hepatitis Flashcards
non alcoholic fatty liver disease
Risk factors are mainly those of metabolic syndrome, including obesity, type 2 DM, hypertension, and hyperlipidemia, steroids
Patients with NASH induced cirrhosis need US surveillance every 6 months due to what
increased risk of hepatocellular carcinoma
In non-alcoholic fatty liver disease ALT > AST. differentiate from what
alcoholic fatty liver disease where AST to ALT ratio is >2
Necrosis of liver cells followed by fibrosis and nodule formation.
cirhosis
what is end result of cirrhosis
End result is impairment of liver cell function and gross distortion of the liver architecture leading to portal hypertension
serum AFP if lvl higher than 200 suggest
HCC
hepatorenal syndrome
The development of acute kidney injury in a patient who usually has advanced liver disease, either cirrhosis or alcoholic hepatitis.
diagnosis of hepatorenal syndrome
o Oliguria
o Rising serum creatinine (over days to weeks)
o Low urine sodium (<10 mmol/L)
clinical features of ascites
• Fullness in the flanks with shifting dullness and fluid thrill. • Tense ascites is uncomfortable and produces respiratory distress.
• Pleural effusion (usually right sided) and peripheral edema may also be present.
• Meigs syndrome: triad of benign ovarian fibroma, ascites, and pleural effusion
what is SAAG ratio
Serum albumin – ascitic albumin (SAAG) ratio differentiates between different causes of ascites (Transudate vs Exudate). A high gradient (SAAG >11.1 g/L) indicates portal hypertension and suggests a nonperitoneal cause of ascites
what are causes of SAAG <11.1g/L (Exudate)
• Peritoneal carcinomatosis
• Peritoneal tuberculosis
• Pancreatitis
• Nephrotic syndrome
• Lymphatic obstruction (chylous)
causes of SAAG >11.1g/L (Transudate)
• Portal hypertension (cirrhosis)
• Heart failure
• Hepatic outflow obstruction (Budd-Chiari syndrome, venoocclusive disease)
what is asitic fluid protein
may be used to differentiate causes of ascites, esp. if ascitic albumin or serum albumin is not known
Ascitic T. Protein < 25
•Portal hypertension (cirrhosis)
•nephrotic syndrome
Ascitic T. Protein > 25
Heart failure
Spontaneous bacterial peritonitis (SBP)
-Most common infecting organism is Escherichia coli
-Suspect diagnosis in any patient with cirrhotic ascites who deteriorates
Management of ascites due to portal hypertension/cirrhosis:
o Dietary sodium restriction 40 mmol/day and oral spironolactone daily
o Furosemide daily is added if the response is poor
o Aim of treatment: to lose about 0.5 kg of body weight each day
o Too rapid diuresis causes intravascular volume depletion & hypokalemia which can precipitate encephalopathy.
o A rising creatinine level or hyponatremia indicates inadequate renal perfusion and the need for temporary cessation of diuretic therapy
portal vein formed by
union of superior mesenteric (from the gut) and
splenic vein (from the spleen) and transports blood to the liver.
The normal portal pressure is 5–8 mmHg. >10mmHg indicates
portal htn
Causes of Portal Hypertension Prehepatic
(due to blockage of the portal vein before the liver)
Portal vein thrombosis
post hepatic causes of portal HtN
Budd-Chiari syndrome (thrombosis in hepatic veins)
Right heart failure
Constrictive pericarditis
Inferior vena cava obstruction
what are most common causes of acute hepatic failure
Viral hepatitis and paracetamol overdose
what is acute hepatic failure
Hepatic failure characterized by encephalopathy and coagulopathy
hepatic encephalopathy
-Neuropsychiatric syndrome which occurs with advanced hepatocellular disease,
-Toxic substances normally detoxified by the liver bypass the liver via the collaterals and gain access to the brain.
