GI test 1: Portal HTN- hepatic granulomas Flashcards
What is portal HTN?
increased resistance to bf, usu from dz in liver or (uncommonly) from blockage of splenic or portal vein or impaired venous output
Causes of portal HTN, what does it lead to often?
cirrhosis (developed countries), schistosomiasis (endemic areas), hepatic vascular abn
often leads to eso varices, portal-systemic encephalopathy
Ssxs of portal HTN?
usu asx
sxs usu from complications: acute variceal bleeding, sudden, painless upper GI bleed
PE of portal HTN
low systolic BP splenomegaly ascites, PEd dilated abd wall veins (caput medusae) mb jaundice or spider angioma
Procedure for portal HTn to dx
direct portal P via transjugular catheter, US or CT reveals dilated intra-abdominal collateral arteries
Prognosis of portal HTN
mortality during acute variceal bleed may be >50%
predicted by degree of hepatic reserve & degree of bleeding
Causes of portal-systemic encephalopathy?
neuropsychiatric syndrome
cirrhosis, portal HTN, fulminant hepatitis
Precipitating causes of portal-systemic encephalopathy?
already have liver dz &: metabolic stressors, disorders that inc gut protein, non-specific cerebral depressants (EtOH)
Pathophys of portal-systemic encephalopathy
things that would normally be detoxified end up in systemic circulation–> possibility to be toxic to brain
SSxs of portal-systemic encephalopathy
constructional apraxia
uncommon: agitation & mania
characteristic flapping tumor (asterixis)= “liver flap”
W/u of portal-systemic encephalopathy
psychometric eval, CMP, EEG: diffuse slow-wave activity
What is postoperative liver dysfxn?
mild liver dysfxn after surgery even w/o pre-existing liver d/o’s, usu from ischemia or effects of anesthesia
Types of postoperative liver dyxfxn
postoperative jaundice
postoperative hepatitis
postoperative cholestasis
What is postoperative jaundice?
increased bilirubin & decreased clearance
often after multiple transfusions needed
usu worst few days post-op then clears
What is post-op hep?
insufficient liver profusion= transient perioperative hypoTN or hypoxia
LFT: high aminotransferases, bili only mildly elevated
resolves w/in a few days post-op
What is post-op cholestasis?
extrahepatic biliary obstruction dt intrabdominal complications or post-op drugs
What is a hepatic cyst?
fluid-filled mass
detected incidentally on US or CTusu
usu asx w/no clinical significance
What are benign liver tumors? Types?
relatively common, most asx
hepatocellular adenoma, focal nodular adenoma, hemangiomas, lipomas & fibromas
Ssxs of benign liver tumors?
hepatomegaly, RUQ discomfort, intraperitoneal hemorrhage
W/u of benign liver tumors?
labs: LFTs, usu normal to slightly abn
imaging: may require bx
What is primary liver CA known as?
hepatocellular carcinoma: most common type of liver CA, more common in East Asia & sub-Saharan Africa
Who does liver CA occur in? Risk factors?
pts w/cirrhosis, common in areas where hep B & C are prevalent
risk factors: HBV, HCV, hemochromatosis, alcoholic cirrhosis
Ssxs of primary liver CA?
previously stable cirrhosis pt presents w/RUQ pain, wt loss, RUQ mass, unexplained deterioration
some first 1st sx is bloody ascites, shock, peritonitis dt hemorrhage of tumor
W/u of primary liver CA
AFP will be high
imaging: CT, US or MRI
liver bx needed if dx unclear
Prognosis of primary liver CA
usu poor
Is metastatic liver CA more or less common than primary liver CA? Common sites?
more common than primary liver CA
GI tract, breast, lung, pancreas
Ssxs of met liver CA
early: asx
sxs usu non-specific: wt loss, anorexia, fever
PE of met liver CA
mb heptomegaly, hard or tender w/easily palpated nodules (advanced dz if nodes)
uncommon: hepatic bruits
mb splenomegaly
ascites if peritoneal seeding
jaundice only if tumor causing biliary obstruction
W/u for met liver CA
CT or MRI w/contrast
suspect in any pt w/wt loss, hepatomegaly & primary tumor elsewhere
definitive dx: liver bx
What are hepatic granulomas?
localized collections of chronic inflammatory cells w/epithelioid cells & giant multinucleated clles
Causes of hepatic granulomas?
drugs, systemic d/o, infxns (TB, schistosomiasis)
Ssxs of hepatic granulomas?
usu asx, if sxs occur they reflect the underlying cause (eg fever w/infxn)
W/u for hepatic granulomas?
LFTs, US, CT, MRI but not specific or diagnostic, DX: liver bx
