Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Remediation > Liver > Flashcards

Liver Flashcards

1
Q

Four stages of cirrhosis

A

1) Compensated. undetectable w/o bx
2) Compensated w/ varices.
3) Decompensated. This is when we start seeing our real symptoms,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Major common complications of cirrhosis (think decompensated)

A

WE DON’T SEE THESE UNTIL LATE STAGE

Ascites
HRS
pHTN
Spontneous bacterial peritonitis
Coagulopathy 
Varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Biggie causes of cirrhosis

A 
HCV
EtOH
HCV and EtOH
Cryptogenic (NAFLD)
HBV
Weird random things like PSC/hemochromatosis/wilson
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of cirrhosis dt the liver malfunctioning (pHTN, portosystemic shunting, dec detox)

A 
Fatigue
Sleep disturbance
Weight loss/wasting
Spider telangiectasis
Caput medusa
Abdominal pain dt liver enlargement
Hematemesis
GYN dysfunction (amenorrhea/ED)
Jaundice
Pruritis
Confusion/AMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PE findings of cirrhosis

A

LATE.

Appear sick
Palpable liver
SPlenomegaly
Caput medusa
Ascites
Pleural effusion
Jaundice
Derm findings (caput medusa, spider nose)
Esophageal/gastric varices (hematemesis/melena)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Labs for cirrhosis

A

Not until starting to compensate less.

Anemia
WBC low
THrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Imaging for cirrhosis

A

US- liver size/ascites/nodular liver

CT/MRI characterize nodular liver

LIVER BIOPSY IS IMPERFECT GOLD STANDARD. Can indicate etiology. Transjugular approach.

EGD for varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Use of fibrosure test for cirrhosis

A

Biomarker. Uses 6 serum tests to generate score which is equivalent in predictive value to a liver biopsy in patients with known chronic liver disease!

Kinda cool, we would use this before doing a biopsy. If someone has chronic liver disease and a low fibrosure, this excludes adv cirrhosis. If someone has a high score, then you know it is liver cirrhosis and don’t need to confirm that with a biopsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Role of Fibroscan (transient elastography) in cirrhosis

A

Bedside US that measures the liver stiffness/fibrosis.

Can be used to stage the disease & determine if treatment is warranted. Limited by ascites, obesity and severe liver inflammation. Nice idea, not super practical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MELD score in cirrhosis

A

Prognostic scoring system. Measures a mortality risk for pts with end stage liver disease, and useful for predicting short term survival. Also determines where you are on the liver transplant list

Scored from 6->40 made up of lab values that actually has nothing to do with liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MELD score >26?

MELD Score 16-20?

A

90 day mortality of 85%

90 day mortality of 56%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Level of pHTN that collaterals begin to develop

A

> 10-12mmhg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sequelae of pHTN

A

Ascites
Varices (eso/gastric)
Hepatic encephalopathy
Splenomegaly/thrombocytopenia dt sequestration.

Beginning of the ned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ppx tx for variceal bleeding/pHTN

A

Nonselective BB! Nadolol and propranolol!

Reduce portal/collateral blood flow and decrease the portal pressure slightly.

Totally useless once the bleeding starts, but it reduces the first bleed likelihood by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prehepatic causes of portal HTN

A

Thrombosis/stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Intrahepatic causes of portal HTN

A 
Cirrhosis!!!
Hepatitis
Cancer
PSC
Wilson
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Post hepatic causes of pHTN

A

Budd chiari
Tumor compression
R sided HF (backflow)
IVC thrombosis (backflow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Three main causes of ascites

A

Cirrhosis (80%)
Neoplasm
CHF

Protein level will tell you what it is. Elevated protein means it’s not cirrhosis. Same or lower is straight up portal HTN caused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ascites PE and why it’s innaccurate

A

Need at least 1,500 ml to see it on PE. That’s massive.

Abdominal distention
Bulging flanks
Shifting dullness to percussion
Thrills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Large volume paracentesis amount

A

5-10L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Large volume paracentesis albumin supplementation

A

Supplement 5g of albumin for every liter you tap out over 5L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Two lab values you should get in large volume paracentesis

A

CBC & Cx to r/o SBP

Albumin and total protein to determine etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

First line therapy for ascites

A

Sodium restriction (<1.5 Na) and fluid restriction (<1.5L) This is for the grade I fluid that is only seen on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Second line tx for ascites

A

Diuretics. Spironolactone, then furosemide if we don’t see a good enough change. Make sure K is okay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Surgical management for grade III ascites (thrills)

A

Large volume paracentesis (symptomatic relief)

TIPS

liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Not every patient with wicked bad ascites can get TIPS, why? What criteria do we use?

A

Need MELD <18 and TB <3 (???). Otherwise we’re putting the patient at risk of hepatic encephalopathy and exacerbating the liver dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Two theories behind hepatic encephalopathy etiology

A

Ammonia buildup, it isn’t being detoxed into urea.

GABA inc NT inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PE signs of encephalopathy

A

Asterixis, twitchiness.

PE signs are just as reliable as getting an ammonia level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Common causes of hepatic enceph

A 
SBP
Diuretic therapy
Hypovolemia (ammonia buildup)
Renal failure 
GIB
Constipation (ammonia buildup in gut)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tx for enceph

A

Lactulose to clear out ammonia

Abx- Xifaxan absorbs ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most common site of gastroesophageal varices

A

Distal esophagus and proximal stomach. It’s where the IVC and SVC hang out

32
Q

RF for rupturing existing GE varices

A

Anything that increases the pHTN
EtOH
Red marks on varices (seen on EGD, called the red wale sign)
Liver failure

33
Q

Sx of a vairceal bleed

A

Hematemesis/melena/hematochezia
Hemorrhagic shock sx
Liver disease/cirrhosis signs

34
Q

Emergent tx of a variceal bleed

A 
pRBC until Hb>7 
NGT w/ lavage
Octerotide (splanchic vasoconstriction)
Balloon tamponade
ENDOSCOPY (banding, sclerotherapy)
35
Q

Endoscopy doesn’t work in a variceal bleed, what now?

A

TIPS! Decompresses the varices.

Can also consider angiotherapy or open surg.

36
Q

Endoscopy for variceal bleed has a lot of treatment options to stop the blood. Let’s talk about them, what’s best?

A

Band ligation has the least rebleeding/complications. But it’s operator dependent, esp during an acute bleed.

Also epi injection
Sclerosant injection
Hemoclipping

37
Q

What is acute hepatitis? What are the two types?

A

Inflammation of the liver.

Infectious etiology (Viral)
Non infectious (AI,  Toxiv, EtOH)
38
Q

Acute hepatitis sx

A

Varies from subclinical to fulminant liver failure.

Fatigue/malaise
Anorexia
N/V
Fever
Enlarged liver
Jaundice
Normal to low WBC
Markedly elevated aminotransferase (>1000)
39
Q

Let’s just talk about hepatitis A

A

Fecal oral transmission. International travel is the leading RF.

Vaccine available
Mortality very low unless pt already has HCV
Anti HAV appears early
Symptomatic tx
Full clinical recovery w/n 3 months
40
Q

IgM indicates ___ disease, whereas IgG indicates _____

A

IgM- active disease

IgG- previous exposure

41
Q

How is HBV transmitted

A

Blood

42
Q

HBV adults/infant recovery discrepancies

A

95% of adults totally recover and have lowkey infections.

90% of infants born with HBV develop acute infection, and of those kids 50% of them develop chronic HBV

43
Q

Exposed to HBV? What do we do

A

HBIG w/n 7 days of exposure followed by HBV vaccination series.

44
Q

Newborns w/ HBV + mom

A

For newborns at risk (mom +) we do a vaginal delivery and give HBIG and HBV vax w/n 12 hours of birth. We’ll also put mom on antiviral therapy during third trimester is the viral load is high

45
Q

HbsAg

A

First evidence of HBV infection. If it persists >6mo, this indicates chronic infection

46
Q

HBV DNA?

A

Active replication :(

47
Q

AntiHBc IgM

AntiHBg IgG

A

Acute hepatitis infection that you’re fighting

IgG indicates chronic or recovered infection

48
Q

HIV/HCV coinfection

A

30%

49
Q

HCV and chronic illness

A

Unlike HBV, 85% of these patients will develop chronic HCV

50
Q

Diagnosing HCV labs

A

HCV RNA PCR serology is confirmatory.

Can also do an ELISA and antiHCV?

51
Q

HCV tx

A

8-12 weeks Harvoni (ledipasvir/sofosbuvir) Takes 3-6 mo for full clinical recovery

52
Q

Hepatitis D is associated with

A

HBV!! Terrible disesae with fulminant hepatic failure/cirrhosis but like you can only get this if you’re actively infected with HBV.

Africa, central asia, eastern europe, amazon

53
Q

Hepatitis E Let’s talk about it

A

Very rare. Fecal oral
Can be spread by pig
No chronic state
Only seen typically in IC patients

54
Q

Autoimune hepatitis, who’s our most common patient? How often does it turn into acute hepatitis?

A

The same patient that gets AI anything. Young to middle aged women.

Despite an insidious onset, this actually turns acute 40% of the time

55
Q

Labs for acute AI hepatitis

A

Aminotransferase >1000
Positive ANA and/or smooth muscle ab
IgG elevated

56
Q

What is needed to establish dx of AI hepatitis

A

Liver biopsy

57
Q

AI hepatitis Tx

A

Corticosteroids. It’s AI silly

58
Q

Is alcoholic hepatitis reversible?

A

Hell yeah!

59
Q

Labs in EtOH hepatitis

A

Macrocytic anemia
Thrombocytopenia (EtOH has a direct toxic effect)
AST/ALT 2:1 & mildly elevated (not >300)
TB elevated
PT/INR elevated

60
Q

Imaging for EtOH hepatitis

A

US- ascites

CT/MRI- moderate/severe steatosis but not inflammation or fibrosis

61
Q

Emergent tx for improving short term mortality for EtOH Hep

A

32mg PO methylprednisone QD for 1 mo if MELD >18

62
Q

Most common drugs that cause drug induced hepatitis

A

MACROBID AND MINOCYCLINE. That’s just because of the widesperad use of them though.

These suckers can cause some problems thru potentiation efx
IND, rifampin, APAP, etOH

63
Q

1/3 of the worlds population has

A

HBV. Mostly from being born with it :(

64
Q

Dominant cause of cirrhosis and HCC

A

HBV

65
Q

How much does HBV inc HCC risk

A

20-30%

Having a high viral load is a predictor of cirrhosis/HCC risk

66
Q

First line for chronic HBV

A

Entecavir/Tenofavir. Lifelong therapy, prevents repliation

67
Q

When do we consider HCV to be chronic

A

> 6 mo of persistent HCV RNA serology

68
Q

HCC is associated with

A

Underlying liver disease. Hepatitis, NASH

69
Q

HCC clinical presentation

A 
Insidious until cirrhotic
Weakness, weight loss, anorexia
Ascites
Jaundice, icterus pruritis
Tender enlarged liver
70
Q

HCC WU

A 
CBC
CMP
Lipase
PT
Alpha fetoprotein
HCV/HBV testing
Alpha 1 antitrypsin
EtOH
71
Q

Imaging for HCC

A

US

MRI

72
Q

Diagnostic for HCC

A

Biopsy, but 1-3% chance of seeding with needle.

73
Q

Size of tumor and biopsy guidelines

<1cm?
1-2cm?

A

<1cm gets CT/MRI every 3 months to assess for enlarging lesion

1-2? Bx should be performed

74
Q

> 2cm HCC lesion w/ cirrhosis, elevated AFP levels?

A

Manage w/o biopsy. Don’t need the risk, that’s definitely cancer

75
Q

Only long term cure for HCC

A

Surgical. Be it resection or transplant. HCC is radioinsensitive and chemo is ineffective. VEGF blockers have been shown to slow progression.

76
Q

HCC tumor near the hepatic artery?

A

Can try transarterial chemoembolization (TACE) or transarterial radioembolization (TARE)

GI Remediation (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions