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CPD II > GI test 1: Fibrosis-peliosis hepatitis > Flashcards

GI test 1: Fibrosis-peliosis hepatitis Flashcards

1
Q

What is fibrosis? What is it due to?

A

scarring, accumulates in the liver in response to chronic, repeated cell injury

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2
Q

What are the causes of fibrosis?

A

d/o’s w/hepatic effects, d/o’s affecting hepatic blood flow, drugs & chemicals

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3
Q

What are the ssxs of fibrosis?

A

Asx, sxs that present will be secondary to the primary disorder

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4
Q

What is cirrhosis?

A

late stage of hepatic fibrosis that has resulted in widespread distortion of normal hepatic architecture

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5
Q

Causes of cirrhosis?

A

d/o’s w/hepatic effects, d/o’s affecting hepatic blood flow, drugs & chemicals

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6
Q

SSxs of cirrhosis?

A

non-specific (anorexia, fatigue, weight loss); late manifestations: portal HTN

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7
Q

PE’s for cirrhosis?

A

skin: pallor, jaundice, petechiae, purpura
abd: ascites, splenomegaly
extremities: nail clubbing

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8
Q

W/u for cirrhosis?

A

labs: LFTs often normal
coagulation tests: PT
CBC
viral tests (to look for cause)

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9
Q

Prognosis for cirrhosis?

A

IRREVERSIBLE

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10
Q

What is primary biliary cirrhosis? What 3 diseases can it lead to?

A

autoimmune liver d/o w/progressive destruction of intrahepatic bile ducts–> cholestasis, cirrhosis & liver failure

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11
Q

What is your patient picture for someone who is likely to develop primary biliary cirrhosis? What sxs will they present with?

A

middle aged women w/classic sxs: unexplained pruritis, fatigue, RUQ pain, jaundice

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12
Q

Ssxs of primary biliary cirrhosis?

A

insidious fatigue, pruritis, dry mouth, RUQ pain

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13
Q

PE for primary biliary cirrhosis?

A

enlarged, firm, non-tender liver

mb splenomegaly

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14
Q

W/u for primary biliary cirrhosis?

A

labs: elevated GGT, alk phos & anti-mitochrondrial abs; minimally abn AST & ALT

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15
Q

What two blood vessels supply blood to the liver?

A 
portal vein (2/3): rich in nutrients & relatively high in O2
hepatic artery (1/3): supplies rest of O2
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16
Q

What vessel drains the liver? Where do they drain to?

A

hepatic veins: drain into IVC

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17
Q

What ways can the liver be damaged? (big picture)

A
  • ischemia
  • insufficient venous drainage
  • specific vascular lesions
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18
Q

What are the 2 types of hepatic ischemia?

A

ischemic hepatitis

ischemic cholangiopathy

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19
Q

What is ischemic hepatitis?

A

diffuse liver damage dt inadequate blood or O2

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20
Q

Causes of ischemic hepatits

A

systemic: impaired hepatic perfusion, hypoxemia, increased metabolic damage (sepsis)

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21
Q

SSxs of ischemic hepatisis

A

N/V, tender hepatomegaly

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22
Q

W/u for ischemic hepatitis

A

VERY HIGH aminotransferases, moderate inc in bilirubin, LDH increases w/in hrs of ischemia

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23
Q

Imaging for ischemic hepatitis

A

US, MRI, arteriography (obstructed vessel)

24
Q

What is ischemic cholangiopathy?

A

focal damage to biliary tree dt disrupted flow from hepatic artery via peribiliary arterial complex

25
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
26
SSxs of ischemic cholangiopathy
pruritis, pale stool
27
W/u for ischemic cholangiopathy
labs: cholestasis, UA dark urine imaging: US but most will require MRCP, ERCP to r/o cholelithiasis or cholangiocarcinoma
28
What is congestive hepatopathy?
diffuse venous congestion in liver dt RHF
29
SSxs of congestive hepatopathy?
most asx RUQ discomfort severe congestion: massive jaundice
30
PE for congestive hepatopathy
ascites, hepatomegaly, (+) hepatojugular reflex (unlike in Budd-Chiari syndrome)
31
Labs for congestive hepatopathy
moderately elevated LFTs
32
What are the 2 type of hepatic artery d/o's? Which is uncommon?
hepatic artery occlusion | aneurysm (uncommon)
33
Causes of hepatic artery occlusion
thrombosis, emboli, iatrogenic, vasculitis, structural abn, eclampsia, cocaine, sickle cell crisis
34
SSxs of hepatic artery occlusion
infarc may be asx or may= RUQ pain, fever, N/V & jaundice
35
W/u for hepatic artery occlusion
US usu followed by angiography
36
Causes of hepatic aneurysm
arteriosclerosis, trauma, vasculitis, infxn
37
W/u of hepatic aneurysm, prognosis of hepatic aneurysm
US followed by contrast CT to confirm, untreated may cause DEATH
38
2 types of hepatic vein d/o's?
Budd-Chiari syndrome | Veno-occlusive dz
39
What is Budd-Chiari syndrome?
obstruction of hepatic venous outflow from small hepatic veins inside liver to IVC & R atrium
40
Causes of Budd-Chiari?
hypercoagulability- clot obstructs hepatic veins & IVC
41
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
42
PE & labs for acute obstruction in Budd-Chiari?
PE: tender heptomegaly, ascites labs: high aminotransferases
43
W/u for Budd-Chiari?
LFTs, vascular imaging
44
Prognosis of Budd-Chiari?
most will die w/in 3 yrs of liver failure if left untx
45
What is veno-occlusive disease?
endo injury--> non-thrombotic occlusion of terminal hepatic venules & hepatic sinusoids
46
Causes of veno-occlusive disease
irradiation, graft vs. host dz, hepatotoxins
47
What kind of sx pic would you suspect veno-occlusion disease in?
pt w/unexplained liver dz AND matching hx (BM transplant, irradiation, etc)
48
SSxs of veno-occlusive dz?
sudden jaundice
49
PE for veno-occlusive dz?
ascites, tender, smooth hepatomegaly
50
W/u for veno-occlusive dz
lab: LFTs procedures: US, liver bx
51
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
52
Causes of portal vein thrombosis?
surgery, hypercoagulable states, CA, cirrhosis, trauma--> GI bleed from varices
53
SSxs of portal vein thrombosis?
usu asx unless another painful d/o like pancreatitis
54
W/u for portal vein thrombosis
lab: LFTs procedure: US, usu shows decreased or absent portal vein flow & sometime thrombosis
55
What is peliosis hepatitis?
multiple blood-filled cystic spaces randomly occuring in the liver
56
Cause of peliosis hepatitis?
damage to sinusoidal lining cells from use of hormones
57
Ssxs of peliosis hepatitis?
usu asx but occ cysts rupture= hemorrhage & sometimes death | some develop jaundice, hepatomegaly & liver failure

CPD II (10 decks)

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