Liver 4 Flashcards
Which condition?
- Assoc. w/ ulcerative colitis
- Positive p-ANCA
Primary sclerosing cholangitis
What is seen on MRCP in Primary Sclerosing Cholangitis (PSC)
Stricturing of bile ducts
PSC vs. PBC:
T cell attack on bile ducts
PBC
PBC vs. PSC:
- MC middle aged women
- asymptomatic
- fatigue
- pruritis
- jaundice
- Xanthlasma
- Xanthoma
- steatorrhea
PBC
PBC vs. PSC:
- Incr. alk phos
- + AMA
- Incr. IgM
- Incr. Cholesterol
PBC
(PSC does NOT have +AMA)
PBC vs. PSC:
- Middle aged males
- a/w ulcerative colitis
- increased risk if first degree relative has
PSC
PBC vs. PSC:
- Jaundice then pruritis (MC)
- fatigue
- weight loss
- RUQ pain
- +/- hepato/splenomegaly
PSC
Laboratory findings in PBC or PSC?
- Incr. alk phos
- Incr. bili
- Mild incr. transaminase
- P-ANCA
PSC
(PBC doesnt have P-ANCA )
What is the tx for PBC?
- Ursodiol
- Cholestyramine
- Liver transplant
What is the tx for PSC?
- Stent
- Ursodiol
- Liver transplant
How do you screen for cholangiocarcinoma in a patient with PSC?
Every 6-12 mo:
- CA 19-9
- CT/MRI of abdomen
What 7 conditions can lead to cirrhosis?
- HCV, HBV
- EtOH (AST>ALT)
- Steatohepatitis/NASH/Fatty liver disease (ALT>AST, obese)
- Hemochromatosis (autosomal recessive HFE gene mutation)
- Wilsons Disease
- Alpha-1 antitrypsin deficiency
- PSC/ PBC
What is the MELD score used for
assess degree of end stage liver disease–> used for transplant
What MELD score puts you on the transplant list due to increase risk of mortality
>15
What is the difference b/w compensated and decompensated cirrhosis? (3 each)
- Compensated:
- no sxs of cirrhosis
- Normal/near normal lab values
- Child-Pugh class A
- Decompensated:
- sxs of cirrhosis
- Abnl lab values
- Child-Pugh class B/C
What is the Child-Pugh classification and MELD score used for
Surgeons use the Child-Pugh classification and MELD score to determine the operative mortality rate of patients
What are 5 complications of ESLD?
- Palmar erythema
- Spider angioma
- Encephalopathy with asterixis (“liver flap”)
- Portal vein thrombosis
- Ascites and muscle wasting
Hepatic encephalopathy leads to what in the serum
increased serum ammonia levels
How do you treat hepatic encephalopathy (complication of ESLD)
Lactulose
(reduces ammonia)
How do you diagnose portal vein thrombosis (complication of ESLD)
Doppler US, CT or MRI
How do you treat portal vein thrombosis (complication of ESLD)
Heparin
How do you treat Fluid overload (ascites, LE edema and pleural effusion), a complication of ESLD
1st line= diuretics (Furosemide and spironolactone)
2nd line= paracentesis
3rd line= shunt (TIPS)
How do you treat spontaneous bacterial peritonitis (infection of ascites fluid)- a complication of ESLD
IV cefotaxime x5 d
+
IV albumin
+
TMP-SMX post infection
Which complication of ESLD?
- F
- abd pain
- change in mental status
- Dx: fluid w/ >250 neutrophils or positive culture
Spontaneous bacterial peritonitis
