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GK F3 E3 > Liver 4 > Flashcards

Liver 4 Flashcards

1
Q

Which condition?

  • Assoc. w/ ulcerative colitis
    • Positive p-ANCA
A

Primary sclerosing cholangitis

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2
Q

What is seen on MRCP in Primary Sclerosing Cholangitis (PSC)

A

Stricturing of bile ducts

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3
Q

PSC vs. PBC:

T cell attack on bile ducts

A

PBC

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4
Q

PBC vs. PSC:

  • MC middle aged women
  • asymptomatic
  • fatigue
  • pruritis
  • jaundice
  • Xanthlasma
  • Xanthoma
  • steatorrhea
A

PBC

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5
Q

PBC vs. PSC:

  • Incr. alk phos
  • + AMA
  • Incr. IgM
  • Incr. Cholesterol
A

PBC

(PSC does NOT have +AMA)

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6
Q

PBC vs. PSC:

  • Middle aged males
  • a/w ulcerative colitis
  • increased risk if first degree relative has
A

PSC

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7
Q

PBC vs. PSC:

  • Jaundice then pruritis (MC)
  • fatigue
  • weight loss
  • RUQ pain
  • +/- hepato/splenomegaly
A

PSC

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8
Q

Laboratory findings in PBC or PSC?

  • Incr. alk phos
  • Incr. bili
  • Mild incr. transaminase
  • P-ANCA
A

PSC

(PBC doesnt have P-ANCA )

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9
Q

What is the tx for PBC?

A
  1. Ursodiol
  2. Cholestyramine
  3. Liver transplant
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10
Q

What is the tx for PSC?

A
  1. Stent
  2. Ursodiol
  3. Liver transplant
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11
Q

How do you screen for cholangiocarcinoma in a patient with PSC?

A

Every 6-12 mo:

  • CA 19-9
  • CT/MRI of abdomen
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12
Q

What 7 conditions can lead to cirrhosis?

A
  1. HCV, HBV
  2. EtOH (AST>ALT)
  3. Steatohepatitis/NASH/Fatty liver disease (ALT>AST, obese)
  4. Hemochromatosis (autosomal recessive HFE gene mutation)
  5. Wilsons Disease
  6. Alpha-1 antitrypsin deficiency
  7. PSC/ PBC
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13
Q

What is the MELD score used for

A

assess degree of end stage liver disease–> used for transplant

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14
Q

What MELD score puts you on the transplant list due to increase risk of mortality

A

>15

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15
Q

What is the difference b/w compensated and decompensated cirrhosis? (3 each)

A
  • 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
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16
Q

What is the Child-Pugh classification and MELD score used for

A

Surgeons use the Child-Pugh classification and MELD score to determine the operative mortality rate of patients

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17
Q

What are 5 complications of ESLD?

A
  1. Palmar erythema
  2. Spider angioma
  3. Encephalopathy with asterixis (“liver flap”)
  4. Portal vein thrombosis
  5. Ascites and muscle wasting
18
Q

Hepatic encephalopathy leads to what in the serum

A

increased serum ammonia levels

19
Q

How do you treat hepatic encephalopathy (complication of ESLD)

A

Lactulose

(reduces ammonia)

20
Q

How do you diagnose portal vein thrombosis (complication of ESLD)

A

Doppler US, CT or MRI

21
Q

How do you treat portal vein thrombosis (complication of ESLD)

A

Heparin

22
Q

How do you treat Fluid overload (ascites, LE edema and pleural effusion), a complication of ESLD

A

1st line= diuretics (Furosemide and spironolactone)

2nd line= paracentesis

3rd line= shunt (TIPS)

23
Q

How do you treat spontaneous bacterial peritonitis (infection of ascites fluid)- a complication of ESLD

A

IV cefotaxime x5 d

+

IV albumin

+

TMP-SMX post infection

24
Q

Which complication of ESLD?

  • F
  • abd pain
  • change in mental status
  • Dx: fluid w/ >250 neutrophils or positive culture
A

Spontaneous bacterial peritonitis

25
Q

What are the 5 serologic indicators of ESLD?

A
  1. decr. Albumin and Globulins (hypoalbuminemia)
  2. Hyponatremia
  3. Incr. PT/INR
  4. Incr. Cr
  5. Thrombocytopenia
26
Q

What 2 diagnostic studies should you use in order to screen for complications of cirrhosis

A
  1. EGD to r/o varices caused by portal HTN
  2. Abdominal imaging to r/o HCC
27
Q

Is HCC more common in men or women?

What are 2 risk factors

A

Men

Smoking, EtOH

28
Q

How do you dx HCC? (3)

A
  • US and/or CT
  • Serum cancer marker= AFP
  • Bx to confirm
29
Q

How do you tx HCC if no mets

A
  • transplant
  • monitor q 6 mo w/ CT/MR
30
Q

How do you tx HCC?

A
  • No mets= transplant and monitor
  • radiofrequency/microwave ablation
  • transarterial chemoembolization (TACE)
31
Q

What is the name for cancers arising from the bile duct epithelium?

What type of carcinoma is this

A

cholangiocarcinoma

95% are adenocarcinomas

32
Q

Between what ages do 2/3 of cholangiocarcinomas occur in

A

50 and 70 y/o

33
Q

Presentation of what?

  • Painless jaundice
  • weight loss
  • abdominal pain
  • patient >55y/o
  • pruritis
  • palpable GB
  • dark urine
  • pale stools
A

CHolangiocarcinoma

34
Q

What is the triad for cholagiocarcinoma

A
  1. fever
  2. jaundice
  3. RUQ pain
35
Q

What is the tumor marker for cholangiocarcinoma?

A

CA 19-9

36
Q

How do you diagnose cholangiocarcinoma

A

elevated CA 19-9

Biopsy (needed for dx)

37
Q

Tx of resectable cholangiocarcinoma:

How do you tx an intrahepatic (perihilar) cholangiocarcinoma

A

partial liver resection

Chemo +/- radiation

38
Q

Tx of resectable cholangiocarcinoma:

How do you tx a extrahepatic (distal) cholangiocarcinoma

A

Surgical excision

chemo +/- radiation

39
Q

How do you treat cholangiocarcinoma if it is unresectable

A
  • Liver transplant + chemo +/- radiation
  • If not a transplant candidate: chemo +/- radiation and palliative therapy
40
Q

What are the 5 contraindications to liver transplant?

A
  1. Active EtOH or drug abuse
  2. cancer (HCC, cholangiocarcinoma, etc)
  3. Severe cardiopulmonary disease
  4. Comorbidities
  5. Unfavorable psych/social issues
41
Q

Does a patient with a high or low MELD score get transplant first

A

The higher the MELD score, the higher on the transplant list you are and the sooner you will get transplant

GK F3 E3 (24 decks)

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