Liver disease Flashcards
all forms of chronic liver disease can produce
- ascites 2. coagulopathy 3. Asterixis (+ encephalopathy) 4. Hypoalbuminemia (+edema)
- spider angiomata + palmar erythema
- portal hypertension (–> varives)
- thrombocytopenia (from splenic sequestration)
- renal insufficiency (hepatorenal syndrome)
- hepatopulmonary syndrome
all cloating factor except … are made in liver
VIII
Ascites - paracentesis if
- new onset
- abdominal pain and tenderness
- fever
Serum ascites albumin gradient (SAAG is aka)
differencs or gradient between the serum and ascites
ascitis - causes regarding SAAG
if above 1.1 g/dL: infection, cancer
lower: Portal hypertension, CHF, hepatic vein thrombosis, constrictive pericarditis, Cirrhosis, nephrotic syndrome
ascitis - nephrotic syndrome - SAAG
according to MTB is above 1.1
according to medscape lower
spontaneous bacterial peritonitis (SBP)?
infection of the bowel without a perforation
we don’t actually know how bacteria gets there
spontaneous bacterial peritonitis (SBP) - organisms
- E. coli is the MC
- Anaerobes are rarely the cause
- Pneumococcus also causes (for unknown reasons)
spontaneous bacterial peritonitis (SBP) - best initial test
cell count with more than 250 neutrophils is the basis upon which we start therapy (from abdominal cavity fluid)
spontaneous bacterial peritonitis (SBP) - gram stain
almost always negatie
spontaneous bacterial peritonitis (SBP) - most accurate test
fluid culture –> results are never available at the time we have to make a treatment decision
spontaneous bacterial peritonitis (SBP) - LDH
too nonspecific
spontaneous bacterial peritonitis (SBP) - treatment
cefotaxime or cefriaxone
spontaneous bacterial peritonitis (SBP) - recurrence
frequent
spontaneous bacterial peritonitis (SBP) - prophylaxis indcation
- ascitis when fluid albumin level is low
- all patients with SBP need lifelong prophylaxis
- all variceal bleeding
spontaneous bacterial peritonitis (SBP) - prophylaxis how
norfloxacin or TMP/SXM
spontaneous bacterial peritonitis (SBP) - treatment vs prophylaxis antibiotics
treatment: cefotaxime or cefriaxone
prophylaxis: norfloxacin or TMP/SXM
ascites + edema - treatment
spironolactone and other diuretics
serial paracenteses for large-volume ascites
coagulopathy and thrombocytopenia - treatment
FFP +/ platelets only if bleeding occurs
liver disease encephalopathy - treatment
lactulose + rifamixin
liver disease hypoalbuminemia - treatment
no specific therapy
spider angiomata + palmar erythema - treatment
no specific therapy
liver disease and varices - treatment
propranolol + banding via endoscopy
hepatorenal syndrome - treatment
- octreotide
2. midodrine (α1 agonist)
hepatopulmonary syndrome - treatment
no specific therapy
hepatopulmonary syndrome?
lung disease + hypoxia entirely on the basis of liver failure
Look for orthodeoxia
orthodeoxia?
hypoxia upon sitting upright
specific causes of cirrhosis
- Alcoholic liver disease
- primary biliary cirrhosis
- primary sclerosing cholangitis
- alpha 1-antitrypsin deficiency
- hemochromatosis
- chronic HBV + HCV
- wilson
- autoimmune hepatitis
- Nonalcoholic steatohepatitis or nonalcoholic fatty liver disease
Alcoholic liver disease - how to diagnose
it is a diagnosis of exclusion
Alcoholic liver disease - therapy
no specific therapy
Alcoholic liver disease - most accurate test
most of the causes of cirrhosis, except for sclerosing cholangitis, is liver biopsy
Alcoholic liver disease - specific lab characteristic
greater elevation in AST compared to ALT
BINGE drinking gives sudden rise in GGTP
binge drinking - lab test
sudden rise in GGTP
primary biliary cirrhosis - epidimiology
woman 40-50
associated with other autoimmune conditions (Sjogren, Hashimoto, CRREST, RA etc)
primary biliary cirrhosis - presentation
- fatique and itching
- xanthalesma/xanthoma
- osteoporosis
primary biliary cirrhosis - labs
- normal bilirubin –> elevated in in very far advanced
- ## elevated ALP
primary biliary cirrhosis - tests
- most accurate test: liver biopsy
- most accurate blood test: antimitochondrial antibody
- normal bilirubin and IgM –> elevated in in very far advanced
- elevated ALP
primary biliary cirrhosis - treat with
ursodeoxycholic acid
primary biliary cirrhosis - antibodies
antimitochondrial antibody
primary sclerosing cholangitis - epidimiology
over 80% of primary sclerosing cholangitis occurs in association with IBD
middle aged men