GI EXAM II Flashcards
DILI- Cholestasis
Anabolic steroids, phenothiazine derivatives, total parenteral nutrition
DILI- Fatty change
Steroids
DILI- Acute Hepatitis
INH, Augmentin, Phenytoin
DILI- Fulminant Hep. Failure
Acetaminophen, Halothane
DILI- Chronic Hepatitis
α-methylDOPA, Isoniazid (INH)
DILI- Fibrosis/Cirrhosis
Methotrexate
DILI- Granulomatous Hepatitis
Allopurinol, Sulfa drugs
DILI- Hepatic Cell Adenomas
Oral contraceptive pills e.g. 1st generation
remove pill tumor regresses
DILI- Hepatocellular Carcinoma
Anabolic steroids
Epidemiological Associations
Hepatic adenoma
oral contraceptives
Epidemiological Associations (3)
Cholangiocarcinoma
Primary sclerosing cholangitis (PSC),
Clonorchis,Opisthorchis (Found mainly in Asia
–> irritation of bile ducts–> bile duct cancer)
Epidemiological Associations
Angiosarcoma
Arsenic, (poly)vinylchloride(PVC)
Epidemiological Associations (7)
Hepatocellular Carcinoma
Hepatitis B virus
•Hepatitis C virus
•Aflatoxin
•Cirrhosis (e.g. Hemochromatosis, Alcoholic liver dis.)
•Non-alcoholic fatty liver disease (NAFLD)
•Anabolic steroids
•Tyrosinemia/A1AT deficiency
Hepatitis B and Hepatocellular Carcinoma
Southeast Asia and Southern Africa
Stromal Tumors of the Liver
Malignant
Malignant •Angiosarcoma •Embryonal sarcoma •Leiomyosarcoma •Lymphoma
Stromal Tumors of the Liver
Benign
Benign •Hemangioma •Mesenchymal hamartoma •Angiomyolipoma •Leiomyoma •Inflammatory pseudotumor •Peliosis hepatis
Epithelial Tumors of Liver
Benign
Benign •Focal nodular hyperplasia •Hepatic cell adenoma •Bile duct hamartoma •Bile duct adenoma
Epithelial Tumors of Liver
Malignant
Malignant
•Hepatocellular carcinoma (HCC)
•Cholangiocarcinoma (CC)
Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis
Preferred (3)
Preferred - Tenofovir DF, Entecavir, Peg-IFN alfa-2a
Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis
Alternative
Alternative- Adefovir, Telbivudine*
Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis
Not Preferred
Not Preferred- Lamivudine
autoimmune hepatitis
Type 1
Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine
Type 1: ANA, ASMA, IgG hypergammaglobulinemia
Most common type
autoimmune hepatitis
Type 2
Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine
Type 2: Anti‐LKM.
Predominantly in children.
Rare in adults . Patients have more extra hepatic immunologic diseases, lower gamma globulins and higher tendency to develop cirrhosis despite steroid therapy
autoimmune hepatitis
Type 3
Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine
Type 3: Anti‐SLA. Rare It may rapidly progress to cirrhosis
What to order
Chronic liver disease/Cirrhosis- ascites
• Routine – Cell count – Albumin – Culture • Optional – Total protein – Glucose – Lactic dehydrogenase – Gram stain • Special – Cytology – TB smear and culture – Triglycerides – Bilirubin – Amylase
Hepatorenal syndrome progression may
be slow (type II) or rapid (type I).
• Type I disease frequently is accompanied
by rapidly progressive liver failure.
Diagnosis
Diagnosis
• creatinine clearance less than 40 mL/min
• a serum creatinine greater than 1.5 mg/dL,
• urine volume less than 500 mL/d, and a
• urine sodium less than 10 mEq/L is
present.
• Urine osmolality is greater than plasma
osmolality.
Clinically, the diagnosis may be reached if
central venous pressure is determined to
be normal or if no improvement of renal
function occurs following the infusion of at
least 1.5 L of a plasma expander
HEPATIC ENCEPHALOPATHY
What gets through BBB
and Grades
facilitate the passage of neurotoxins into the
brain [short-chain fatty acids, mercaptans,
false neurotransmitters (eg, tyramine,
octopamine, and beta-phenylethanolamines),
ammonia, and gamma-aminobutyric acid
(GABA) ]
• Grade 0 - Subclinical; normal mental status, but minimal
changes in memory, concentration, intellectual function,
coordination
• Grade 1 - Mild confusion, euphoria or depression,
decreased attention, slowing of ability to perform mental
tasks, irritability, disorder of sleep pattern (ie, inverted
sleep cycle)
• Grade 2 - Drowsiness, lethargy, gross deficits in ability to
perform mental tasks, obvious personality changes,
inappropriate behavior, intermittent disorientation
(usually for time)
• Grade 3 - Somnolent but arousable, unable to perform
mental tasks, disorientation to time and place, marked
confusion, amnesia, occasional fits of rage, speech is
present but incomprehensible
• Grade 4 - Coma, with or without response to painful
stimuli
