Hepatology Flashcards
What is the pattern of hepatocellular injury?
- Very high ALT (specific)
- Very high AST (non-specific)
- Mildly high bilirubin
- Direct bilirubin >50% total bilirubin (because its conjugated hyperbilirubinemia)
What is the pattern of cholestatic injury?
- Very high alk phos
- Minorly high AST and ALT
- +/- jaundice
- Usually direct bilirubin is a high percentage (conjugated hyperbilirubinemia)
What is the pattern of Hep B and C?
Moderately high of everything (Alk phos, ALT, AST)
What is the pattern of muscle injury?
Very high AST, mildly high ALT. Normal bilirubin
What should you do in a patient with isolated unconjudgated (indirect) hyperbilirubinemia and no symptoms?
Nothing. This is probably Gilbert syndrome. If it were cholestatic, it would be at least 50% conjugated/direct.
What is the pathogenesis of Gilbert syndrome?
Reduced expression of the enzyme that conjugates bilirubin (glucoronyltransferase)
What is the highest total bilirubin concentration you would see in Gilbert disease?
3.0
What 2 things can cause a high INDIRECT (unconjugated) bilirubin?
- Hemolytic anemia
2. Gilbert syndrome
What are indications for cholecystectomy?
Symptomatology. Even if it resolves, you take the gall bladder out after it resolves, because there is a 30% chance of recurrence within 3 months
What is ERCP shincterotomy used for?
Remove obstructing stones from the gall bladder
What can you do for patients who have gallstones but can’t undergo surgery?
ursodeoxycholic acid (although this mostly only helps prevent future stones)
Is primary sclerosing cholangitis seen more with UC or with Crohn disease?
Ulcerative Colitis
How is a diagnosis of PSC confirmed. Why do we use this method?
Use ERCP because you can both diagnose it AND place stents at places with big stictures, AND take biopsies to rule out cholangiocarcinoma
If you can’t use ERCP, what would you use to diagnose PSC?
MRI cholangiopancreatogrpahy
What are the symptoms of acute Hep A?
fatigue, nausea, mild upper abdominal pain, juandice
AST and ALT>500 (often >1000 if acute)
What is the pattern of liver enzyme elevation in PSC?
cholestatic (high alk phos, high direct bilirubin). Minorly high AST and ALT
What is the charcot triad, and what is it for?
- fever
- jaundice
- RUQ pain
classic for ascending cholangitis (stone at the bottom of the biliary tree with inflammation) or cholecystitis (inflamed gall bladder)
*memory: Charcot was right, hot and yellow
How do you treat acute cholangitis?
- Immediately start broad spectrum antibiotics for anaeroebes, aerobes, and enterococci
- then do ERCP to remove the stone
How do you SCREEN for hepatocellular carcinoma?
Liver ultrasound
Can patients with chronic Hep B but no cirrhosis develop HCC?
Yes
How do you diagnose hepatocellular carcinoma?
A liver ultrasound with a subsequent AFP>500 is enough for diagnosis. You don’t need a biopsy.