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G2F > Liver Diseases CIS > Flashcards

Liver Diseases CIS Flashcards

1
Q

hepatocellular- labs

A

-ALT and AST

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2
Q

cholestasis

A

-ALK phos

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3
Q

IgM and IgG

A
  • IgM- acute

- IgG- chronic

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4
Q

liver fxn tests

A

PT and serum albumin

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5
Q

ascites- caused by? risk factors?

A
  • portal HTN from chron liver dz

- ETOH, transfusions, tattoos, IVDU, viral hepatitis

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6
Q

fatty liver (hepatic steatosis)- caused by

A
  • NAFLD
  • alcoholic related fatty liver dz
  • vinyl chloride
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7
Q

NAFLD- sx, etiology

A
  • usually asymptomatic- RUQ pain, hepatoemgaly
  • obesity, DM, hypertriglyceridemia, metabolcic syndrome
  • coffee reduces risk of fibrosis and cirrhosis
  • protective- physical activity
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8
Q

NAFLD- histology

A
  • macrovesicular steatosis

- NASH (nonalcoholic steatohepatitis)- macrovesicular steatosis and focal infiltration by PMN’s and Mallory hylain

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9
Q

NAFLD- imaging, tx

A
  • US- can see macrovascular steatosis
  • liver bx- diagnostic
  • tx- weight loss, dietary fat restriction, exercise, vit E, gastric bypass
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10
Q

do what test for ascites?

A

-US

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11
Q

if abd pain, ascites, and fever- must rule out what? via?

A

spontaneous bacterial peritonitis

  • via Paracentesis!!- run WBC count with differential!
  • if malnourished- run adenosine deaminase- for tb!!
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12
Q

spontaneous bacterial peritonitis- caused by? presentation?

A
  • ascitic fluid infection w/o an apparent source
  • translocation of gut bacteria- gram neg (E coli or Klebsiella) or gram + (strep pneumo, viridans, enterococcus)
  • 10-20% of known cirrhotic pts- present with decompensation- encephalopathy, fever, abd pain, worsening renal fxn!!!!
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13
Q

spontaneous bacterial peritonitis- lab test

A
  • paracentesis- WBC count with diff
  • PMN > 250 with 75% of all white cells!!!- highly suggestive
  • if elevated WBC count and lymphocyte predominance- think TB or peritoneal carcinomatosis
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14
Q

calculate SAAG

A
  • serum albumin - ascitic fluid albumin
  • > 1.1 = a portal HTN cause
  • <1.1= non portal HTN cause!!
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15
Q

causes for ascites

A 
Portal HTN (SAAG >1.1)- most common
-hepatic congestion
-liver dz
-portal v occlusion
Hypoalbuminemia (SAAG <1.1)
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16
Q

alcoholic- follow up for?

A

EGD- esophageal varices

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17
Q

Hepatitis A- Dx, Tx

A
  • RNA hepatovirus
  • acute
  • inc aminotransferases- inc Alk phos and bilirubin
  • fecal-oral transmission- international travel is a risk factor!!
  • Dx- IgM anti-HAV
  • Tx- self limited
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18
Q

Had Hep A but not anymore

A

-Anti-HAV IgG

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19
Q

Had Hep C but not anymore

A

-Anti-HCV with neg HCV RNA

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20
Q

acute HBV infection- window period

A
  • b/w HBsAg disappearing and HBsAb appearing
  • ACUTE HBV!!
  • only detectable with HBcAb IgM
  • important for screening blood donations
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21
Q

Hepatitis B

A
  • acute or chronic
  • dsDNA genome
  • inc aminotransferases- elevated Alk phos and billirubin
  • transmitted- infected blood, sexual contract, mother to baby at delivery!!- asia!
  • HBV vaccine
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22
Q

Acute HBV- presentation

A
  • variable
  • asymptomatic-> fulminant dz and death (<1%)
  • aminotransferase levels > HAV
  • can become chronic
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23
Q

HBV- window period- lab

A

-Anti-HBc IgM +

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24
Q

HBV-Acute Infx- lab

A
  • HBsAg +
  • HBeAg +
  • Anti-HBc IgM +
  • HBV DNA +
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25
Q

HBV- prior infection- lab

A

-Anti-HBs +!!!!
-Anti-Bc IgG +
-Anti-Hbe +/-
(ASIA- maternal transmission)

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26
Q

HBV- chronic infection- lab

A
  • HBsAg +
  • HBeAg +
  • Anti-HBc IgM +
  • Anti-HBc IgG +
  • Anti-HBe +/-
  • HBV DNA +
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27
Q

HBV- immunization- lab

A

-Anti-HBs +

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28
Q

Chronic HBV- where?

A

Asia!

  • 90% of infants with maternal transmission
  • risk of HCC and cirrhosis
29
Q

HDV (delta agent)

A
  • acute or chronic
  • only in assoc with HBsAg
  • percutaneous exposure
  • immigrants from endemic areas
30
Q

HDV- dx

A
  • anti-HDV
  • HDAg
  • HDV RNA
31
Q

HCV

A
  • ssRNA
  • 50% by IV drug use
  • risk factors- body piercing, tattoos, hemodialysis
  • sexual and maternal-fetal transmission is LOW
  • 80% chronic
  • no vaccine!!
32
Q

HCV- dx

A
  • enzyme immunoassay for Anti-HCV
  • confirmed by HCV RNA
  • +anti-HCV in serum but neg HCV RNA = recovery from past infection
33
Q

HCV complications

A
  • mixed cryoglobulinemia
  • membranoproliferative GN
  • lichen planus, autoimmune thyroiditis, idiopathic pulm fibrosis
  • inc risk for Non-Hodgkin lymphoma!
  • HCV genotype 3- hepatic steatosis
  • dec in serum chol and LDL
  • cirrhosis and HCC
34
Q

HCV- recommendations

A
  • screen ppl born b/w 1945-1965
  • vaccinate against HAV and HBV
  • check for co infection with HBV and HIV
  • safe sex practice
  • CURABLE
35
Q

Chronic HCV- cirrhosis progression inc in?

A
  • after 20 yrs of dz
  • men
  • drink > 50g of ETOH daily
  • acquire infx after 40 yo
  • immunocompromised
  • tobacco and cannabis smoking
  • Af Am- higher rate of chronic HCV but lower fibrosis
  • coffee- slows progression
  • risk of cirrhosis and HCC
  • HCV is curable!
36
Q

HEV- in who? dx?

A
  • acute hepatitis in Asia, Africa
  • waterborne- pets, swine
  • self-limited
  • transplant recipients- those treated with tacrolimus!!!
  • Dx- IgM anti-HEV
37
Q

Acute Liver Failure- causes

A
  • Acetaminophen
  • idosyncratic drug rxn
  • risk inc with DM, outcome worse in the obese
38
Q

acute liver failure- sx

A
  • fulminant = hepatic encephalopathy within 8 wks and coagulopathy
  • labs= severe hepatocellular damage!
  • acetaminophen toxicity- AST/ALT > 5000
  • ammonia level elevated- encephalopathy and intracranial HTN
39
Q

Tylenol OD

A
  • treat with NAC if in toxicity area
  • get a 4 hr acetaminophen level!!
  • empiric treatment if ingestion is unknown- acetylcysteine
40
Q

Autoimmune hepatitis- who? labs?

A
  • young-mid age women
  • +ANA and/or smooth m AB (type I)
  • Anti-LKM1 (type II)
  • AST/ALT can be >1000
  • inc risk of cirrhosis and HCC
41
Q

Autoimmune hepatitis- tx

A

steroids +/- azathioprine

42
Q

alcoholics- what vit def?

A

-thiamine (B1)- wernicke korsakoff syndrome

43
Q

wernicke encepalopathy

A
  • encephalopathy- confusion, ataxia, involuntary abnormal eye movements
  • syndrome- memory issues, confabulate/make up stories
44
Q

Alcoholic Liver Disease- labs

A
  • AST 2x > ALT

- when total bili > 10 and PTT > 6 sec = severe alk hep with 50% mortality; susceptible to infections

45
Q

Alcoholic Liver Disease- effects

A
  • dec platelets- direct effect on megakaryocytes prod or hypersplenism
  • inc hepatic iron stores
  • reversible!
  • most common precursor to cirrhosis in US!
  • risk of HCC
46
Q

Alcoholic Liver Disease- Bx, Tx

A
  • polymorphonuclear infiltration with hepatic necrosis (Mallory bodies) and perivenular/perisinusoidal fibrosis
  • abstinence from alcohol!!
  • nutritional support for anorectic pts- glucose admin increases the thiamine requirement!!
  • 6 month abstinence before liver transplant
47
Q

Risk of alcoholic cirrhosis

A

->50 grams daily for over 10 yrs

48
Q

Maddrey Discriminant function- used for?

A
  • disease severity and mortality risk in pts with alcoholic hepatitis
  • > 32 = high short-term mortality- may benefit from tx with glucocorticoids!!
49
Q

Glascow alcoholic hepatitis score (GAH)

A
  • predicts mortality in alcoholic hepatitis
  • > 9 who received glucocorticoids- higher survival rates than those who didnt receive glucocorticoids!!
  • no survival benefit with glucocorticoids <9
50
Q

Cirrhosis- who? caused by? risk factors?

A
  • fibrosis and regenerative nodules
  • Mex Ams and Af Ams > whites
  • causes- alcohol, chronic HCV, HBV, NAFLD, hemochromatosis
  • risk factors- heavy alcohol use, obesity, iron overload
  • coffee and tea consumption reduces risk
  • methotrexate and vit A assoc with fibrosis and cirrhosis
51
Q

Cirrhosis- signs/sx

A
  • asymptomatic for a long time
  • fatigue, disturbed sleep, m cramps, weight loss
  • portal HTN
  • others- gynecomastia, spider telangiectasias, palmar erythema, dupuytren contractures, asterixis
52
Q

Cirrhosis- effects

A
  • portal HTN- varices, ascites, hyperdynamic circulatory state
  • liver insufficiency- cant syn albumin, coag factors, and cant excrete bilirubin
  • portosystemic shunts
53
Q

Cirrhosis- labs

A
  • macrocytic anemia- folic acid def, hemolysis (hypersplenism)
  • dec WBC (hypersplenism)
  • inc infection
  • thrombocytopenia- marrow suppression, sepsis
  • prolongation of prothrombin time
  • elevation of AST, Alk phos, T bilirubin
  • dec in albumin
  • inc risk of DM!!
  • vit D def
54
Q

Cirrhosis- imaging

A
  • US- liver size, ascites, nodules
  • contrasted CT- nodules- biopsy
  • fibrosure- low/high excludes/predicts advanced fibrosis
  • liver bx
  • EGD
  • detect varices or causes of bleeding in esophagus, stomach, duodenum
55
Q

Cirrhosis- complications

A
  • Upper Gi bleeding- portal HTN gastropathy, gastroduodenal ulcer, varices
  • liver failure
  • hepatic encephalopathy
  • SBP (spontaneous bacterial peritonitis)
  • hepatorenal syndrome
  • coagulopathy
  • HCC
  • osteoporosis
56
Q

Ascites- caused by?

A
  • secondary to portal HTN!
  • found in 50% of pts with cirrhosis
  • 1/3 will develop upper GI bleeding
  • upper endoscopy- dx!
57
Q

Child Pugh score

A

estimates cirrhosis severity!

  • ascites, encephalopathy, bilirubin, albumin, PT time
  • Class A- 5-6
  • class B- 7-9
  • Class C- 10-15
58
Q

MELD score

A

(model for end-stage liver dz)

  • predict survival in pts with cirrhosis
  • serum bilirubin, creatinine, INR
  • inc of 2 in first wk- predict in-hospital mortality
59
Q

PBC (primary biliary cholangitis)- lab, assoc with? risk factors? tx

A
  • autoimmune destruction of small intrahepatic bile ducts and cholestasis
  • W>M
  • isolated elevated Alk phos!!!
  • antimitochondrial ab!!!
  • IgM elevated, inc chol
  • assoc HLA DRB1 and DQB1
  • asoc with Sjogren, autoimmune thyroid, raynaud, scleroderma, celiac
  • risk factors- smoking
  • TX- ursodeoxycholic acid
60
Q

Absorption- colon, duodenum, ileum

A
  • colon- water
  • duodenum- iron
  • ileum- vit B12, bile salts
61
Q

Hemochromatosis- caused by?

A
  • autosomal recessive
  • HFE mutation- C282Y
  • iron accum- liver, pancreas, heart, adrenals, testes, pituitary, kidneys
62
Q

Hemochromatosis- sx

A
  • usually not until fifth decade!!

- cirrhosis, HF, hypogonadism, arthritis, skin pigmentation, DM

63
Q

hemochromatosis- tx?

A
  • avoid food rich in iron (Red meat), alcohol, vit C, raw shellfish, supplemental iron
  • phelbotomies
  • PPI- reduces intestinal iron abs
  • Deferoxamine- chelating agent
64
Q

Wilson disease- sx, tx

A

(hepatolenticular degeneration)

  • autosomal recessive, <40
  • N european
  • copper deposition- brain, kidney, liver
  • neuropyschiatric disease
  • kayser-fleischer rings
  • tx- oral penicillamine, liver transplant
65
Q

Wilson dz- lab findings

A
  • serum ceruloplasmin- low
  • urinary excretion of copper- high
  • hepatic copper- high
66
Q

Budd-Chiari

A
  • RUQ pain, painful hepatic enlargement, ascites, HSCM, jaundice
  • occlusion of hepatic v or ICV
  • hypercoagulable state!!
  • complicated by HCC!
67
Q

Budd-Chiari- Dx

A
  • prominent caudate lobe!!
  • screening- Doppler ultrasonography
  • direct venography- “spider web” pattern!
  • Bx- centrilobular congestion! (nutmeg liver)
68
Q

assoc with oral contraception

A

-hepatocellular adenoma

69
Q

Alpha-1 antritrypsin def

A
  • autosomal recessive
  • defective alpha1-AT accum in hepatocytes
  • chrom 14- PIZZ
  • micronodular cirrhosis- risk of HCC
  • panacinar emphysema
  • TX- smoking abstinence, liver transplant

G2F (17 decks)

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