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
What are the 5 serologic indicators of ESLD?
- decr. Albumin and Globulins (hypoalbuminemia)
- Hyponatremia
- Incr. PT/INR
- Incr. Cr
- Thrombocytopenia
What 2 diagnostic studies should you use in order to screen for complications of cirrhosis
- EGD to r/o varices caused by portal HTN
- Abdominal imaging to r/o HCC
Is HCC more common in men or women?
What are 2 risk factors
Men
Smoking, EtOH
How do you dx HCC? (3)
- US and/or CT
- Serum cancer marker= AFP
- Bx to confirm
How do you tx HCC if no mets
- transplant
- monitor q 6 mo w/ CT/MR
How do you tx HCC?
- No mets= transplant and monitor
- radiofrequency/microwave ablation
- transarterial chemoembolization (TACE)
What is the name for cancers arising from the bile duct epithelium?
What type of carcinoma is this
cholangiocarcinoma
95% are adenocarcinomas
Between what ages do 2/3 of cholangiocarcinomas occur in
50 and 70 y/o
Presentation of what?
- Painless jaundice
- weight loss
- abdominal pain
- patient >55y/o
- pruritis
- palpable GB
- dark urine
- pale stools
CHolangiocarcinoma
What is the triad for cholagiocarcinoma
- fever
- jaundice
- RUQ pain
What is the tumor marker for cholangiocarcinoma?
CA 19-9
How do you diagnose cholangiocarcinoma
elevated CA 19-9
Biopsy (needed for dx)
Tx of resectable cholangiocarcinoma:
How do you tx an intrahepatic (perihilar) cholangiocarcinoma
partial liver resection
Chemo +/- radiation
Tx of resectable cholangiocarcinoma:
How do you tx a extrahepatic (distal) cholangiocarcinoma
Surgical excision
chemo +/- radiation
How do you treat cholangiocarcinoma if it is unresectable
- Liver transplant + chemo +/- radiation
- If not a transplant candidate: chemo +/- radiation and palliative therapy
What are the 5 contraindications to liver transplant?
- Active EtOH or drug abuse
- cancer (HCC, cholangiocarcinoma, etc)
- Severe cardiopulmonary disease
- Comorbidities
- Unfavorable psych/social issues
Does a patient with a high or low MELD score get transplant first
The higher the MELD score, the higher on the transplant list you are and the sooner you will get transplant
