GI Liver more

Question 1

Cilastozol used in peripheral artery disease

Answer 1

oh ok

Question 2

TZDs can help NASH

Answer 2

B/c reduces insulin resistance maybe

Question 3

Spider telangectasia can happen in liver failure/cirrhosis from high estrogen

Answer 3

oh ok

Question 4

What is budd chiari? Tx?

Answer 4

Thrombosis of hepatic vein or IVC. Presents with:

Ascites (BIG CLUE)
Hepatomegaly
Jaundice

RUQ pain, and the rest happening

Anticoag or shunting!

Question 5

What is SAAG? What is cutoff?

Answer 5

Serum Albumin - Ascites Albumin

(Serum-Albumin Ascites Gradient)

1.1 is cutoff. If more than that it is low ascites in albumin. So FROM PORTAL HTN

If less than that, high albumin in ascites, or low albumin in serum. Cancer, Tb in peritoneum, pancreatitis, Nephrotic…

Question 6

Ascites has high albumin and high LDH?

Answer 6

Means cancer caused it. Do workup for cancer

Question 7

Spontaneous bacterial peritonitis tx?

Answer 7

Albumin and 3rd gen ceph

Question 8

Portal HTN tx?

Answer 8

SPironolactone and furosemide
Beta blockers
Vasopressin
Hepatic shunting

Question 9

Abd pain, testiculur atrophy, arhtralgia, polydipsea, has what kind of cardiomyopathy?

Answer 9

Hemochromatosis (test atrophy is from deposition in pituitary)

Dilated more common than restrictive

Question 10

Screening test for hemochromatosis? Aut rec

tx

Answer 10

Ferritin.

Then biopsy is to see extent

Phlebotomy is tx once per week or so

avoid booze b/c always avoid it in liver disease

Question 11

Complications of hemochromatosis?

Answer 11

Cirrhosis, hep carcionoma, CHF, diabetes, hypopituitarism (all makes sense)

Question 12

Wilson caused by what

Answer 12

impaired copper secretion. You will find low ceruloplasm for screening (not the cause of it, but you find it)

Builds in liver, brain, cornea

Depression, personality change, loss of coordination, parkinsonian like symptom, tremor

Jaundice, hepatomegaly, cirrosis

Keyser flescher rings in cornia

Question 13

Wilsons tx?

Answer 13

Trientine or penicillamine to chelate copper

zinc
restrict copper
Vit B6 supplements
Liver transplant

Question 14

Alpha1 antitrypsin does what? Who you suspect?

Answer 14

inhibits elastase. So breaks down elastin in lungs

In liver, it Alpha 1 antitrypsin accumulate in liver, and that is toxic

Codominant, one bad gene, might get COPD in a smoke at a young age. If double bad genes bad early on (before 30)

Question 15

Antibodies in autoimmune hepatitis? Tx?

Answer 15

Anti-smooth muscle (classic type 1)

Liver kidney microsomal LKM antibodies

Tx with azothiprine and steroids

Question 16

Benign liver issues associated with what?

Answer 16

OCP use. Hep adenoma, focal nodular hyperplasia, hemangioma, hep cyst

Question 17

What is associated with hepatic adenoma?

Answer 17

Benign tumor

OCP use
Steroids use (trend with hormones)
Glycogen storage disease

Can have mass effect and pain
Malignant transformation in 10%

Question 18

Tx of hepatic adenoma?

Answer 18

AFP screening or serial imaging after stopping OCP

Resection if grows b/c 10% goes malignant

Question 19

What do you do if hepatic cancer?

Answer 19

DO CT TO FIND WHERE METS CAME FROM

Consider colonoscopy

Question 20

Aflatoxin ingestion is risk for what?

Answer 20

Infected grain products

Question 21

Bruit over liver?

Answer 21

Consider cancer b/c lots of revascularization

SO TRY NOT TO BIOPSY B/c it will bleed

Question 22

Tx liver carcinoma?

Answer 22

Surger, chemo, transplant, ready to block bleeding

Question 23

Paraneoplastic stuff with hepatocarinoma?

Answer 23

Hypoglycemia
High Epo
Refractory watery diarrhea
Hypercalcemia
Skin lesions

Question 24

Epo is high with what? mnemonic

Answer 24

Potentially Really High Hematocrit

Pheo
Renal cell
Hepatocellular
Hemangioblastoma (CNS)