Liver disease Flashcards
What indicates hepatocellular injury?
AST/ALT elevation
What is the lab pattern for cholestasis?
elevation in alkaline phosphatase, with or without increased bilirubin
elevation in alkaline phosphatase, with or without increased bilirubin - what pattern of liver abnormality is this?
cholestasis. if there is no bilirubin elevation, confirm the alk phos is from the liver with elevated GGT or 5’nucleotidase
pattern of labs for alcoholic hepatitis?
super high bilirubin.
AST more than double ALT. (ALT normally higher in other conditions.)
pattern of labs for ischemic colitis?
extreme elevation of AST/ALT (in the 1000’s), after a severe drop in blood pressure.
Only other thing that causes such high elevations is acute hepatitis.
T/F: AST/ALT levels corrrelate with level of liver injury.
FALSE
2 most common diseases for mild hepatocellular injury (
- Non alcoholic fatty liver disease
- chronic viral hepatitis.
DDx for cholestatic pattern liver disease
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- drugs
- biliary obstruction
- infiltrative process (TB, amyloid)
High bilirubin, slightly elevated alk phos. High DIRECT bilirubin component. Diagnosis?
-high direct bilirubin = sepsis!
High bilirubin, slightly elevated alk phos. High INDIRECT bilirubin component. Diagnosis?
Gilbert’s syndrome or hemolysis.
when should you tap /test ascites?
“the sun should never set on untapped ascites”
- confirm etiology or rule out infection.
- ANY evidence of clinical deterioration.
T/F: coagulopathy is a contraindication to paracentesis of ascites, wait for PT/PTT to normalize before doing it.
FALSE. not a contraindication.
tests to run on ascites paracentesis
- serum albumin vs. ascites album gradient (SAAG)
- CBC/diff (for infection)
What SAAG (serum ascites-albumin gradient) means portal hypertension?
1.1 or above.
how many PMNs in ascitic fluid is evidence of SBP - spontaneous bacterial peritonitis?
> 250
-cultures are negative 50% of the time, so you need to rely on the WBC count!!
treatment for ;spontaneous bacterial peritonitis
cefotaxime and IV albumin
treatment of ascites
- sodium restricted diet** = most importan
- spironolactone and furosemide (oral, NOT IV)
- fluid restriction not needed
treatment of hepatic encephalopathy
identify and correct the precipitating cause!
-also, give lactulose and rifaximin
what is the MELD score?
score based on the total bilirubin, prothrombin time, and the creatinine.
Predicts 3 month mortality for transplants
signs of cirrhosis
- fatigue
- volume overload / ascites/edema
- nodular liver
- enlarged spleen
T/F: People usually die of HCV-hepatitis within 10 years.
FALSE! cirrhosis is not a death sentence! In HCV hepatitis, 75% have NOT
decompensated by 10 years after diagnosis.
what 3 blood tests should you do (in addition to hemoglobin/ MCV) if you are evaluating someone for blood loss in the gut?
- ferritin
- iron
- transferrin
