Goljan inflammatory and infectious disorders of liver Flashcards
pathogen for ascending cholangitis
E. coli
pathogen for liver abscess
E. coli;
Bacteroides fragilis;
streptococcus faecalis
pathogen for granulomatous hepatitis
mycobacterium Tb;
histoplasma capsulatum
pathogen for spontaneous peritonitis
E. coli in adults;
strept pneumoniae in children
pathogen for leptospirosis
leptospira interrogans
pathogen for amebiasis
entamoeba histolytica
pathogen for clonorchiasis
clonorchis sinensis (chinese liver fluke)
pathogen for schistosomiasis
schistosoma mansoni
pathogen for echinococcosis
echinococcus granulosus (sheepherder’s disease)
Define ascending cholangitis
inflammation of bile ducts (cholangitis) from concurrent biliary infection and duct obstruction (stone);
life threatening disease
clinical findings of ascending cholangitis
fever, jaundice, RUQ pain
What is ascending cholangitis likely to cause?
MC cause of multiple liver abscesses
Tx for ascending cholangitis
decompression and drainage;
piperacillin-tazobactam
Epidemiology for autoimmune hepatitis
type 1 is predominant form in US and worldwide (80%);
type 2 is uncommon in US;
young women
what are the range of autoimmune presentations?
symptomatic w/ increased transaminases;
fulminant hepatitis;
cirrhosis
Genetic associations w/ autoimmune hepatitis
HLA-D3 and DR4 association
What are autoimmune associations w/ AI hepatitis?
Hashimoto’s thyroiditis;
Graves’ disease
clinical findings of AI hepatitis
fever;
jaundice;
hepatosplenomegaly
lab findings for type I AI hepatitis
positive ANA (>60%);
anti-smooth muscle Ab (>85%);
increased serum transaminases;
decreased serum albumin in severe disease;
prolonged prothrombin time in severe disease
Tx for AI hepatitis
initial Tx w/ corticosteroids + azathioprine;
liver transplantation if resistant to Tx
where do a majority of liver abscess occur?
right lobe w/ majority being solitary
What are causes of liver abscess?
ASCENDING CHOLANGITIS (MC); INTRA-ABDOMINAL INFECTION (pathogen spread via portal vein, diverticulitis, bowel perforation); DIRECT EXTENSION (empyema of gallbladder, subphrenic abscess); HEMATOGENOUS SPREAD (bacterial endocarditis)
Clinical findings of liver abscess
spiking, intermittent fever;
RUQ or right CVA tenderness;
jaundice is uncommon
How is liver abscess diagnosed?
ultrasound (least expensive);
CT scan
Tx for liver abscess
percutaneous drainage;
metronidazole + ceftriaxone
What does granulomatous hepatitis indicate?
sign of miliary spread
When will spontaneous peritonitis occur?
develops in ascities => cirrhosis, nephrotic syndrome
Tx for spontaneous peritonitis
cefotaxime