Liver and gallbladder Flashcards
What has contributed to the increase in chronic liver disorders in the US?
A doubling of nonalcoholic fatty liver disease (NAFLD).
What are the etiologies of newly diagnosed chronic liver disease?
- Hepatitis B
- Hepatitis C
- Alcohol-related liver disease
- Nonalcoholic fatty liver disease (NAFLD)
- Alternative/undetermined etiologies.
What is the most common etiology of chronic liver disease in the US?
Hepatitis C.
What defines hepatitis?
End organ inflammatory damage to the liver.
What are common causes of hepatitis?
- Viral infection
- Toxic alcohol exposure
- Chemical or medication exposure
- Bacterial, fungal, or parasitic infection
- Genetic disorders
- Immune mediated pathology.
Which viruses are known to cause the most significant cases of viral hepatitis?
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Delta viruses.
How is Hepatitis A virus (HAV) primarily transmitted?
By the fecal-oral route.
What is the incubation period for hepatitis A?
15 to 45 days (typically 30 days).
What is the significance of the hepatitis A vaccine?
Approved in the US in 1995, it has contributed to a decrease in reported new cases.
What is the main mode of transmission for Hepatitis B virus (HBV)?
Parenteral exposure.
What is the mean interval between exposure and onset of clinical illness for Hepatitis B?
120 days.
What percentage of adults and neonates will become asymptomatic chronic carriers of HBsAg?
- 10% of adults
- 90% of infected neonates.
What does the term ‘non-A, non-B hepatitis’ refer to?
Hepatitis C and E.
What is the leading cause of cirrhosis in the US?
Hepatitis C infection.
What is the primary risk factor for Hepatitis C virus (HCV) infection?
History of intravenous drug use (IVDU).
What percentage of HCV infections progress to chronic hepatitis?
Approximately 90%.
What characterizes Hepatitis D virus (HDV)?
It can only infect patients who are actively producing HBsAg.
What is the prevalence of Hepatitis D in those with Hepatitis B worldwide?
5%.
How is Hepatitis E primarily transmitted?
Fecal-oral transmission.
What is the incubation period for Hepatitis E?
15 to 60 days.
What is the recent hepatitis virus referred to as?
Hepatitis G (HGV) or hepatitis GB virus type C (GBV-C).
True or False: Hepatitis A is associated with a chronic carrier state.
False.
Fill in the blank: Hepatitis B surface antigen is abbreviated as _______.
HBsAg.
What is the annual estimated number of new HBV infections in the US?
22,000.
What is the clinical presentation of viral hepatitis?
Highly variable, often asymptomatic, with common findings including malaise, fever, anorexia, nausea, vomiting, abdominal discomfort, diarrhea
Jaundice may be the initial finding prompting further evaluation.
What are the common hepatitis viruses?
A, B, C, D, E, G
These viruses are often clinically nondistinct.
What is fulminant hepatitis?
An acute onset illness that progresses to hepatic failure and encephalopathy over days
Characterized by altered mentation and spontaneous mucosal bleeding.
What are some physical findings associated with fulminant hepatitis?
Fever, scleral icterus, abdominal tenderness, vomiting, dehydration, tachycardia, hypotension, hepatomegaly
Tenderness may be present even without liver enlargement.
What is scleral icterus and when does it occur?
Yellowing of the sclera due to elevated bilirubin, occurs when serum bilirubin level is above 2.5 mg/dL
Muddy sclera may obscure this finding.
What are common medications associated with hepatopathy?
- Acetaminophen
- Antimicrobial drugs (e.g., amoxicillin-clavulanate, isoniazid)
- Anticonvulsants (e.g., phenytoin)
- Statins
Acetaminophen is the most common cause of acute liver failure in the US.
What laboratory findings are typically associated with hepatitis?
Elevated serum AST and ALT levels (10- to 100-fold), moderately increased bilirubin levels
Hyperbilirubinemia typically emerges days to 1 week after onset of symptoms.
How is acute hepatitis A diagnosed?
Presence of immunoglobulin M (IgM) HAV antibody
IgG antibody indicates previous infection.
What characterizes acute hepatitis B?
Presence of HBsAg and IgM antibody to HBcAg
HBsAg alone does not establish the diagnosis.
What is the role of serologic testing in hepatitis diagnosis?
Provides confirmation of viral causes, impacts prognosis, and may have public health importance
Serologic testing should be initiated as soon as feasible.
What is the recommended management for most patients with viral hepatitis?
Supportive management, attention to fluid/electrolyte imbalances, antiemetics, and gradual diet advancement
Most patients have self-limited disease with resolution in 2 to 4 weeks.
What complications can arise from viral hepatitis?
Fluid/electrolyte imbalance, refractory emesis, liver failure, hepatic encephalopathy
Severe vomiting can lead to upper gastrointestinal bleeding.
What is the window for effective HBV disease prevention after exposure?
About 2 weeks from the time of exposure
Passive immunization with immune globin may prevent disease.
What is the risk of seroconversion after percutaneous exposure to HCV?
Approximately 1.8%
No effective vaccine for HCV is currently available.
What is the goal endpoint of chronic hepatitis C treatment?
Sustained virologic response (SVR), defined as absence of HCV RNA by PCR testing at 3 to 6 months following treatment
DAA regimens demonstrate SVR rates exceeding 95%.
What should be done for health care workers exposed to potentially infectious materials?
Vaccination against HBV and testing within 48 hours for baseline disease presence
Universal precautions are the first and best means of defense.
What should be provided to family members and close contacts of a patient with viral hepatitis?
Immuno-prophylaxis if not previously immunized.
What is the recommendation for patients with HAV infection who handle food?
They must not return to work while potentially infectious.
When is it advisable for patients with HAV infection to return to work?
After the jaundice has cleared.
True or False: Infectivity is greatly diminished by the time jaundice emerges in HAV infection.
True.
Serologic Markers in Hepatitis
What is alcoholic hepatitis?
It is the most extreme manifestation of ongoing alcoholic liver disease, resulting from long-term alcohol consumption and characterized by hepatic decompensation or failure.
It requires specialized medical care.
What factors increase the risk of developing alcoholic hepatitis?
Factors include:
* Long-term alcohol consumption
* Gender (women are at higher risk due to estrogen effects)
* Daily ethanol consumption exceeding 80 g in men or 20 g in women
* Obesity
* Dietary factors
* Smoking
* Comorbidities: Viral hepatitis, Hemachromatosis, HIV
Risk fact
What is the most common form of alcohol-induced liver disease?
Steatosis
Fatty infiltration of the liver is often reversible upon cessation of alcohol intake.
What percentage of chronic alcoholics may develop hepatocellular carcinoma?
Approximately 3% to 10%.
What are common clinical features of alcoholic hepatitis?
Features may include:
* Nausea
* Vomiting
* Abdominal pain
* Acute liver failure
* Tachycardia
* Fever
* Hypotension
What laboratory findings are typical in alcoholic hepatitis?
Typical findings include:
* Moderate elevations of AST and ALT
* Predominance of AST over ALT
* Leukocytosis
* Hyperbilirubinemia
* Coagulopathy
True or False: A liver biopsy is the diagnostic and prognostic gold standard for alcoholic hepatitis.
True
What is the Maddrey discriminant function (MDF) score used for?
It assesses disease severity in alcoholic hepatitis and helps determine the need for steroid therapy.
Fill in the blank: The risk of liver injury increases with daily alcohol consumption exceeding _______ in men or _______ in women.
80 g; 20 g
What is the recommended treatment for patients with a MDF score greater than 32?
Corticosteroids (oral prednisolone or parenteral methylprednisolone)
This is recommended in the absence of GI bleeding, hepatorenal syndrome, or sepsis.
What dietary considerations should be made for patients with alcoholic hepatitis?
A high-calorie, vitamin-supplemented diet should be administered, with possible protein restriction if cirrhosis and encephalopathy are present.
What complications can arise from alcoholic hepatitis?
Complications may include:
* Variceal bleeding
* Hepatorenal syndrome
* Ascites
What is the role of magnesium in the management of alcoholic hepatitis?
Magnesium replacement is often necessary due to ethanol-induced magnesium wasting.
What are the characteristic physical signs of cirrhosis?
Signs may include:
* Gynecomastia
* Spider angiomata
* Muscle wasting
* Ascites
* Palmar erythema
What is the typical progression of liver disease in chronic alcohol users?
Progression typically goes from steatosis to fibrosis, cirrhosis, and potentially hepatocellular carcinoma.
What is the mortality rate associated with variceal bleeding within 5 years?
65%
What should be assessed in patients with clinical signs of alcoholic hepatitis?
Patients should be assessed for symptoms of gastritis or GI bleeding.
What is the potential effect of short-term abstinence from alcohol in patients with alcoholic hepatitis?
It may increase the risk for withdrawal.
What are the common causes of differential diagnosis for alcoholic hepatitis?
Common causes include:
* Gastritis
* Pancreatitis
* Other alcohol-related GI maladies
What is the expected AST to ALT ratio in alcoholic hepatitis compared to viral hepatitis?
A relative predominance of AST to ALT is expected in alcoholic hepatitis.
What is the recommended treatment for close personal contact exposure to Hepatitis A?
ISG, 0.1 mL/kg IM
What is the treatment for daycare center employees or attendees exposed to Hepatitis A?
ISG, 0.1 mL/kg IM
What is the treatment for school contacts exposed to Hepatitis A?
None
What is the treatment for hospital contacts exposed to Hepatitis A?
None
What is the treatment for workplace contacts exposed to Hepatitis A?
None
What is the treatment for food-borne source exposure to Hepatitis A within 2 weeks?
ISG, 0.2 mL/kg IM
What is the treatment for food-borne source exposure to Hepatitis A after 2 weeks?
None
What is the recommended treatment for percutaneous or mucosal exposure to Hepatitis B from an HBsAg (+) source?
- HBIG ×1
- Hepatitis B vaccination booster
What should be done if the anti-HBs titer is adequate after exposure to Hepatitis B?
No treatment
What is the treatment for an unvaccinated individual exposed to an HBsAg (−) source of Hepatitis B?
Initiate hepatitis B vaccination series
What is the treatment for a vaccinated individual exposed to an HBsAg (−) source of Hepatitis B?
No treatment
What is the treatment for exposure to an unknown source of Hepatitis B?
- HBIG ×1
- Initiate hepatitis B vaccination series
What is the treatment for intimate sexual exposure to an HBsAg (+) source of Hepatitis B?
- HBIG ×1
- Initiate hepatitis B vaccination series
What is the recommended treatment for Hepatitis C prophylaxis?
ISG, 0.06 mL/kg IM can be considered for parenteral exposures
What is the treatment for Hepatitis Delta exposure?
Same as for hepatitis B
What is autoimmune hepatitis (AIH)?
AIH results from antibodies targeted to hepatospecific antigens
What are the common age peaks for autoimmune hepatitis?
Second, fifth, and sixth decades
Is autoimmune hepatitis more common in males or females?
Females
What are the two diagnostic types of autoimmune hepatitis based on?
Individual’s expression of autoantibodies
What is the primary treatment modality for autoimmune hepatitis?
Immunosuppression with corticosteroids
What is defined as remission in autoimmune hepatitis treatment?
Normalization of aminotransferases, serum bilirubin, and IgG levels and absence of clinical symptoms
What is the 5-year survival rate for untreated autoimmune hepatitis?
Approximately 32%
What is the 10-year survival rate with treatment for autoimmune hepatitis?
Approximately 90%
What second-line therapy is widely supported for autoimmune hepatitis?
Mycophenolate mofetil
What is cirrhosis?
End-stage chronic liver disease characterized by destruction of hepatocytes and fibrotic tissue
What type of cirrhosis is characterized by a diffuse process involving the entire lobule?
Laënnec cirrhosis
What is a common cause of postnecrotic cirrhosis?
Chronic hepatitis of various causes
What is biliary cirrhosis a consequence of?
Chronic extrahepatic biliary obstruction or autoimmune-mediated intrahepatic duct inflammation
What are common clinical features of cirrhosis?
Chronic fatigue, poor appetite, GI bleeding, ascites, hepatic encephalopathy
What physical examination findings may be present in cirrhosis?
Muscle wasting, spider angiomata, palmar erythema, gynecomastia
What is the most common complication of cirrhosis?
Ascites
What laboratory findings are suggestive of biliary cirrhosis?
Elevation of alkaline phosphatase out of proportion to other liver enzyme levels
What is the MELD score used for?
Predicting 3-month mortality in patients with end-stage liver disease
What is the primary treatment for ascites?
Therapeutic paracentesis
What is the recommended IV dosing of albumin after large-volume paracentesis?
8 g/L removed
What should be avoided in patients with ascites without peripheral edema?
Exceeding 500 mL of fluid removal/day
What dietary recommendation is suggested for chronic management of ascites?
A low-sodium diet of less than 2000 mg of sodium
What medications should be avoided in patients with cirrhosis?
ACEIs, ARBs, NSAIDs
What is the mortality rate associated with acute upper GI bleeding in patients with cirrhosis?
10% to 15%
This statistic highlights the seriousness of GI bleeding in cirrhotic patients.
What are common causes of GI bleeding in cirrhosis patients?
Esophageal or gastric varices and other sources such as gastritis and duodenal ulcer
Over half of the cases result from sources other than varices.
What is the target platelet count for transfusion in active bleeding with coagulopathy in cirrhosis?
Greater than 50,000/mm3
This target helps manage bleeding risks effectively.
What is the role of fresh-frozen plasma in treating asymptomatic abnormalities in PT and INR?
There is little support for its use
Fresh-frozen plasma is not recommended for asymptomatic cases.
What is the recommended dose of cryoprecipitate for active bleeding?
1 unit/10 kg body weight
This treatment aims to achieve a fibrinogen level of more than 100 mg/dL.
What treatment may be used for uncomplicated prolongation of PT or INR in individuals with nutritional or gastrointestinal losses?
Oral vitamin K supplementation (10–20 mEq PO every 6 to 12 hours)
This approach helps manage clotting issues.
What is the significance of mean arterial pressure (MAP) in patients with cirrhosis?
MAP is an independent predictor of mortality
Lowering MAP may adversely affect survival.
Which medications should be used with caution in patients with cirrhosis?
ACEIs, ARBs, and beta blockers such as propranolol
These medications can impact blood pressure and survival.
What is hepatorenal syndrome (HRS)?
Renal dysfunction occurring in the setting of cirrhosis without obvious renal pathology
HRS is a serious complication that requires careful management.
What serum creatinine level is associated with type I hepatorenal syndrome?
Exceeding 2.5 mg/dL
Type I HRS is the more severe form of this syndrome.
What treatments are typically used for hepatorenal syndrome?
Albumin and vasoactive medications such as norepinephrine
These treatments aim to increase MAP.
What is the mortality risk associated with hepatorenal syndrome?
High mortality
Hepatorenal syndrome is a critical condition with poor outcomes.
Common underlying causes of hepatic encephalopathy in patients with known liver disease
How does ammonia affect the brain in hepatic encephalopathy?
It disrupts GABA receptors
What is the grading scale for the severity of hepatic encephalopathy?
Grade I to IV
What are the symptoms of Grade I hepatic encephalopathy?
Mild confusion and slurred speech
What is asterixis?
Low-amplitude, alternating flexion and extension of the wrist
What is fetor hepaticus?
Musty breath odor from mercaptans
What physical signs may be present in patients with hepatic encephalopathy?
- Spider angiomata
- Testicular atrophy
- Muscle wasting
- Superficial bruising
- Gynecomastia
- Ascites
What can be included in the differential diagnosis for hepatic encephalopathy?
All causes of altered sensorium
What tests are recommended for diagnosing hepatic encephalopathy?
Liver function tests, serum ammonia levels, serum chemistry tests
What is the principal treatment for hepatic encephalopathy?
Nonabsorbable disaccharides such as lactulose
What is the usual dose of lactulose for hepatic encephalopathy?
30 to 60 g orally or 200 g rectally daily
What is the main adverse effect of lactulose?
Excessive diarrhea
Which oral antibiotic is preferred in treating hepatic encephalopathy?
Rifaximin
What dietary recommendations are made for patients with hepatic encephalopathy?
Small frequent meals with complex carbohydrates
What is spontaneous bacterial peritonitis (SBP)?
An acute bacterial infection of ascitic fluid in liver disease
What is the primary organism associated with SBP?
Escherichia coli
What is a key laboratory finding for diagnosing SBP?
Elevated PMN leukocytes (>250 cells/mm3) in peritoneal fluid
What is the first-line treatment for SBP?
IV antibiotics, specifically third-generation cephalosporins like cefotaxime
What is the significance of a serum-ascites albumin fluid gradient greater than 1.1 g/dL?
It is an early indicator of SBP
What should be done if a patient with SBP has a PMN count greater than 250 cells/mm3?
Empiric antibiotics should be initiated
What is the typical duration of antibiotic treatment for SBP?
5 days
What are common symptoms of peritonitis in patients undergoing peritoneal dialysis?
- Abdominal pain
- Cloudy peritoneal effluent
What is the typical management for bacterial peritonitis in peritoneal dialysis patients?
Intraperitoneal antimicrobial administration
What prophylactic measure can reduce the risk of infection at the catheter exit site in peritoneal dialysis?
Topical application of mupirocin or aminoglycosides
What is the role of prophylaxis at the catheter exit site?
Reduces the risk for infection through topical application of mupirocin or aminoglycosides.
What increases the risk for the development of SBP in patients with ascites?
Ascitic fluid protein levels less than 1 g/dL.
What are other important risk factors for SBP?
- Serum bilirubin level greater than 3.2 mg/dL
- Platelet count less than 98,000/mm3
- Previous history of SBP
How can management with diuretics affect SBP risk?
It helps decrease the risk of developing SBP.
What is the controversy surrounding proton pump inhibitors (PPIs) in relation to SBP?
Some studies found an increased risk of SBP with PPIs, while a recent study showed no increased incidence.
How might beta blockers affect SBP risk?
They may increase risk secondary to resultant systemic hypotension.
What is the effect of antibiotic prophylaxis in high-risk patients for SBP?
It can reduce SBP incidence by 60% to 80% and can be cost-effective.
What is a common daily prophylaxis regimen for high-risk patients?
- Norfloxacin 400 mg PO daily
- Ciprofloxacin 500 mg PO daily
- Trimethoprim-sulfamethoxazole (TMP-SMX) 800/160 mg PO daily
What prophylactic antibiotic is recommended for patients with cirrhosis admitted for GI bleeding?
Ceftriaxone (1 g IV daily) until the patient can take food orally.
What should be done when a patient starts eating after receiving ceftriaxone for GI bleeding?
Switch to oral TMP-SMX.
What is recommended for long-term outpatient prophylaxis in cirrhosis patients?
- Norfloxacin
- Ciprofloxacin
- TMP-SMX
What are high-risk features that warrant long-term outpatient prophylaxis?
- Ascitic fluid protein less than 1.5 g/dL
- Serum BUN level greater than 25 mg/dL
- Serum creatinine greater than 1.2 mg/dL
- Serum sodium level less than 130 mmol/L
In what situations might repeat paracentesis be helpful?
Inconsistent symptoms, abnormal treatment response, atypical organisms, or recent beta-lactam exposure.
Runyon criteria for SBP
What are the two broad categories of hepatic abscesses?
Pyogenic and amebic.
What are some conditions that may lead to pyogenic hepatic abscess?
- Biliary tract obstruction
- Cholangitis
- Diverticulitis
- Pancreatic abscess
- Omphalitis
- Appendicitis
- Inflammatory bowel disease
- Pneumonia
What is a common causative organism of pyogenic hepatic abscess?
- E. coli
- Klebsiella
- Pseudomonas
- Enterococcus spp.
- Anaerobic streptococci
- Various Bacteroides spp.
What are the typical clinical features of a pyogenic hepatic abscess?
- High fever
- Chills
- RUQ pain
- Nausea
- Vomiting
What laboratory findings are common in pyogenic hepatic abscess?
- Leukocytosis (70-80% of cases)
- Elevated alkaline phosphatase (up to 90%)
- Bilirubin > 2 mg/dL (50% of patients)
- Elevated serum aminotransferase levels (2-4 times normal)
What is the initial treatment for a pyogenic hepatic abscess?
- Hemodynamic stabilization
- IV antibiotics
- Pain control
True or False: Abscesses less than 5 cm are often treated with drainage.
False.
What is the recommended antibiotic regimen for pyogenic hepatic abscess?
- Cefotaxime 2 g IV every 8 hours
- Ceftriaxone 2 g IV daily plus metronidazole 500 mg IV every 8 hours
- Ampicillin 2 g IV every 6 hours plus gentamycin and metronidazole
- Piperacillin-tazobactam 3.375 IV every 6 hours
- Imipenem 500 mg every 6 hours
- Meropenem 1 gm every 8 hours
What is the typical management for amebic abscess?
- Supportive therapy
- Initiation of amebicidal therapy
- Metronidazole for tissue infection
- Paromomycin for luminal cysts
What protozoan is responsible for amebic liver abscess?
Entamoeba histolytica.
What are the common symptoms of amebic abscess?
- Fever
- Chills
- Nausea
- Vomiting
- Abdominal pain
What are the laboratory findings in amebic abscess?
- Neutrophilic leukocytosis
- Elevated alkaline phosphatase (75% of cases)
- Elevated aminotransferase levels (50%)
What is the incidence of liver disease in pregnancy?
Less than 1%.
What are the two primary hepatic disorders associated with pregnancy?
- Benign cholestasis
- Acute fatty liver
What is a key symptom of benign cholestasis during pregnancy?
Progressive pruritus.
What is the treatment for benign cholestasis in pregnancy?
Ursodeoxycholic acid (UDCA) 300 mg PO every 8 hours until delivery.
What is Budd-Chiari syndrome caused by?
Hepatic venous outflow obstruction.
What are the two types of Budd-Chiari syndrome?
- Primary BCS (thrombosis or phlebitis)
- Secondary BCS (external compression)
What imaging modality is the choice for diagnosing Budd-Chiari syndrome?
Doppler ultrasound imaging of the hepatic vein.
What is the significance of the Swansea criteria in pregnancy?
High sensitivity for diagnosing acute fatty liver disease.
Fill in the blank: Acute fatty liver of pregnancy can progress rapidly to _______.
[maternal or fetal demise]
What complication can occur with rupture of an amebic liver abscess?
- Involvement of the lung
- Abdominal pain with peritonitis
- Involvement of the pericardium
What factors are associated with primary Budd-Chiari syndrome?
- Hypercoagulable states
- Factor V Leiden
- Protein S or C deficiency
- Thrombophilia
- Antithrombin III deficiency
What is the clinical distinction between acute hepatic necrosis secondary to viral infection and BCS?
It is clinically indistinguishable from acute hepatic necrosis but treatment options differ significantly.
What is the sensitivity of Doppler ultrasound imaging of the hepatic vein for diagnosing BCS?
85% to 95%
What is the most sensitive diagnostic modality for BCS?
Venography with access through internal jugular, cephalic, or femoral veins.
What may ascitic fluid analysis help distinguish in BCS?
It helps distinguish among etiologies of ascites due to high portal pressure.
What serum-to-ascites protein gradient is associated with elevated portal pressure in BCS?
Greater than 1.1 g/dL.
What does the management of BCS focus on?
Relieving underlying disorders such as hypercoagulopathy and managing complications of portal hypertension.
What interventions are considered for newly diagnosed BCS with acute decompensation?
- TIPS placement
- Percutaneous angioplasty
- Thrombolytic therapy
How can previously diagnosed BCS with worsening ascites be managed?
- Modification of diuretics
- Therapeutic paracentesis
- Referral to a primary care physician or gastroenterologist
What treatment is used to prevent clot propagation in primary BCS?
Anticoagulation.
What are the treatment options for disease refractory to medical or percutaneous interventions in BCS?
- Portacaval surgical shunting
- Liver transplantation
What is the 5-year survival rate for patients undergoing human orthotopic liver transplantation?
Approximately 80%.
What are common early complications of liver transplantation?
- Bleeding
- Acute rejection
- Vascular or biliary tract issues
- Infection
What are delayed complications that may occur after liver transplantation?
- Recurrence of underlying disease
- Malignancy
- Infection
- Chronic rejection
- Medication toxicity
- Biliary complications
- Renal failure
What is a common regimen of immunosuppressive agents used after liver transplantation?
- Glucocorticoid (e.g., prednisone)
- Calcineurin inhibitor (e.g., cyclosporine or tacrolimus)
- Either sirolimus, mycophenolate, or azathioprine
What is a potential side effect of corticosteroid toxicity?
- Glucose intolerance
- Diabetes
- Osteoporosis
- Gastric ulceration
- Muscle wasting
What is the most common dose-limiting effect of cyclosporine and tacrolimus?
Renal impairment.
What complications are associated with azathioprine?
- Hepatotoxicity
- Bone marrow suppression
What remains the leading cause of mortality in liver transplant recipients?
Infections.
What are the signs of chronic rejection in liver transplant recipients?
- Low-grade temperature elevation
- Fatigue
- Jaundice
What laboratory abnormalities are expected in rejection of a transplanted liver?
- Elevated bilirubin
- Elevated transaminase levels
- Prolonged PT or INR
- Low serum albumin level
What is the best means of early identification of evolving renal dysfunction post-transplant?
Routine serum creatinine level measurement.
What assessments may be included in the management of liver transplant complications?
- CBC
- Glucose
- BUN
- Creatinine
- Serum electrolytes
- Transaminase
- Bilirubin
- Albumin levels
- Coagulation studies
