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Clin Med II - GI Exam > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

List the common liver function tests

A 
Aspartate Aminotransferase (AST, SGOT)
Alanine Aminotransferase (ALT, SGPT)
Alkaline Phosphatase (ALP)
Total Bilirubin
Albumin
*not on LFT panel but still used:
Gamma Glutamyl Transpeptidase
PT
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2
Q

Where is aspartate aminotransferase (AST) enzyme made?

A 
RBC's
Liver
Heart
Muscle tissue
Pancreas
Kidney
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3
Q

Normal values of AST are

A

Low

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4
Q

Abnormal Values of AST are

A

high

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5
Q

What does an increased AST indicate?

A

damage to tissue (not very specific)

Amount of AST in blood is directly related to extent of tissue damage (time = tissue)

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6
Q

What test can AST be done along with to determine whether the liver or another organ has been damaged?

A

ALT

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7
Q

Where is alanine aminotransferase (ALT) enzyme made?

A

Mainly in the liver, but also in small amounts in kidneys, heart, muscles pancreas

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8
Q

Normal values of ALT are?

A

Low

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9
Q

Abnormal values of ALT are?

A

High

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10
Q

What can elevated ALT levels indicate?

A

liver disease (more convincing when associated with elevated AST)

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11
Q

Where is Alkaline Phosphatase (ALP) enzyme made?

A 
Liver 
Bone 
intestines
kidneys
placenta of preg
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12
Q

What body part makes the most ALP?

A

liver (more than other organs/bones)

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13
Q

What conditions can cause elevated ALP?

A 
rapid bone growth (during puberty)
bone disease
hyperparathyroidism
vit D deficiency
Damaged liver cells
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14
Q

What is the function of gamma glutamyl transpeptidase in the body?

A

transport molecule that helps liver metabolize drugs/toxins

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15
Q

Where is glutamyl transpeptidase found in the body?

A 
concentrated in the liver
Also found in GB
Spleen
pancreas
kidney
NOT IN THE BONES
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16
Q

What other lab test is helpful to use along with GGT to diagnose liver disease?

A

ALP

Not found in bones, so helps r/o bones as cause of elevated lab.

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17
Q

What does a total bilirubin measure?

A

amount of bilirubin in the blood

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18
Q

What is bilirubin a by-product of?

A

RBC’s are broken down daily-bilirubin is produced as a result. The liver then breaks down the bilirubin and it is excreted in the feces.

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19
Q

What 2 forms of bilirubin exist?

A

direct (conjugated) bilirubin

indirect (unconjugated) bilirubin

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20
Q

Elevated levels of indirect (unconjugated) bilirubin are a sign of____?

A

hemolysis or failure of liver uptake

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21
Q

Elevated levels of direct (conjugated) bilirubin are a sing of ___?

A

Impaired secretion of liver

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22
Q

Which of the 2 forms of bilirubin is measured directly in the blood?

A

direct (conjugated)

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23
Q

Where is Albumin produced?

A

liver

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24
Q

What is the fxn. of albumin?

A 
moves bilirubin
calcium
hormones
medications through the blood
Keeps fluid in the blood from leaking into capillaries
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25
Q

What is albumin used to test for?

A

kidney and liver dz

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26
Q

greatly decreased values of Albumin are indicative of?

A

Liver/kidney dz

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27
Q

decreased values of albumin are indicative of?

A 
Absorption problem
post surgery
malnutrition
low protein diet
crohns etc.
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28
Q

Increased levels of albumin are indicative of?

A

dehydration and high protein diet

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29
Q

What will occur to Prothrombin time in the setting of chronic liver dz?

A

increase

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30
Q

Define Steatosis

A

fatty infiltration of the liver

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31
Q

Define steatohepatitis

A

fatty infiltrate PLUS inflammation

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32
Q

Define cirrhosis

A

Chronic degenerative dz in which cells are damaged and replaced by scar tissue

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33
Q

functions of the liver

A 
Conjugates bilirubin
produces bile
produces many proteins
processes ETOH, some meds/toxins
Regulates lipids
Converts glycogen into glucose and vice versa
Excretes some wastes
storage unit
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34
Q

Definition of Alcoholic liver dz?

A

Acute or chronic inflammation and parenchymal necrosis of the liver induced by ETOH

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35
Q

Which of the discussed liver diseases is reversible?

A

Alcoholic liver dz

Non alchoholic fatty liver disease

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36
Q

Which type of liver dz is the most common precursor of cirrhosis in the US?

A

Alchoholic liver dz

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37
Q

What are the three pathologic stages of alcoholic liver dz?

A

Fatty liver-reversible
Alcoholic hepatitis-reversible
Cirrhosis-irreversible

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38
Q

Fatty liver =

A

steatosis

asymptomatic

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39
Q

Alcoholic hepatitis =

A

Steatohepatitis

Asymptomatic-symptomatic

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40
Q

_______ as the first histological response in response to any hepatotoxic stimuli (ETOH in ALD)

A

fat accumulation (steatosis)

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41
Q

What is the deficiency found in ALD in the liver?

A

alcohol dehydrogenase deficiency

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42
Q

What is the hallmark of the shift from steatosis to steatohepatitis in ALD?

A

Hepatocyte injury

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43
Q

RF for ALD?

A 
Alcohol intake (duhhhhh)
Females more than males
Concurrent viral Hep C
Genetics
Fattly liver/obesity
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44
Q

ETOH threshold for females for developing liver dz?

A

Chronic use exceeding 30-40g/day (3/4 beers a day)

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45
Q

ETOH threshold for males for developing liver dz?

A

Chronic use exceeding 80g/day (6/7 beers a day)

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46
Q

sx of early (fatty liver) ALD?

A 
Asymptomatic 
Hepatomegally
RUQ tenderness occasionally
Nausea
Jaundice - very rare
47
Q

sx of advanced steatohepatitis in ALD?

A 
Asymptomatic in some
Fever
SPIDER NEVI
jaundice
abd tenderness/acute and.
encephalopathy
portal hypertension (ascites, esophageal varicies)
48
Q

Lab finding for ALD early?

A

Modest increase in GGTP, AST, ALT
Hypertriglyceridemia
hypercholesterolemia
hyperbilirubinemia

49
Q

Lab finding for ALD advanced?

A 
SEVERE INCREASE in GGTP, AST, ALT, (AST greater than ALT (ratio greater than 1))
Hyperbilirubinemia
ALK PHOS HIGH**
HYPOALBUMINEMIA**
INCREASED PT**
50
Q

Imaging for ALD?

A

US detects fatty infiltration

51
Q

T/F US can distinguish between fibrosis and inflammation in ALD?

A

FALSE

52
Q

What test is used as gold standard for ALD to confirm diagnosis and guide therapy?

A

Liver Bx

53
Q

How can you differentiate ALD from NASH?

A

Not on Bx (can’t tell difference).

Have to get a good HX from pt.

54
Q

General tx for ALD?

A

Abstain from ETOH
Nutrition (particularly in malnourished/anorexic pt’s)
Psych.

55
Q

Pharm Tx for ALD?

A

Methylprednisolone reduces short term mortality

Pentoxyfylline (for severe)

56
Q

Most important prognosis for pt’s with ALD?

A

continued ETOH use

57
Q

What is the MC chronic liver dz in the US?

A

Nonalchoholic fatty liver disease (NAFLD)

58
Q

Why is there an increase in the US in NAFLD?

A

rise in childhood obesity

59
Q

MC causes of NAFLD?

A 
Obesity (MC)
DM
Hypertriglyceridemia
Meds (steroids)
Cushings syndrome/hypothyroidism
PCOS
OSA
Metabolic syndrome
60
Q

RF for progressive NAFLD?

A

Older age
obesity
DM

61
Q

SX of NAFLD?

A

Mostly asymptomatic
RIQ discomfort
Hepatomegaly (75% of pt’s)
Progression of chronic liver dz is common

62
Q

Labs for NAFLD?

A

may be normal or mildly elevated AST/ALT alk pos.

Ratio of AST:ALT is almost always greater than 1

63
Q

Imaging for NAFLD?

A

may be seen on CT, US MRI but won’t distinguish between stages

64
Q

Diagnostic test of choice for NAFLD?

A

Liver Bx

65
Q

lifestyle tx for NAFLD

A

Wt loss
dietary fat restriction
exercise

66
Q

Pharm options that are being studied for use in NAFLD?

A

TZD’s
Vit. E
Metformin (but causes wt gain)
Pentoxyfylline

67
Q

Surgical options for NAFLD?

A

Gastric bypass

68
Q

What percentage of pt’s with NAFLD progress to NASH?

A

25%

69
Q

define NASH?

A

Nonalcoholic steatohepatitis

70
Q

NASH histologically presents exactly like ____?

A

Alcoholic hepatitis

71
Q

What distinguishes NASH from ALD?

A

lack of Hx of chronic excessive ETOH use

72
Q

Common sx of NASH?

A

fatigue
wt loss
weakness

73
Q

What confirms diagnosis of NASH?

A

Liver bx

74
Q

What are the 2 most common causes of Cirrhosis in the US?

A

Alcohol and Hep C are 2 MC causes of Cirrhosis in the US

75
Q

Describe three stages of Cirrhosis?

A

Compensated-no complications
Compensated with varices
Decompensated-with complications

76
Q

Complications of Cirrhosis

A 
Portal hypertension (ascites, spontaneous bacterial perionitis, variceal bleeding)
Hepatorenal syndrome
hepatic encephalopathy
Hepatopulmonary HTN
malnutrition
coagulopathy
bone dz
Hematologic abnormalities
77
Q

sx of cirrhosis

A 
weakness
fatigue
anorexia
wt loss
stigmata of liver dz (see complications)
78
Q

Standout symptoms of cirrhosis?

A 
Gynecomastia
Caput medusa (dilated abd vessels)
Asterixis (dorsiflexion of palms)
spider angiomas (trunk/upper arms)
Dupuytren's contracture (can't straighten finger)
Palmar erythema (spares palmar region)
ascites
esophageal varices
79
Q

Labs that are abnormal in cirrhosis?

A 
(can be normal/abnormal depended on stage)
macrocytic anemia
WBC low or high (if infxn.)
thrombocytopenia
prolonged PT
Elevated AST/ALT and ALP
Bili elevated
Albumin decreased
GGTP increased
Serum sodium decreased
Vit D level low
80
Q

Gold standard for diagnosis of cirrhosis?

A

Liver BX

81
Q

When is a liver Bx not needed?

A

if clinical, lab, and radiologic data strongly suggests cirrhosis already

82
Q

Imaging for Cirrhosis?

A

Doppler US (liver size, nodules, ascites, patency)
CT/MRI
EGD

83
Q

General Tx for cirrhosis?

A

Tx cause (ETOH, Hep C, Hep B)
proper diet
psych counseling
vaccine UTD

84
Q

Tx for cirrhosis (meds)

A

NONE!

85
Q

What is TX aimed at for Cirrhosis?

A

Complications

Prevention of progression

86
Q

What is the MC complication of cirrhosis?

A

Ascites and edema

87
Q

tx for ascites?

A

restrict Na consumption
diuresis (spironolactone first, add loop)
Paracentesis
TIPS

88
Q

Tx of Variceal hemorrhage

A

Vasoconstricting agents
Balloon tamponade
TIPS/band ligation
Prophylaxis-routine screening for all pt’s with cirrhosis

89
Q

define hepatorenal syndrome?

A

Development of renal failure in pt’s with advanced liver dz.

90
Q

Progressive increase in _____ occurs during hepatorenal syndrome?

A

Creatinine

91
Q

Why does hepatic encephalopathy occur?

A

buildup of toxins in the body , neurotoxins are not removed by live and end up in the brain.

92
Q

Sx of hepatic encephalopathy?

A 
mental status change
hypersomnia
personality change
asterixis
brain swelling 
high emonia
93
Q

tx of hepatic encephalopathy?

A

Hydration with IV fluid
electrolyte correction
Lactulose (removes GI nitrogenous product)
Mannitol (decreases brain swelling)
Rifaxim or metronidazole plus neomycin If pt doesn’t tolerate lactulose
zinc supplementation

94
Q

Signs of hepatopulmonary syndrome with cirrhosis?

A

dyspnea and drop in O2 sat that is worse when UPRIGHT. (weird)

95
Q

define portopulmonary HTN

A

presence of pulm htn. in pt’s with portal htn.

96
Q

how is portopulmonary HTN diagnosed?

A

echo and cardiac cath.

97
Q

Tx of malnutrition 2nd to cirrhosis?

A

sietary supplementation

98
Q

How common in coagulopathy in cirrhosis?

A

VERY- universal in all pt’s with cirrhosis

99
Q

tx of coagulopathy in Cirrhosis?

A

Vit K (if Vit K is diminished)
If synthesis of clotting factors d/t mass in liver
Vit K will NOT correct problem. Tx requires FFP if active bleeding or before surgery

100
Q

Tx for bone disease 2nd to cirrhosis?

A

Bisphosphonates

101
Q

What is the ultimate tx of decompensated cirrhosis?

A

Liver transplant

102
Q

Define hemochromatosis

A

inherited disorder of iron metabolism.

results in progressive increase in iron deposition which can cause cirrhosis

103
Q

What labs can be used to evaluate for Hemochromatosis?

A

Elevated fasting transferrin sat and elevated ferritin level

genetic testing, liver bx

104
Q

Tx of hemochromatosis?

A

regular phlebotomy

105
Q

Define Wilson’s disease?

A

Autosomal recessive d/o of copper homeostasis w/ failure to excrete excess copper leading to liver damage

106
Q

What groups are generally affected by Wilson’s disease?

A

young adults and adolescents

107
Q

What group is usually effected by Wilson’s disease?

A

young adults and adolescents.

108
Q

Important PE finding of Wilson’s disease?

A

Kayser-Fleisher corneal rings (ring of copper around the eye).

109
Q

How is Wilson’s disease diagnosed?

A

Low serum ceruloplasmin concentration and increased hepatic copper on LIVER BX.

110
Q

Tx of Wilson’s disease?

A

Copper-chelating agents indefinitely (penicillamine)

111
Q

define alpha-1 antitrypsin deficiency

A

autosomal recessive d/o that causes abnormal folding of the alpha 1 antitrypsin protein leading to failure of the liver (also effects pulm system-emphysema)

112
Q

Diagnosis of Alpha-1 antitrypsin is done by doing___?

A

phenotype testing and alpha 1 antitrypsin levels

113
Q

tx of alpha-1 antitrypsin deficiency?

A

Liver transplant is curative.

Clin Med II - GI Exam (14 decks)

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