Liver disorders Flashcards
hepatitis
acute or chronic hepatocellular damage
most common cause of acute hepatitis
viral!!! toxins (like EtoH) is the second most common cause
chronic hep
viral (hep BCD) also- Wilson’s dz, alpha 1 antirypsin deficiency, autoimmune dz, systemic dz
how is hep A and E transmitted?
via Fecal-oral route
hep BCD transmitted?
parenterally or by mucous membrane contact
hep C risk of progression?
20% may progress to serous liver dz (RF: alcohol or coinfection w/ hep B or HiV
CF of viral hepatitis
fatigue, maliase, anorexia, N, **tea-colored urine, vagje abdominal discomfort
rx of A E
self-limited, mild, w/o long term sequalae
hep B C
variable presentation
hep D?
only seen w. hep B and associated w/ a more severe course
common Lab findings for hep
aminotransferase elevations- even in hepatocellular damage, bilirubin >3.0–> scleral icterus, if not frank jaundice
*look at notes for serology
how many types of hep c ar there?
type 1, 2 & 3
what type of hep C has a better prognosis?
type 2/3, but type 1 is most common in US
how else to evaluate hep?
liver bx- determine the level of fibrosis; sonography and alpha-fetoprotein help too
tx of acute viral hep
supportive
what should pts avoid?
alcohol
tx Hep B and if positive for HIV
always tx HIV regardless of CD4 count- truvada! (emtricitabine/tenofovir disproxil fumarate)
tx for hep C
vaccinate againse hep A and B, evaluate for level of fibrosis
types of hep c tx
pegylated interferon w/ ribavirin- goal of therapy is reduction of viral RNA to undetectable at 6 mnths post therapy
cirrhosis
irreversible fibrosis and nodular regeneration throughout the liver
main causes of cirrhosis
45% alcohol, remainder assoicated w/ hepatitis BC or congenital disorders
Clinical presentation of cirrhosis
weakness, fatigue, weight loss are common, N,V, anorexia
amenorrhea, impotence, loss of libido, gynecomastia,
abdominal pain and hepatomegaly
late stage disease
ascites, plerual effusions, peripheral edema, ecchymoses, esophageal varices, signs of hepatic encephalopathy
hepatic encephalopathy signes
asterixis, tremor, dysarthria, delirium and eventually coma
spontaneous bacteril peritonitis-
fever, chills, worsening ascites, abdominal pain–> D and renal failure
diagnostic studies
lab values-minimally abnormal until late in the dz
anemia, mild elevations of AST and alkaline phosphatase, increased y-globulin, decreased albumin, Prolonged PT
US, CT, MRI can confirm the size and number of nodules
tx for cirrhosis
can use glucocorticosteroids, , abstinence from alcohol
tx of ascites
salt restriction, bed rest, spironolactone 100 mg
when do you use liver transplant
decompensated and w/ complications
what can cause portal hypertension?
presinusoidal, sinusoidal, or postsinusoidal levels
sinusoidal being the c kliver capillaries
what are presinusoidal causes of portal HTN?
schistosomiasis and portal vein thrombosis
what are sinusoidal causes?
cirrhosis (from alcohol and Hep B/c)
what are post sinusoidal causes of portal htn?
budd-chiari syndrome (hepatic vein occlusion, pericarditis, right sided HR)
what are severe complications of Portal HTN?
varices that bleed!!
PE of portal htn
- ascites,
- jaundic,
- “cherubic face”
- spider angioma,
- testicular atrophy
- gynecomastia
- palmar erythema
- caput medusa
- hemorrhoids
(think alcholic sx)
portal HTN tx?
BB: decrease risk of bleeding
-endocsopic surveillance
if pt does bleed in portal HTN?
large bore IV, volume
-then if emergency endocopy doesnt work and bleeding can be controlled:
balloon tamponade, vasporressin
transjugular intrahepatic portosystemic shuntingd
if pt doesn’t have cirrhosis or good residual liver fxn,
surgical shunts will prolly work better
than TIPs
Altered MS in pts with cirrhosis and portal HTN (encephalopathy?
indicator of poor hepatic reserve and would generally CI shunting until resolved
o Hepatic encephalopathy should be treated with TPN. Malnutrition can be quite severe and these patients are prone to vitamin and mineral deficiencies
