Hepatobiliary Worksheet- Paulson (Exam 3) Flashcards
_________ _________ _________ is a progressive disease of the liver and gallbladder characterized by inflammation and scarring/fibrosis of intrahepatic and/or extrahepatic bile ducts.
Primary sclerosing cholangitis
Pt’s with Primary sclerosing cholangitis may be asymptomatic, or complain of _______, __________, _________, and/or ______ pain. Hepatomegaly and splenomegaly may also be seen.
jaundice, pruritis, fatigue, RUQ
In Primary sclerosing cholangitis, a cholestatic pattern is seen, with ___ usually predominantly elevated.
These pt’s may also have a positive ________, as well as elevated ________ and ___/_____.
ALP (predominantly)
P-ANCA
bilirubin, ALT/ AST
Multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on MRCP or ERCP would be indicative of __________ ___________ _________.
Primary sclerosing cholangitis
Primary sclerosing cholangitis is strongly associated with what 3 other conditions?
These pt’s are also at higher risk for developing ___________ (type of cancer).
inflammatory bowel dz, ulcerative colitis (90%), and +/- Crohns Dz.
Cholangiocarcinoma
What is the best definitive treatment for Primary sclerosing cholangitis?
Liver transplant
True or false?
No meds have been shown to slow the disease process in Primary sclerosing cholangitis.
TRUE.
UDCA is a med that is often used, but none have been proven to slow the Dz.
_________ _________ __________ is an autoimmune disease of intrahepatic small bile ducts, caused by T-cells attacking them causing gradual destruction/disappearance, which leads to cholestasis, and eventually cirrhosis/liver failure.
Primary biliary cirrhosis
Primary biliary cirrhosis is usually seen in what patient population?
middle aged women
Pt’s with primary biliary cirrhosis will have what symptoms?
Fatigue* Pruritus* RUQ discomfort jaundice hepatomegaly
Primary biliary cirrhosis will cause a significant elevation in _____ and ______. Almost all pt’s will have positive _________ antibodies.
ALP and GGT
Mitochondrial
What is the 1st line treatment for primary biliary cirrhosis?
UDCA (Ursodeoxycholic acid or Ursadiol)
__________ ___________ is a chronic disease with continuing hepatocellular inflammation and necrosis that tends to progress to cirrhosis.
Autoimmune hepatitis
Pts with autoimmune hepatitis may be asymptomatic or have symptoms like ____________, stigmata of chronic liver dz, ________, or _______ _______ _________.
hepatosplenomegaly
jaundice
acute liver failure
In autoimmune hepatitis, what 2 labs would you expect to be elevated?
These pt’s may also have _____ _______ antibodies or a positive ____.
Transaminases and bilirubin
smooth muscle antibodies
positive ANA
How would you make the diagnosis of autoimmune hepatitis?
Liver biopsy
What is the treatment for autoimmune hepatitis?
Prednisone and Azathioprine
then taper pred down
______ ______ _________ is the development of severe acute liver injury with encephalopathy and elevated INR (>1.5) in a pt without cirrhosis or pre-existing liver disease.
Acute liver failure
_____________ _________ is the most common cause of acute liver failure, but other common causes include _____ ________ and ________ _________.
Acetaminophen toxicity
drug reactions and viral hepatitis
Clinical manifestations of acute liver failure include? (There are 6)
encephalopathy (by definition) jaundice hepatomegaly RUQ tenderness renal failure thrombocytopenia
_______ __________ and ________ _______ often complicate acute liver failure.
Adrenal insufficiency and cardiac injury
In acute liver failure, you would expect to see (on labs) a PT/INR greater than ______, and elevated ______ and _____’s.
1.5
ammonia and LFT’s
What med is used in the tx of Tylenol overdose? What are you trying to prevent?
Acetylcysteine
Development of cerebral edema
What is the definitive treatment for acute liver failure?
Liver transplant
NAFLD is subdivided into what 2 categories?
What is the difference between these conditions?
NAFL (non-alcoholic fatty liver)
NASH (Non-alcoholic steatohepatitis)
Difference: in NAFL, hepatic steatosis is present without any significant inflammation, but in NASH hepatic steatosis is associated with inflammation. NASH may be histologically indistinguishable from alcoholic steatohepatitis.
True or false? NAFLD cannot progress into cirrhosis.
FALSE, NAFLD can progress into cirrhosis.
Name 4 major risk factors for NAFLD.
obesity
DM2
dyslipidemia
metabolic syndrome
True or false? Most pt’s with NAFLD are asymptomatic.
True.
If pts with NAFLD are symptomatic, what would you expect?
fatigue, malaise, vague RUQ discomfort
Labs on a pt with NAFLD would show mild to moderate elevations of what?
AST/ ALT
How would you definitively diagnose NAFLD?
liver biopsy
What is the treatment for NAFLD? What should these pt’s avoid?
WEIGHT LOSS is associated with histologic improvement.
Avoid: alcohol consumption
_______________ is the condition of excess iron absorption and deposition in parenchymal cells of the heart, liver, pancreas, adrenals, testes, pituitary, and kidneys.
Hemachromatosis
Hemochromatosis is most common in which population?
Men. (autosomal recessive)
Clinical manifestations of hemochromatosis usually begin after age ___ to _____ and include what? (there are 6).
age 40-50 yrs
weakness/lethargy, skin hyperpigmentation, arthralgia, cardiac enlargement +/- heart failure, diabetes, ED/impotence
Labs for hemochromatosis would show elevated serum ______ with increased _____ _________ and ______.
iron
transferrin saturation and ferritin
If you are trying to rule out or diagnose hemochromatosis, _________ testing can eliminate the need for a liver biopsy.
genetic
What is the treatment for hemochromatosis?
What should these pts avoid in their diet?
Therapeutic phlebotomy until iron stores are depleted, then begin maintenance (less frequently). If pt cannot tolerate phlebotomy, chelation therapy is recommended.
Pts should avoid Iron, Vit C, and alcohol
