Gall Bladder & Liver Flashcards
2 Big Issues you should ask about?
Alcohol-consumption?
Hepatitis- Sexual activity? Drugs/needles? Tattoos?
Tests for hepatocyte damage?
Hepatic panel: ALP, AST, ALT, Ttil, and direct Bilirubin
Tests for hepatocyte function?
Bilirubin, Total protein, Albumin, Prothrombin time, BUN, Ammonia
ALT elevations are greater than AST elevations except when?
Cirrhosis Alcohol abuse (run a GGT for more info)
Alcoholic Cirrhosis
Sx: Wt loss, Pruritis, Jaundice, Clubbing of fingers, Dupuytren’s contracture, Dilated superficial abd veins, Ascites
PE: Ascites, Small hard bumpy liver, Jaundice, Yellow Sclera
Imx: US, CT, Liver biopsy
Labs: CBC, CMP, Prothrombin time, Increased Bilirun & Alk phase, GGT
Ddx: Biliary cirrhosis, Fatty liver, Hep C
Tx: Avoid alcohol, GF diet, 25,000 IU Vitamin A, 1tsp Probiotics/day
Alcoholic Hepatitis
Sx: Fever, Jaundice, Fatigue, Ascites, bleeding
PE: Ascites, Jaundice, Varicosities
Imx: Same as cirrhosis
Labs: Same as cirrhosis (except Alk Phos and Bilirubin)
Tx: Same
Ddx: Same
Alcoholic Fatty Liver
Sx: Usu asx. RUQ Pain, HTN, Muddy sclera.
Everything else similar to hepatitis
Cholecystitis
Sx: Acute-colicky RUQ pain, Rebound tenderness, Pain radiates to shoulder/flanks, sx gradually improve over 24hr. Chronic-Gas, diarrhea, RUQ pain
PE: +Murphy’s Sign
Imx: US, CT
Labs: CBC for WBC*, ALT, AST, Bilirubin, Alk Phos, Amylase
Ddx: Appendicitis, IBD, Diverticular disease, GERD, IBD, IBS
Tx: IV fluids, Cholescytectomy, Avoid fowl, eggs, onions, pork.
Cholelithiasis
Sx: 90% Asx. Biliary colic after fatty meal disappearing 30-90m later.
PE: +Murphys
Imx: US
Labs: CBC, CMP, Amylase & Lipase to r/o pancreatitis.
Ddx: IBS, Pancreatitis, Appendicitis, Pancreatic CA
Tx: Cholecystectomy, Avoid poor, fowl, eggs, lions. Bile salts TID (Cholochol)
Non Alcoholic Steatohepatitis (NASH)
Sx: Usu asx. Increased BP, Muddy sclera, Mylagia.
PE: Hepatosplenomegaly, blotchy skin on hands
Imx: Liver biopsy, US
Labs: Liver unction test, Hep B & C screening, CRP
Ddx: Alcoholic hepatitis, Hep B/C, Cirrhosis, Hepatic Steatosis
Tx: Diet, Exercise
