GI test 1: Fibrosis-peliosis hepatitis Flashcards
What is fibrosis? What is it due to?
scarring, accumulates in the liver in response to chronic, repeated cell injury
What are the causes of fibrosis?
d/o’s w/hepatic effects, d/o’s affecting hepatic blood flow, drugs & chemicals
What are the ssxs of fibrosis?
Asx, sxs that present will be secondary to the primary disorder
What is cirrhosis?
late stage of hepatic fibrosis that has resulted in widespread distortion of normal hepatic architecture
Causes of cirrhosis?
d/o’s w/hepatic effects, d/o’s affecting hepatic blood flow, drugs & chemicals
SSxs of cirrhosis?
non-specific (anorexia, fatigue, weight loss); late manifestations: portal HTN
PE’s for cirrhosis?
skin: pallor, jaundice, petechiae, purpura
abd: ascites, splenomegaly
extremities: nail clubbing
W/u for cirrhosis?
labs: LFTs often normal
coagulation tests: PT
CBC
viral tests (to look for cause)
Prognosis for cirrhosis?
IRREVERSIBLE
What is primary biliary cirrhosis? What 3 diseases can it lead to?
autoimmune liver d/o w/progressive destruction of intrahepatic bile ducts–> cholestasis, cirrhosis & liver failure
What is your patient picture for someone who is likely to develop primary biliary cirrhosis? What sxs will they present with?
middle aged women w/classic sxs: unexplained pruritis, fatigue, RUQ pain, jaundice
Ssxs of primary biliary cirrhosis?
insidious fatigue, pruritis, dry mouth, RUQ pain
PE for primary biliary cirrhosis?
enlarged, firm, non-tender liver
mb splenomegaly
W/u for primary biliary cirrhosis?
labs: elevated GGT, alk phos & anti-mitochrondrial abs; minimally abn AST & ALT
What two blood vessels supply blood to the liver?
portal vein (2/3): rich in nutrients & relatively high in O2 hepatic artery (1/3): supplies rest of O2
What vessel drains the liver? Where do they drain to?
hepatic veins: drain into IVC
What ways can the liver be damaged? (big picture)
- ischemia
- insufficient venous drainage
- specific vascular lesions
What are the 2 types of hepatic ischemia?
ischemic hepatitis
ischemic cholangiopathy
What is ischemic hepatitis?
diffuse liver damage dt inadequate blood or O2
Causes of ischemic hepatits
systemic: impaired hepatic perfusion, hypoxemia, increased metabolic damage (sepsis)
SSxs of ischemic hepatisis
N/V, tender hepatomegaly
W/u for ischemic hepatitis
VERY HIGH aminotransferases, moderate inc in bilirubin, LDH increases w/in hrs of ischemia
Imaging for ischemic hepatitis
US, MRI, arteriography (obstructed vessel)
What is ischemic cholangiopathy?
focal damage to biliary tree dt disrupted flow from hepatic artery via peribiliary arterial complex
Causes of ischemic cholangiopathy & what it results in (one main thing & 3 subsequent dzs)
vascular injury during procedures which results in bile duct injury= cholestasis, cholangitis, biliary strictures
SSxs of ischemic cholangiopathy
pruritis, pale stool
W/u for ischemic cholangiopathy
labs: cholestasis, UA dark urine
imaging: US but most will require MRCP, ERCP to r/o cholelithiasis or cholangiocarcinoma
What is congestive hepatopathy?
diffuse venous congestion in liver dt RHF
SSxs of congestive hepatopathy?
most asx
RUQ discomfort
severe congestion: massive jaundice
PE for congestive hepatopathy
ascites, hepatomegaly, (+) hepatojugular reflex (unlike in Budd-Chiari syndrome)
Labs for congestive hepatopathy
moderately elevated LFTs
What are the 2 type of hepatic artery d/o’s? Which is uncommon?
hepatic artery occlusion
aneurysm (uncommon)
Causes of hepatic artery occlusion
thrombosis, emboli, iatrogenic, vasculitis, structural abn, eclampsia, cocaine, sickle cell crisis
SSxs of hepatic artery occlusion
infarc may be asx or may= RUQ pain, fever, N/V & jaundice
W/u for hepatic artery occlusion
US usu followed by angiography
Causes of hepatic aneurysm
arteriosclerosis, trauma, vasculitis, infxn
W/u of hepatic aneurysm, prognosis of hepatic aneurysm
US followed by contrast CT to confirm, untreated may cause DEATH
2 types of hepatic vein d/o’s?
Budd-Chiari syndrome
Veno-occlusive dz
What is Budd-Chiari syndrome?
obstruction of hepatic venous outflow from small hepatic veins inside liver to IVC & R atrium
Causes of Budd-Chiari?
hypercoagulability- clot obstructs hepatic veins & IVC
SSxs of Budd-Chiari? acute vs chronic?
none to fulminant liver failure
acute: fatigue, RUQ pain, N/V, mild jaundice
chronic: mb asx until progresses then mb fatigue, abd pain, hepatomegaly & edema
PE & labs for acute obstruction in Budd-Chiari?
PE: tender heptomegaly, ascites
labs: high aminotransferases
W/u for Budd-Chiari?
LFTs, vascular imaging
Prognosis of Budd-Chiari?
most will die w/in 3 yrs of liver failure if left untx
What is veno-occlusive disease?
endo injury–> non-thrombotic occlusion of terminal hepatic venules & hepatic sinusoids
Causes of veno-occlusive disease
irradiation, graft vs. host dz, hepatotoxins
What kind of sx pic would you suspect veno-occlusion disease in?
pt w/unexplained liver dz AND matching hx (BM transplant, irradiation, etc)
SSxs of veno-occlusive dz?
sudden jaundice
PE for veno-occlusive dz?
ascites, tender, smooth hepatomegaly
W/u for veno-occlusive dz
lab: LFTs
procedures: US, liver bx
What is a portal vein disorder? (description & the one disorder we need to know)
obstruction of portal venous flow which results in portal HTN
portal vein thrombosis
Causes of portal vein thrombosis?
surgery, hypercoagulable states, CA, cirrhosis, trauma–> GI bleed from varices
SSxs of portal vein thrombosis?
usu asx unless another painful d/o like pancreatitis
W/u for portal vein thrombosis
lab: LFTs
procedure: US, usu shows decreased or absent portal vein flow & sometime thrombosis
What is peliosis hepatitis?
multiple blood-filled cystic spaces randomly occuring in the liver
Cause of peliosis hepatitis?
damage to sinusoidal lining cells from use of hormones
Ssxs of peliosis hepatitis?
usu asx but occ cysts rupture= hemorrhage & sometimes death
some develop jaundice, hepatomegaly & liver failure
