Liver Flashcards
The most common and most characteristic symptom of liver disease
Fatigue
Hallmark symptom of liver disease and perhaps the most reliable marker of severity
Jaundice
Bilirubin level where jaundice is rarely detectable
<43 umol/L or 2.5 mg/dL
Autochthonous cases of hepatitis
Hepatitis E
Alcohol consumption with increased risk of alcoholic liver disease
2 drinks women (22-30)
3 drinks men (33-45)
Kaiser fleischer rings
Wilson’s disease
Golden brown copper pigment deposited in the Descemet’s membrane
S/s suggestive of chronic alcoholic disease
Dupuytren contracture
Parotid enlargement
Anti mitochondrial antibody
Primary biliary cirrhosis
Liver disease pANCa posituve
Primary sclerosing cholangitis
Ceruloplasmin and copper levels in Wilson’s disease
Decrease serum ceruloplasmin
Increased urinary copper
Increased hepatic copper level
Procedure of choice for the identification and evaluation of hepatic masses,
staging of liver tumors
Pre operative assessment
Multidirectional or spiral CT and MRI
Why can’t a hyperbilirubinemia of more than 4 mg/dL be attributed solely to hemolysis?
Bone marrow is only capable of a sustained 8 fold rise in erythrocytes production in response to hemolytic stress
Dse due to decreased hepatic bilirubin uptake—> unconjugated huperbilirubinemia
Gilbert syndrome
Disease characterized by striking conjugated hyperbilirubinemia of about 20-45 mg/dL that appears in the neonatal period and persists for life
No detectable constitutive expression of UGT1A1 activity in the hepatic tissue
Criggler najjar syndrome type I
Cardinal feature of DJS
Coarsest granular pigment
Hence liver may be grossly black in appearance
Disorders leading to conjugated hyperbilirubinemia
Dubin Johnson syndrome
Rotor syndrome
BRIC (benign recurrent intrahepatic chole stasis)
Disorders leading to unconjugated hyperbilirubinemia
Crocker najjar syndrome
Gilbert syndrome
Disorder in hepatic excretory function, defective expression of MRP2 an ATp dependent canalicular membrane transporter
(+) abnormal urine cipro porphyria excretion
Dubin Johnson syndrome
Recurrent attacks of pruritus and jaundice
Mild malaise and elevations in serum amino transferase levels
Benign recurrent intrahepatic cholestasis
Unique form of hemolytic anemia with spur cells and acanthocytes found in patients with severe alcoholic hepatitis
Zieves syndrome
Size of nodules in alcoholic cirrhosis
<3 mm (micro nodular)
3 enzyme systems responsible for alcoholic Metabolism
- Cytosolic ADH
- Microsomal ethanol oxidizing system (MEOS)
- Peroxisomal catalase
When to use GC in patients with alcoholic cirrhosis
Discrimination function >32
DF= TB+ (PT patient- PT control) X 4.6
Autoantibodies in chronic hepatitis D
Anti LKM3
Antibodies in chronic hepa C
Anti LKM1
Most commonly used Abx for SBP prophylaxis
Cefotaxime
Diff type 1 and 2 HRS
Type 1 progressive increase in renal failure within 1-2 weeks
Type 2 more stable Crea, better outcome than type 1
Feared complication of brain edema in acute liver failure
Cerebral herniation, give mannitol
Mainstay of treatment hepatic enceph
Lactulose to achieve 2-3 stools: day
Duration of abnormal liver tests that define chronic Versus acute liver disease
6 months
Child Pugh score
Class A 5-6
Class B 7-9
Class C 10-15
Components of child Pugh scoring
BAPHA
Score of 2 Bilirubin (2-3) Albumin (3-3.5) PT (1.7-2.3) Hepatic encephalopathy Ascites
Half life of albumin
18-20 days
Why is serum albumin not a good indicator of mild acute hepatic dysfunction?
If not albumin, what is?
Slow turn over 18-20 days
Clotting factors- single best acute measure of hepatic synthetic function
PT ( 2,5,7,9)
These blood types can have an elevation of ALP after eating a fatty meal due to the influx of intestinal alkaline ohosohatase into the blood
Type O and B
All clotting factors are produced. Y the vascular endothelial cells except
F VIII
Which factor has the longest half life? (5 days)
Fibrinogen
Shortest 6h: FVII
Www AMA in 90%
Primary biliary cirrhosis
Dose of udca for primary biliary cirrhosis
13-15 mid
Side effect of udca
Diarrhea
Headache
Main symptoms of PBC
fatigue
Pruritus
Chronic cholestatic syndrome that is characterized by diffuse inflammation and fibrosis involving the entire biliary tree
Primary sclerosing cholangitis
Dreaded complication of Primary sclerosing cholangitis
Cholangiocarcinoma
Define portal hypertension
Elevation of the hepatic venous pressure gradient > 5 mmHg
3 primary complications of portal hypertension
Hemorrhage
Ascites
Hypersplenism
Mortality rate of variceal hemorrhage
20-30%
Tc ascites cirrhosis
Diet Na restriction
Spironolactone
Furosemide
Mechanism for SBP
Bacterial translocation
MC organism SBP
E. coli
Antibiotic SBP
Cefotaxime
Diagnosis of SBP
Neutrophil count >250/uL
Type 1 vs Type 2 HRS
Type 1 progressive deterioration
Crea Cl 1-2 weeks
Type 2 reduction in GFR Crea elevated but fairly stable
