GI Flashcards
term for increased liver fat
no inflammation
steatosis
What does NASH stand for
non-alcoholic steatohepatitis
increased liver fat
with inflammation
Steatohepatitis
Nash leads to
Fibrosis, cirrhosis and liver failure
risk factors for NASH
obesity
metabolic syndrome
-abd fat
-insulin resistance
-DM
-Dyslipidemia
-HTN
-PCOS
-obstructive sleep apnea
signs of end stage liver disease
palmar erythema
spider angioma
muscle wasting
jaundice
encephalopathy
what should you do with elevated ALT and symptoms of infection
reevaluate ALT 2-4 weeks after resolution of symptoms
for asymptomatic patients with elevated liver enzymes…when do you repeat
2 weeks
what viruses can elevate liver enzymes
influenza
EBV
CMV
SARS
elevated enzymes
things to rule out
viral hepatitis
-anti hep c AB
Hep B SA
-Anti Hep A AB
Celiac - tissue transglutaminase and total IgA
Hypothyroidism
Autoimmune hepatitis
-ANA
-Anti-liver/kidneyAB
-Anti-smooth muscle AB
-Total protein and IgG levels
tests for viral hepatitis
-anti hep c AB
Hep B SA
-Anti Hep A AB
tests for celiac
tissue transglutaminase and total IgA
tests for autoimmune hepatitis
ANA
-Anti-liver/kidneyAB
-Anti-smooth muscle AB
-Total protein and IgG levels
Wilson disease tests
Serum ceruloplasmin levels (low)
24 hour urine copper (elevated)
copper in liver biopsy
Kayser-Fleischer rings seen with slit lamp (Optho)
Kayser-Fleischer rings
wilson disease
what are things that elevate ALT
viral causes
NASH
NAFLD
Genetic - Wilson disease
treatment for Wilson disease
oral chelation (Triatine)
also d-penicillamine
(more side effects - n/v, leukocytosis, rash)
Zinc can also be a chelator
(75-150mg TID)
symptoms Gilbert syndrome
malaise
abd discomfort
fatigue
+/- jaundice
labs for Gilbert
total bili
retic
CBC
Periph smear
Genetic UGT1A1
genetic
UGT1A1
Gilbert
elevated CK can be from _____ _______ esp if AST >ALT
muscular dystrophies
AST is specific to ____
ALT is specific to ____
AST - Body
ALT - liver
Alpha 1 antitrypsin deficiency causes
liver and lung disease
in younger pt -> liver disease and cirrhosis
In adults it progresses to lung issues (emphysema)
what type of US looks for fibrosis of liver
RUQ US with elastography
symptoms for celiac
constipation
weight loss
bulky/foul smelling stools
floating stool
flatulence
abd distension
abd pain
oral lesions
liver tumor marker (lab)
Alpha fetoprotein (AFP)
GGT looks at
intrahepatic and gallbladder
platelets - what causes increase and what causes low
Infection - up
liver problems will cause lower
What does DILI stand for
Drug induced liver injury
biologics that can lead to DILI
chemotherapy
Accutane
adhd/psych meds
endocrine worries bout elevated liver enzymes on metformin, elaborate
Leave on metformin and trend liver enzymes…more likely metabolic ..may help due to weight loss
