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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
Q

Causes of ischemic cholangiopathy & what it results in (one main thing & 3 subsequent dzs)

A

vascular injury during procedures which results in bile duct injury= cholestasis, cholangitis, biliary strictures

26
Q

SSxs of ischemic cholangiopathy

A

pruritis, pale stool

27
Q

W/u for ischemic cholangiopathy

A

labs: cholestasis, UA dark urine
imaging: US but most will require MRCP, ERCP to r/o cholelithiasis or cholangiocarcinoma

28
Q

What is congestive hepatopathy?

A

diffuse venous congestion in liver dt RHF

29
Q

SSxs of congestive hepatopathy?

A

most asx
RUQ discomfort
severe congestion: massive jaundice

30
Q

PE for congestive hepatopathy

A

ascites, hepatomegaly, (+) hepatojugular reflex (unlike in Budd-Chiari syndrome)

31
Q

Labs for congestive hepatopathy

A

moderately elevated LFTs

32
Q

What are the 2 type of hepatic artery d/o’s? Which is uncommon?

A

hepatic artery occlusion

aneurysm (uncommon)

33
Q

Causes of hepatic artery occlusion

A

thrombosis, emboli, iatrogenic, vasculitis, structural abn, eclampsia, cocaine, sickle cell crisis

34
Q

SSxs of hepatic artery occlusion

A

infarc may be asx or may= RUQ pain, fever, N/V & jaundice

35
Q

W/u for hepatic artery occlusion

A

US usu followed by angiography

36
Q

Causes of hepatic aneurysm

A

arteriosclerosis, trauma, vasculitis, infxn

37
Q

W/u of hepatic aneurysm, prognosis of hepatic aneurysm

A

US followed by contrast CT to confirm, untreated may cause DEATH

38
Q

2 types of hepatic vein d/o’s?

A

Budd-Chiari syndrome

Veno-occlusive dz

39
Q

What is Budd-Chiari syndrome?

A

obstruction of hepatic venous outflow from small hepatic veins inside liver to IVC & R atrium

40
Q

Causes of Budd-Chiari?

A

hypercoagulability- clot obstructs hepatic veins & IVC

41
Q

SSxs of Budd-Chiari? acute vs chronic?

A

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
Q

PE & labs for acute obstruction in Budd-Chiari?

A

PE: tender heptomegaly, ascites
labs: high aminotransferases

43
Q

W/u for Budd-Chiari?

A

LFTs, vascular imaging

44
Q

Prognosis of Budd-Chiari?

A

most will die w/in 3 yrs of liver failure if left untx

45
Q

What is veno-occlusive disease?

A

endo injury–> non-thrombotic occlusion of terminal hepatic venules & hepatic sinusoids

46
Q

Causes of veno-occlusive disease

A

irradiation, graft vs. host dz, hepatotoxins

47
Q

What kind of sx pic would you suspect veno-occlusion disease in?

A

pt w/unexplained liver dz AND matching hx (BM transplant, irradiation, etc)

48
Q

SSxs of veno-occlusive dz?

A

sudden jaundice

49
Q

PE for veno-occlusive dz?

A

ascites, tender, smooth hepatomegaly

50
Q

W/u for veno-occlusive dz

A

lab: LFTs
procedures: US, liver bx

51
Q

What is a portal vein disorder? (description & the one disorder we need to know)

A

obstruction of portal venous flow which results in portal HTN
portal vein thrombosis

52
Q

Causes of portal vein thrombosis?

A

surgery, hypercoagulable states, CA, cirrhosis, trauma–> GI bleed from varices

53
Q

SSxs of portal vein thrombosis?

A

usu asx unless another painful d/o like pancreatitis

54
Q

W/u for portal vein thrombosis

A

lab: LFTs
procedure: US, usu shows decreased or absent portal vein flow & sometime thrombosis

55
Q

What is peliosis hepatitis?

A

multiple blood-filled cystic spaces randomly occuring in the liver

56
Q

Cause of peliosis hepatitis?

A

damage to sinusoidal lining cells from use of hormones

57
Q

Ssxs of peliosis hepatitis?

A

usu asx but occ cysts rupture= hemorrhage & sometimes death

some develop jaundice, hepatomegaly & liver failure

CPD II (10 decks)

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