liver Flashcards
alpha 1 antittrypsin
inherited condition that affects the lungs, causing emphysema, and the liver, causing cirrhosis and hepatocellular carcinoma.
Without alpha-1 antitryptase there is less defence against neutrophil elastase, which destroy the alveoli. This process is exacerbated in smokers.
presentation of alpha 1 antitypsin
COPD presenting 30-40 years old
Neonatal jaundice at birth
Deranged LFTs in adults with no other identified cause
diagnosis of alpha 1 antitrypsin
iver biopsy (evidence of Periodic acid Schiff positive globules).
genetic testing
check levels of antitrypsin
tx of alpha 1 antitrypsin
The condition has few management options and patients are advised to stop smoking. Intravenous A1AT pooled from human donors is expensive and not widely used. Liver transplant may be required in cases of decompensation.
whats the main symptom of liver cirrhosis
fatigue
why is there thrombocytopenia in liver cirrhosis
increase sequestration of platelets in spleen
and reduced production of TPO from liver
SAAG
serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites.[1] The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate
if more than 1.1= transudate
if less than 1.1 = exudate
Transuddate vs exudate
transudate - more clear fluid, less protein m less cells
exudate- more protein, more cells . inflammatory and malignancy
what does transudate ascites imply
its due to an increase in hydrostatic pressure such as portal hypertension seen in liver cirrhosis
pathogenies of liver cirrhosis
activation of stellar cell which increase collagen
classification system for liver cirrhosis
child Pugh - o predict mortality in cirrhosis patients
looks at albumin, br , PT, ascites, ecepatplathy
AB C
A- compensated
B- failing
C- decompensated
can you have portal hypertension without liver cirrhosis
YES - its called non cirrhotic portal hypertension
budd chiari syndrome
clots in your hepatic vein , caused by conditions that increase a hypercoagubale state like
Myeloproliferative diseases , including polycythemia (the body makes too many red blood cells), and thrombocythemia (the body produces too many platelets).
Sickle cell disease (a blood disease in which red blood cells change shape from round to sickle-shaped).
Inflammatory bowel disease (a group of disorders that cause irritation and swelling of the digestive tract).
Pregnancy.
whats the risk of having ascites
spontaneous peritoneal ascites
tx of Budd chair syndrome
warfarin - Coumadin - to prevent future clots
medication to dissolve the clots
ransjugular intrahepatic portosystemic shunt (TIPS) and percutaneous transluminal angioplasty:
