-Progressive rise in serum creatinine
-azotemia
-very low urine sodium concentration
-

36
Q

What is type 1 hepatorenal syndrome?

A
  • Rapidly and progressive renal failure with severe multi organ failure
  • median survival is ≤4 weeks
37
Q

What is type 2 hepatorenal syndrome?

A

Associated with refractory ascites

-median survival is 6 months

38
Q

How Is hepatorenal syndrome prevented?

A
  • use albumin IV with large volume paracentesis
  • Protect against GI bleeding with EGD surveillance or beta blocker use
  • No NSAIDs
  • SBP prophylaxis with ABX with Cipro or Bactrim
39
Q

What are the 4 types of benign liver lesions that do not require intervention?

A
  • Cavernous hemangioma <4cm
  • focal nodular hyperplasia
  • Simple cyst and asymptomatic
  • focal fatty change/sparing
40
Q

What are the benign liver lesions that require management?

A
  • Adenoma (malignant potential)
  • Liver abscess
  • inflammatory pseudo tumor
  • atypical/complex cyst and large symptomatic cysts
41
Q

What are the 3 malignant liver lesions?

A
  • Mets
  • Lymphoma
  • Primary liver neoplasm
42
Q

What are the 3 types of primary liver neoplasm?

A
  • HCC
  • Cholangiocarcinoma
  • other rare tumors
43
Q

What are neoplasms arising from parenchyma cells called?

A

HCC

44
Q

What are neoplasms arising from ductal cells called?

A

Cholangiocarcinomas

45
Q

What patients have a high risk for HCC?

A

Cirrhotic patients and non-cirrhotic Hep B

46
Q

What lab is often elevated in HCC?

A

Alpha fetoprotein

Clin Med 3 (17 decks)

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