Liver Disease Flashcards
Increased aminotransferases (ALT, AST) suggests ____
Hepatocellular injury
Increased alkaline phophatase suggests ____
Cholestasis
When there is an increase in alkaline phosphatase w/o increase in bilirubin and aminotransferases, where do you think the source of the injury is?
Bone
Placenta
What tests do you perform withincreased alkaline phosphatase to confirm liver origin?
Increased GGT
5’nucleotidase
What condition?
Large increase in AST and ALT
Viral hepatitis
What condition?
Large increase in AST and ALT
Increase in LDH
Ischemic Hepatitis
What condition?
AST >2xALT
Increased bilirubin
Alcoholic liver disease
What condition?
Increased alkaline phosphatase
Large increase bilirubin
Cholestasis
What condition?
Increase in bilirubin
Increased LDH
Decreased haptoglobin
Hemolysis
What condition?
Increased in alkaline phosphatase
Normal ALT/AST
Hemolysis
(ALT/AST) is more specific for liver.
ALT
Which of the following is NOT on the differential for mild hepatocellular injury (ALT/AST elevation) A. Chronic viral hepatitis B. Primary biliary cholangitis C. Non-alcoholic fatty liver disease D. Autoimmune hepatitis
B. Primary biliary cholangitis is on differential of cholestatic injury
Which of the following is NOT on the differential for extreme hepatocellular injury (ALT/AST elevation >30x ULN = 1,000U/L)? A. Drug induced liver injury B. Acute viral hepatitis C. Hepatic ischemia D. Congestive hepatopathy
D. Congestive hepatopathy is on the differential for mild hepatocellular injury
Hyperbilirubinemia of sepsis shows (direct/indirect) bilirubin.
T/F: Labs show elevated alk. phos, ALT and AST.
Direct
False. Normal ALT, AST. Minimal elevation in alk phos
Gilbert’s Syndrome =
Unconjugated (indirect) hyperbilirubinemia
3 types of decompensation of chronic liver disease
Acites
Variceal bleeding
Hepatic encephalopathy
T/F: A patient with platelet defficiency is contraindicated for paracentesis.
False. Coagulopathy is NOT a contraindication for tapping ALL ascites.
Diagnosis of Spontaneous Bacterial Peritonitis
> 250 PMN/mm3 in ascetic fluid
SAAG > 1.1 =
portal HTN
T/F: Prophylactic abx should be given to cirrhotic patients admitted with nausea/vomitting.
False. Admitted with GI bleeding
T/F: You should wait for culture to come back before giving abxwhen suspiscious of Spontaneous Bacterial Peritonitis to ensure that you are giving the right antibiotic.
False. Start abx immediately
The most effective management of ascites
Sodium restriction
Which of the following is FALSE about management of ascites? A. Sodium restricted diet B. Spironolactone, furosemide C. Fluid restriction D. Avoid IV diuretics E. Acetaminophen for pain management
C.NO fluid restriction needed for serum Na>120
E. Acetaminophen is ok b/c it’s not an NSAID. NSAID should be avoided in pts w/ cirrhosis.
Most common cause of upper GI bleeding in cirrhotics
Variceal bleeding
Clinical diagnosis of hepatic encephalopathy based on presence of:(3)
Advanced liver disease
Asterixis
Hyperreflexia
T/F: Elevated blood ammonia levels is required to make diagnosis of Hepatic Encephalopathy.
False. NOT required
Which of the following is NOT a treatment of hepatic encephalopathy? A. Lactulose (laxative) B. Rifaximin C. Protein restriction D. ID and correct precipitating causes
C. NO need for protein restriction
MELD score is based on (3)
MELD score used for ____
Creatinine
Bilirubin
INR
Predicting 3 month mortality
