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Liver diseases Flashcards

1
Q

Signs of liver disease

A

palmar erythema, clubbing, flapping tremor, jaundice, spider angioma, gynecomastia, scant body hair, scratch marks, ascities, hepatomegaly, caput medusa, hemorrhoids, small testies

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2
Q

Liver disease tests

A

ALT, AST, alkaline phosphatase, bilirubin

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3
Q

less than 5x normal elevation, ALT

A

chronic heb B/C, acute A-E, EBV, CMV, steatosis, hemochromatosis, medications, toxins, autoimmune hepatitis, alpha-1-antitrypsin, wilson disease, celiac disease

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4
Q

Liver function tests

A

ALT, AST, alkaline phosphatase, bilirubin

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5
Q

ALT and AST

A

enzymes found in hepatocytes, released when liver is damaged, ALT specific for liver, AST also in skeletal and cardiac

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6
Q

less than 5x normal elevation, ALT

A

chronic heb B/C, acute A-E, EBV, CMV, steatosis, hemochromatosis, medications, toxins, autoimmune hepatitis, alpha-1-antitrypsin, wilson disease, celiac disease

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7
Q

less than 5 x normal elevation, AST

A

alcohol related, steatosis, cirrhosis

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8
Q

less than 5x normal elevation non-hepatic source

A

hemolysis, myopathy, thyroid disease, strenuous exerise

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9
Q

greater than 15 x AST/ALT

A

acute viral hepatitis, ischemic hepatitis, sepsis, hemorrhage, MI, autoimmune hepatitis, wilson disease, acute bile duct obstr, hepatic artery ligation, Budd-Chiari syndrome, toxins

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10
Q

Alkaline phosphatase

A

hepatocytes that line bile canaliculi, level raised in biliary obstruction, also in bone and placenta

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11
Q

Bilirubin

A

water insoluble product of heme metabolism, reticuloendothelial cells in spleen, liver and bone marrow produce, taken up by liver and conjugated to become water soluble

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12
Q

Common causes of jaundice

A

increase destruction of RBS, high free bilirubin in plasma, high urobilinogen in urine, obstruction of bile duct or damage to liver cells

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13
Q

Tests of liver function

A

prothrombin time/ INR, albumin

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14
Q

Prothrombin time/ INR

A

measure of VIt K dependent clotting factors, liver activates vit k so if clotting factors not produced liver is damaged

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15
Q

Hepatitis A

A

RNA virus, fecal oral, incubate 15-50 days, anti hepatitis A IgM, treat/prevent vaccine, immune serum globulin, good prognosis

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16
Q

Hepatocellular disease

A

increased transaminases, viral hep, drugs, alcohol, autoimmune, NASH, hemochromatosis

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17
Q

Cholestatic disease

A

increased alk phos/ bilirubin, maybe transaminases; gallstones, primary biliary cirrhosis, sclerosing cholangitis, pancreatic cancer

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18
Q

Acute vs chronic viral hepatitis

A

acute has IgM antibodies, chronic has IgG antibodies

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19
Q

Hepatitis A

A

RNA virus, fecal oral, incubate 15-50 days, anti hepatitis A IgM

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20
Q

Hepatitis B

A

DNA virus, surface and core, can present with arthralgias, glomerulonephritis, urticaria, parenteral or sexual route, bodies rxn to virus not vice versa

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21
Q

Hep B Immunized or previously exposed pt have

A

negative HBsAG and positive IgG antiHBcore

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22
Q

Hepatitis C

A

RNA virus, blood born, IV drug and blood transfusion, anti HCV antibody, 85% develop chronic

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23
Q

Complications of Hep C

A

cirrhosis, hepatocellular carcinoma (1-4% per year), cryoglobulinemia, prophyria cutanea tarda, alcohol increases risk

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24
Q

Management of Hep C

A

interferon alpha w/ ribavirin for 6-12 months clears virus ~40% pt

25
Hepatitis E
acute hepatitis just like Hep A unless pregnant in which can progress to fulminant hepatitis
26
What can cause acute hepatitis in immunocompromised?
EBV, CMV, Herpes
27
Autoimmune liver diseases
autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
28
Autoimmune hepatitis
ANA postive, ant smooth muscle +, high bilirubin and ALT, norm Alk phos, necrosis w/ lymphocyte infiltration, treat with immunosupression/ liver transplant
29
Primary sclerosing cholangitis symptoms
high bilirubin, high alk phos, neg antimitochondrial ab, jaundice, pruritis abdo pain and fatigue
30
Primary biliary cirrhosis
inc Alk Phos and antimitochondrial antibodies +, damage to intralobular bile ducts by chronic granulomatous inflammation, unable to excrete bile
31
Symptoms of primary biliary cirrhosis
malabsorption of fat soluble vits, lethargy, itching, hyperlipidemia
32
Primary sclerosing cholangitis
inflammation, fibrosis, strictures of biliary tree causing beaded biliary tree on ERCP, leads to cirrhosis, mng w/ steroids, cholesyramine or ursodeoxycholic acid, liver transplant
33
Non-alcoholic steatohepatitis
common cause of elevated LFT, pt have metabolic syndrome, progress to cirrhosis, treat by weight loss, control of lipids and diabetes
34
Genetic liver disease
Wilson, hemochromatosis, alpha-a-antitrypsin deficiency
35
Hemochromatosis
autosomal recessive, chromosome 6, increase Fe abs
36
Symptoms of hemochromatosis
Bronze diabetes, artralgias, hepatosplenomegally, testicular atrophy, heart failure, high Fe and ferritin, low TIBC, low testosterone, diabetic, chondrocalcinosis
37
Wilson Disease
autosomal recessive, chromosome 13, defective intrahepatic formation of ceruloplasmin, failure of biliary excretion and high total body and tissue level of Cu
38
Wilson disease symptoms
high urinary Cu, cirrhosis, Kaiser-Fleischer rings, hypoparathyroidism, arthropathy, Fanconi syndrom, psychosis, mental retardation, seizures
39
Treatment of wilson disease
copper chelation with penicillamine, can cure with liver transplant but CNS sequalae will not resolve
40
Cirrhosis complications
portal htn causing variceal bleeding, splenomegally causing low platelets, ascites, encephalopathy, hepatorenal syndrome
41
4 stages of cirrhosis
liver cell necrosis, inflammatory cell infiltrate, fibrosis, nodular regeneration
42
Causes of cirrhosis
alcohol, viral B/C, cryptogenic, primary biliary cirrhosis, hemochromatosis, wilsons, alpha 1 antitrypsin, autoimmune, sclerosing cholangitis
43
Cirrhosis complications
portal htn causing variceal bleeding, splenomegally causing low platelets, ascites, encephalopathy, hepatorenal syndrome
44
Ascites
accumulation of free fluid in peritoneum, assessment involves taking sample of fluid and checking albumin content, SAAG (ascites albumin-serum albumin)
45
SAAG >1.1,
>1.1 portal hypertension, cirrhosis, alcoholic, CHF, hepatic mets
46
Management of ascites
salt restriction, fluid restriction, diuretics, large volume paracentesis
47
Variceal hemorrhage
varices in esophagogastric junction due to portal htn, BB reduce pressure and may prevent rebleeds, serial endoscopy and banding to obliterate varices also preventative
48
Spontaneous bacterial peritonitis
10-20% cirrhotic pts w/ ascities, cell ct and culture of ascitic fluid should be performed in all pts, PMN >250 is diagnositic
49
Acute pancreatitis
abrupt, deep epigastric pain, rad to back, hx of previous related to alcohol, or biliary tract disease, obstruction of ampulla of vater, or direct injury
50
Encephalopathy
dec consciousness in pt w/ severe liver disease, always look for cause, usually inc serum ammonia, treat with lactulose
51
Childs-pugh classification
used to determine how risky surgery will be based on bilirubin, albumin, ptt, ascites, and encephalopathy
52
Acute pancreatitis
abrupt, deep epigastric pain, rad to back, hx of previous related to alcohol, nausea, vomiting, sweating, weakness, abd tenderness, distention and fever
53
Acute pancreatitis exam and labs
UQ pain, often w/out gaurding, rigidity, or rebound, leukocytosis, elevated serum amylase, elevated serum lipase
54
Acute pancreatitis symptoms
nausea, vomiting, sweating, weakness, abd tenderness, distention, and fever
55
Ranson criteria
used to predict severity of acute pancreatitis, based on age, WBC, glucose, lactate dehydrogenase, hematocrit, calcium, BUN, pO2, fluid sequestation
56
Pancreatic necrosis
elevated serum creatinine level at 48 hrs
57
Imaging of acute pancreatitis
ultrasonography not helpful, unenhanced CT is useful for demonstrating enlarge pancreas when uncertain
58
Management of pancreatitis
oral intake of fluids and foods resumed when pt largely free of pain and has bowel sounds, clear liq given at first, followed by gradual advancement to low fat diet, guided by pts tolerance and absence of pain

Clinical medicine (19 decks)

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