Hepatic disorders Flashcards
Alcoholic hepatitis- Eti
- > 5 yrs drinking
- Increases with consumption/ # of years
- Mediated by TNF
- > 80g/day or >40 g/day
Alcoholic hepatitis- Sx
- Fever, RUQ pain, tender hepatomegaly, jaundice
- Acute or chronic inflammation and parenchymal necrosis
- Infection
- Ascites, encephalopathy
Alcoholic hepatitis- Dx
- AST> ALT by factor of 2
- alk phos & bilirubin elevated
- Depressed albumin
- Increased transferrin, hepatic iron
- Folic acid deficiency
Alcoholic hepatitis- Tx
- Give micronutrients
- Abstinence of alcohol
- Nutritional support.
Chronic viral Hep- Eti
- Hep B or C
- Inflammatory run of liver more than 3-6 months
- Lead to cirrhosis & heptocellular carcinoma
Chronic viral Hep- Sx
- N/V, RUQ abd pain
- Loss of appetite, fever, fatigue
- Diarrhea, light stools, dark urine
- Jaundice & icterus
Chronic viral Hep- Dx
Hbs-Ag & Hbe-Ag in serum
Chronic viral Hep- Tx
- Antiviral medication
- Cure for Hep C
Fatty liver- Eti
- Due to obesity, DM & hypertriglyceridemia
- Hallmark of insulin resistance
- Can be due to endocrine disorders
Fatty liver- Sx
- Asymptomatic
- Mild RUQ discomfort
- Hepatomegaly
Fatty liver- Dx
Percutaneous liver biopsy
- ALT:AST > 1
Cirrhosis- Eti
- 12th leading cause of death
- Mexican & african americans higher frequency
Cirrhosis- Sx
- Hepatosplenomegaly
- Fatigue, muscle cramps, wt loss
- Ascites, effusions, edema,
- Encephalopathy
- Abdominal vein dilation
- Hematemesis
- Jaundice
Cirrhosis- Dx
- Elevated AST & Alk phos
- Increased PTT, reduced clotting
- Macrocytic anemia
Cirrhosis- Tx
- Abstinence from alcohol
- Liver transplant
- Treat presenting symptoms
Hemochromatosis- Eti
- Increased accumulation of iron in liver
- Autosomal recessive
- Recognized in 5th decade
- White people
Hemochromatosis- Sx
- Arthropathy, hepatomegaly & hepatic dysfunction
- Skin pigment changes- to grey/ brown
- Cardiac enlargement
- Bleeding esophageal varices
Hemochromatosis- Dx
- Elevated plasma iron, serum ferritin
- Liver biopsy
Hemochromatosis- Tx
- Deferoxamine to chelate iron
- Transplant
- Phlebotomy
Hepatic encephalopathy- Eti
- 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
Hepatic encephalopathy-Sx
- Mild confusion -> drowsiness -> stupor -> coma
- Asterixis
- Delirium, day night reversal, dysarthria
Hepatic encephalopathy-Dx
- Elevated ammonia
- Abnormal liver tests
Budd- Chiari Syndrome- Eti
- Occlusion of hepatic portion of IVC
- Cases in India, China & S. Africa
- Due to thrombosis or HCC
Budd- Chiari Syndrome- Sx
- Tender, painful hepatic enlargement
- Jaundice, splenomegaly & ascites
- hepatic encephalopathy & varices
Budd- Chiari Syndrome-Dx
- Contrast enhanced doppler US
Budd- Chiari Syndrome- Tx
- Lifelong anticoagulation
- Shunting
Wilson disease- Eti
- Rate genetic disorder
- Under age 40
- Excessive copper absorption, increased deposition
Wilson disease- Sx
- Kayser- Fleisher ring
- Hepatitis, splenomegaly, portal hypertension
- Neuro manifestations- dysarthria, dysphagia, incoordination
Wilson disease- Dx
- Increased urine copper excretion
- Ceruloplasmin assay
Wilson disease- Tx
- Penicillamine or zinc to enhance excretion of copper
- Remove excess copper, restrict dietary copper
Portal hypertension- Eti
- Due to obstruction, shisto, splenic vein obstruction, fistula
- Cirrhosis & HCC
- Risks: BCP, preg. inflammatory diseases, injury
Portal hypertension- Sx
- Abd pain
- Splenomegaly
- Ascites
- Low grade hepatic encephalopathy
Portal hypertension- Dx
- Doppler US & CT
- MR angiography
Portal hypertension- Tx
- Anticoagulation
- Band ligation & beta blockers
Autoimmune Hepatitis- Eti
- Young/ middle aged women
- Following viral infection: hep A, EBV, toxins, measles
Autoimmune Hepatitis- Sx
- Healthy young woman with multiple spider angioma, cutaneous striae, hirsutism & hepatomegaly
- Amenorrhea
Autoimmune Hepatitis- Dx
- Smooth muscle antibodies
- liver-kidney antibodies
Autoimmune Hepatitis- Tx
- Prednisone
Primary biliary cirrhosis- Eti
- Middle aged women
- Autoimmune destruction of intrahepatic bile ducts
- Found by chance finding
- May be assoc with sjogre, thyroid, Raynaud, scleroderma
Primary biliary cirrhosis- Sx
- Fatigue & pruritus
- Hepatosplenomegaly
- Xanthomatous lesions
- Jaundice, steatorrhea
Primary biliary cirrhosis- Dx
- Liver biopsy
Primary biliary cirrhosis- Tx
- Urodeoxycholic acid
- Chochicine or methotrexate
MELD score
- Model for end-stage liver disease- quantification for transplant planning- prioritization, prognosis
- Serum bilirubin, serum creatanine & INR
