Exam 2 ALCOHOLIC LIVER DZ Flashcards
Zone of Liver?
Zone 1: Surrounds portal tracts, O2 blood from hepatic aa enters
Zone 2: b/w 1 and 3
Zone 3: Surrounds central vv, deO2 blood
Portal Artery does?
Portal Vein does?
O2 blood to liver
GI blood to liver
Blood exits liver via hepatic vv into IVC
Hepatic Steatosis is?
Fatty liver from alcoholic dz
Most C ALD
U no outward signs
Hepatic Steatosis pathophys? (5)
↑ FFA moved from periph stores
↑ trigly prxdn
↓ FA oxidation
↓ lipoprotein release from liver
REVERSIBLE if EtOH stopped
Non-Alcoholic Steatosis/Steatohepatitis caused by? (6)
Obesiety DM Meds: amiodarone (antiarrhy), glucocort, nifedipine (CCB) Small bowel resection Jejunoileal bypass Peritoneal dialysis
Alcoholic Hepatitis pathophys? (4)
Fatty infiltration,
Neutrophils infiltrate necrotic hepatocytes,
Eosinophilic intracellular clumping (Alcoholic Hyaline/Mallory Bodies),
Fibrosis around hepatic venules
Summary: Necrosis, Fibrosis, Mallory Bodies
Alcoholic Hepatitis presentation? (7)
Asympt to severely ill: Fever Spider angiomas Jaundice Hepatomegaly w/ tenderness Ascites/Edema Oliguria, hypoNa+, hypoK+ Hepatic encephalopathy
Alcoholic Hepatitis labs? (6)
AST»_space; ALT (hepatic enzymes)
however, AST and ALT < 10x normal amount
GGTP (gamma glutamyl transpeptidase)»_space; alkaline phosphatase
PTT = prolonged
Bilirubin = ↑
RBC macrocytosis = folate deficiency
Fe/Transferrin/Ferritin = ↑
Alcoholic Hepatitis management? (6)
Hospitalize if seriously ill Low Na+ diet Diuretics Folate Monitor for encephalopathy P steroids
Mild cases P reversible
Cirrhosis pathophys?
Destruction of liver cells ->
Remodeling into nodules of regenerated hepatocytes + scaring
P Inflamm cell infiltration
Vasculature distortion -> ↑↑ blood flow bypasses scaring
Result is portal HTN, porto-systemic shunting, impaired liver fxn
Cirrhosis Micronodular vs Macronodular?
Micro = from EtOH or hemochromatosis
Macro = from viral hepititis
Cirrhosis presentation? (9)
Fatigue/Weak Ascites/Edema Dupuytrens contractures (thick palms) Palmar erythema/spider angiomas Jaundice Man boobs/shrunken testicles Venous collaterals of abd wall Splenomegaly (-penias) Weight loss/mm wasting
Cirrosis labs? (5)
Similar to EtOH Hep LFT = abnormal Anemia (↓folate, hemolysis, ↓hematopoiesis, GI bleed) Thrombocytopenia Coag = abnormal (↓ clot factor prdxn)
Cirrosis imaging? (3)
US for size, nodules, ascites
CT/MRI
Barium swallow for varices (varicose vv)
Cirrosis tx? (4)
Supportive
Stop EtOH (NOT reversible but may ↓ decline)
Monitor e-, renal fxn, hemo, fluids
No acetamin
Cirrosis complications? (4)
Portal HTN
Bacterial peritonitis
Hepatorenal synd
Hepatic encephalopathy
Portal HTN caused by obstructions where? (3)
Prehepatic: portal vein thrombosis
Intrahepatic: cirrhosis
Posthepatic: CHF, constrictive percarditis
Portal HTN leads to? (3)
Esoph varices/hemorrhoids
Splenomegaly
Ascites
Portal HTN tx? (4)
Na+ restriction
Fluid restriction
Spironolactone + (P) loop
Transjugular intrahepatic portosystemic shunt (TIPS)
TIPS procedure?
Beneficial?
stent b/w branch of hepatic vein and portal vein over catheter inserted thru jugular
Successful procedure but doesn’t ↑ survival
Hepatorenal Syndrome a/w?
Presentation? (5)
End stage liver dz
Azotemia (↑BUN) Oliguria HypoNa+ Low urine Na+ HypoTN
Hepatorenal Syndrome caused by?
Prognosis?
Unknown, dx of exclusion
Very poor
Hepatic Encephalophathy/Portosystemic Encephalopathy is?
Assoc signs? (3)
Neuropsych syndrome w/ conscious, behavior, personality and neuro ∆s
Asterixis (flapping tremor or liver flap)
Distinct EEG ∆s
FETOR HEPATICUS (musty)
Hepatic Encephalophathy caused by?
Hepatocellular dysfxn and portosystemic shunting ->
inability of liver to detox products from gut
AMMONIA most C toxin
Hepatic Encephalophathy precipitated by? (6)
GI bleed High protein diet Alkalosis HypoK+ Drugs Infection
Hepatic Encephalophathy disgnostics? (5)
Tx? (4)
Exclude other mentation disorders Identify/correct precipitants CBC, Chem panel, Ammonia levels
Protein restriction
Laxative
Neomycin or Metro
P liver transplant
Hepatic Neoplasms: Benign? (3)
Hemangiomas
Nodular hyperplasia
Mesenchymal tumors (fibroma, lipoma, leiomyoma)
Hepatocellular CA origin?
parenchymal cells (liver-specific fxn’l cells)
If from biliary duct = cholangiocarcimonas
Hepatocellular CA caused by?
Cirrhosis (80%)
Hep B/C
And Chronic liver dz
Hepatocellular CA presentation?
Cachexia (weak/weight loss/mm wasting)
Sudden ascites
Hepatocellular CA diagnostics? (4)
Alk Phosph = ↑
Alpha-fetoprotein (AFP) = ↑
CT/MRI = preferred
Bx = DIAGNOSTIC
Bx not needed if imaging + and AFP ↑
Hepatocellular CA tx?
Screening?
Surg, chemo, radio, transplant
Poor prognosis
All chronic Hep B
All cirrhosis from Hep C or EtOH
Q 6-12 mo w/ AFP and US
