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GM 3 > Hepatic disorders > Flashcards

Hepatic disorders Flashcards

1
Q

Alcoholic hepatitis- Eti

A
  • > 5 yrs drinking
  • Increases with consumption/ # of years
  • Mediated by TNF
  • > 80g/day or >40 g/day
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2
Q

Alcoholic hepatitis- Sx

A
  • Fever, RUQ pain, tender hepatomegaly, jaundice
  • Acute or chronic inflammation and parenchymal necrosis
  • Infection
  • Ascites, encephalopathy
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3
Q

Alcoholic hepatitis- Dx

A
  • AST> ALT by factor of 2
  • alk phos & bilirubin elevated
  • Depressed albumin
  • Increased transferrin, hepatic iron
  • Folic acid deficiency
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4
Q

Alcoholic hepatitis- Tx

A
  • Give micronutrients
  • Abstinence of alcohol
  • Nutritional support.
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5
Q

Chronic viral Hep- Eti

A
  • Hep B or C
  • Inflammatory run of liver more than 3-6 months
  • Lead to cirrhosis & heptocellular carcinoma
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6
Q

Chronic viral Hep- Sx

A
  • N/V, RUQ abd pain
  • Loss of appetite, fever, fatigue
  • Diarrhea, light stools, dark urine
  • Jaundice & icterus
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7
Q

Chronic viral Hep- Dx

A

Hbs-Ag & Hbe-Ag in serum

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8
Q

Chronic viral Hep- Tx

A
  • Antiviral medication

- Cure for Hep C

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9
Q

Fatty liver- Eti

A
  • Due to obesity, DM & hypertriglyceridemia
  • Hallmark of insulin resistance
  • Can be due to endocrine disorders
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10
Q

Fatty liver- Sx

A
  • Asymptomatic
  • Mild RUQ discomfort
  • Hepatomegaly
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11
Q

Fatty liver- Dx

A

Percutaneous liver biopsy

- ALT:AST > 1

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12
Q

Cirrhosis- Eti

A
  • 12th leading cause of death

- Mexican & african americans higher frequency

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13
Q

Cirrhosis- Sx

A
  • Hepatosplenomegaly
  • Fatigue, muscle cramps, wt loss
  • Ascites, effusions, edema,
  • Encephalopathy
  • Abdominal vein dilation
  • Hematemesis
  • Jaundice
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14
Q

Cirrhosis- Dx

A
  • Elevated AST & Alk phos
  • Increased PTT, reduced clotting
  • Macrocytic anemia
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15
Q

Cirrhosis- Tx

A
  • Abstinence from alcohol
  • Liver transplant
  • Treat presenting symptoms
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16
Q

Hemochromatosis- Eti

A
  • Increased accumulation of iron in liver
  • Autosomal recessive
  • Recognized in 5th decade
  • White people
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17
Q

Hemochromatosis- Sx

A
  • Arthropathy, hepatomegaly & hepatic dysfunction
  • Skin pigment changes- to grey/ brown
  • Cardiac enlargement
  • Bleeding esophageal varices
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18
Q

Hemochromatosis- Dx

A
  • Elevated plasma iron, serum ferritin

- Liver biopsy

19
Q

Hemochromatosis- Tx

A
  • Deferoxamine to chelate iron
  • Transplant
  • Phlebotomy
20
Q

Hepatic encephalopathy- Eti

A
  • Ammonia & other toxic build up causing disordered CNS- failure of liver to detoxify
  • Alcoholic liver disease and chronic Hep C most common
  • Due to GI bleed, alkalosis, medication
21
Q

Hepatic encephalopathy-Sx

A
  • Mild confusion -> drowsiness -> stupor -> coma
  • Asterixis
  • Delirium, day night reversal, dysarthria
22
Q

Hepatic encephalopathy-Dx

A
  • Elevated ammonia

- Abnormal liver tests

23
Q

Budd- Chiari Syndrome- Eti

A
  • Occlusion of hepatic portion of IVC
  • Cases in India, China & S. Africa
  • Due to thrombosis or HCC
24
Q

Budd- Chiari Syndrome- Sx

A
  • Tender, painful hepatic enlargement
  • Jaundice, splenomegaly & ascites
  • hepatic encephalopathy & varices
25
Q

Budd- Chiari Syndrome-Dx

A
  • Contrast enhanced doppler US
26
Q

Budd- Chiari Syndrome- Tx

A
  • Lifelong anticoagulation

- Shunting

27
Q

Wilson disease- Eti

A
  • Rate genetic disorder
  • Under age 40
  • Excessive copper absorption, increased deposition
28
Q

Wilson disease- Sx

A
  • Kayser- Fleisher ring
  • Hepatitis, splenomegaly, portal hypertension
  • Neuro manifestations- dysarthria, dysphagia, incoordination
29
Q

Wilson disease- Dx

A
  • Increased urine copper excretion

- Ceruloplasmin assay

30
Q

Wilson disease- Tx

A
  • Penicillamine or zinc to enhance excretion of copper

- Remove excess copper, restrict dietary copper

31
Q

Portal hypertension- Eti

A
  • Due to obstruction, shisto, splenic vein obstruction, fistula
  • Cirrhosis & HCC
  • Risks: BCP, preg. inflammatory diseases, injury
32
Q

Portal hypertension- Sx

A
  • Abd pain
  • Splenomegaly
  • Ascites
  • Low grade hepatic encephalopathy
33
Q

Portal hypertension- Dx

A
  • Doppler US & CT

- MR angiography

34
Q

Portal hypertension- Tx

A
  • Anticoagulation

- Band ligation & beta blockers

35
Q

Autoimmune Hepatitis- Eti

A
  • Young/ middle aged women

- Following viral infection: hep A, EBV, toxins, measles

36
Q

Autoimmune Hepatitis- Sx

A
  • Healthy young woman with multiple spider angioma, cutaneous striae, hirsutism & hepatomegaly
  • Amenorrhea
37
Q

Autoimmune Hepatitis- Dx

A
  • Smooth muscle antibodies

- liver-kidney antibodies

38
Q

Autoimmune Hepatitis- Tx

A
  • Prednisone
39
Q

Primary biliary cirrhosis- Eti

A
  • Middle aged women
  • Autoimmune destruction of intrahepatic bile ducts
  • Found by chance finding
  • May be assoc with sjogre, thyroid, Raynaud, scleroderma
40
Q

Primary biliary cirrhosis- Sx

A
  • Fatigue & pruritus
  • Hepatosplenomegaly
  • Xanthomatous lesions
  • Jaundice, steatorrhea
41
Q

Primary biliary cirrhosis- Dx

A
  • Liver biopsy
42
Q

Primary biliary cirrhosis- Tx

A
  • Urodeoxycholic acid

- Chochicine or methotrexate

43
Q

MELD score

A
  • Model for end-stage liver disease- quantification for transplant planning- prioritization, prognosis
  • Serum bilirubin, serum creatanine & INR

GM 3 (9 decks)

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