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CPD II > GI test 1: Portal HTN- hepatic granulomas > Flashcards

GI test 1: Portal HTN- hepatic granulomas Flashcards

1
Q

What is portal HTN?

A

increased resistance to bf, usu from dz in liver or (uncommonly) from blockage of splenic or portal vein or impaired venous output

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2
Q

Causes of portal HTN, what does it lead to often?

A

cirrhosis (developed countries), schistosomiasis (endemic areas), hepatic vascular abn
often leads to eso varices, portal-systemic encephalopathy

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3
Q

Ssxs of portal HTN?

A

usu asx

sxs usu from complications: acute variceal bleeding, sudden, painless upper GI bleed

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4
Q

PE of portal HTN

A 
low systolic BP
splenomegaly
ascites, PEd
dilated abd wall veins (caput medusae)
mb jaundice or spider angioma
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5
Q

Procedure for portal HTn to dx

A

direct portal P via transjugular catheter, US or CT reveals dilated intra-abdominal collateral arteries

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6
Q

Prognosis of portal HTN

A

mortality during acute variceal bleed may be >50%

predicted by degree of hepatic reserve & degree of bleeding

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7
Q

Causes of portal-systemic encephalopathy?

A

neuropsychiatric syndrome

cirrhosis, portal HTN, fulminant hepatitis

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8
Q

Precipitating causes of portal-systemic encephalopathy?

A

already have liver dz &: metabolic stressors, disorders that inc gut protein, non-specific cerebral depressants (EtOH)

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9
Q

Pathophys of portal-systemic encephalopathy

A

things that would normally be detoxified end up in systemic circulation–> possibility to be toxic to brain

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10
Q

SSxs of portal-systemic encephalopathy

A

constructional apraxia
uncommon: agitation & mania
characteristic flapping tumor (asterixis)= “liver flap”

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11
Q

W/u of portal-systemic encephalopathy

A

psychometric eval, CMP, EEG: diffuse slow-wave activity

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12
Q

What is postoperative liver dysfxn?

A

mild liver dysfxn after surgery even w/o pre-existing liver d/o’s, usu from ischemia or effects of anesthesia

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13
Q

Types of postoperative liver dyxfxn

A

postoperative jaundice
postoperative hepatitis
postoperative cholestasis

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14
Q

What is postoperative jaundice?

A

increased bilirubin & decreased clearance
often after multiple transfusions needed
usu worst few days post-op then clears

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15
Q

What is post-op hep?

A

insufficient liver profusion= transient perioperative hypoTN or hypoxia
LFT: high aminotransferases, bili only mildly elevated
resolves w/in a few days post-op

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16
Q

What is post-op cholestasis?

A

extrahepatic biliary obstruction dt intrabdominal complications or post-op drugs

17
Q

What is a hepatic cyst?

A

fluid-filled mass
detected incidentally on US or CTusu
usu asx w/no clinical significance

18
Q

What are benign liver tumors? Types?

A

relatively common, most asx

hepatocellular adenoma, focal nodular adenoma, hemangiomas, lipomas & fibromas

19
Q

Ssxs of benign liver tumors?

A

hepatomegaly, RUQ discomfort, intraperitoneal hemorrhage

20
Q

W/u of benign liver tumors?

A

labs: LFTs, usu normal to slightly abn
imaging: may require bx

21
Q

What is primary liver CA known as?

A

hepatocellular carcinoma: most common type of liver CA, more common in East Asia & sub-Saharan Africa

22
Q

Who does liver CA occur in? Risk factors?

A

pts w/cirrhosis, common in areas where hep B & C are prevalent
risk factors: HBV, HCV, hemochromatosis, alcoholic cirrhosis

23
Q

Ssxs of primary liver CA?

A

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

24
Q

W/u of primary liver CA

A

AFP will be high
imaging: CT, US or MRI
liver bx needed if dx unclear

25
Q

Prognosis of primary liver CA

A

usu poor

26
Q

Is metastatic liver CA more or less common than primary liver CA? Common sites?

A

more common than primary liver CA

GI tract, breast, lung, pancreas

27
Q

Ssxs of met liver CA

A

early: asx

sxs usu non-specific: wt loss, anorexia, fever

28
Q

PE of met liver CA

A

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

29
Q

W/u for met liver CA

A

CT or MRI w/contrast
suspect in any pt w/wt loss, hepatomegaly & primary tumor elsewhere
definitive dx: liver bx

30
Q

What are hepatic granulomas?

A

localized collections of chronic inflammatory cells w/epithelioid cells & giant multinucleated clles

31
Q

Causes of hepatic granulomas?

A

drugs, systemic d/o, infxns (TB, schistosomiasis)

32
Q

Ssxs of hepatic granulomas?

A

usu asx, if sxs occur they reflect the underlying cause (eg fever w/infxn)

33
Q

W/u for hepatic granulomas?

A

LFTs, US, CT, MRI but not specific or diagnostic, DX: liver bx

CPD II (10 decks)

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