liver Flashcards
hepatitis a,b,c, disease transmission, vaccine? and tx, mgmt on surgery
hep A - fecal oral
hep b/c - blood
hep a/b - vaccine
hep c - treated with antivirals, can cure now.
mgmt for surgery - check liver enzymes, liver failure, avoid hepatically metabolized drugs? (made this mgmt part up)
alcoholic liver disease
excessive alcohol intake leading to fatty liver, hepatitis, and cirrhosis
nonalcoholic fatty liver disease
fatty liver not caused by alcohol, can lead to cirrhosis, diabetes and other contributing factors, etiology not clear
autoimmune hepatitis
destruction of hepatocytes by T cells and autoantibody molecules.
primary biliary cirrhosis soundbite and labs
cirrhosis caused by autoimmune destruction of small intrahepatic bile ducts
labs - elevated alkaline phosphatase and aminotransferases. positive for antimitochondrial antibodies
tx: ursodeoxycholic acid, liver transplant (but transplanted liver can get attacked too)
what are some sequela of cirrhosis?
1) portal hypertension leading to - gastroesophogeal varices, ascites (can get infected called spontaneous bacterial peritonitis, needs abs, high mortality), hypersplenism
2) third spacing of fluid because of hypoalbuminemia (albumin made in the liver?)
3) hepatorenal syndrome
4) hepatic encephalopathy (due to the ammonia… treat with lactulose?)
5) hepatopulmonary syndrome
6) coagulopathies - decreased synthesis of clotting factors and diminished clearance of anticoagulants
thrombocytopenia secondary to sequestration of platelets because of the hypersplenism from the portal htn as listed above.
- so more prone to bleed??
scoring system for liver cirrhosis
ok for surgery unless cirrhosis
scoring system - most helpful is CTP - child Turcotte Pugh score. based on labs, etc. A and B category can go to surgery with medical optimization and C category - NO ELECTIVE SURGERY
MELD score is the 90 day mortality rate. not sure what specifically for - liver transplant?
