Liver & Gallbladder Condition Flashcards
More specific to liver (AST or ALT)?
Elevation of AST indicates?
ALT “L for liver”
Elevated AST = fatty liver
ALT > AST indicates? (both increased)
Viral hepatitis “more LIVER virus”
AST > ALT indicates? (both increased)
Alcoholic hepatitis “S for Spirits”
GGT
GGT is increased in patients with Gallbladder and liver dz.
These conditions are caused by a number of factors, including drug and alcohol abuse, toxins, or viruses
Increased serum ammonia indicates
Cirrhosis, reye syndrome
ALP elevated, GGP normal
Extrabiliary - r/o bone dz.
Sudden increase ALP & GGP
Hepatocellular carcinoma
alpha-Fetoprotein (AFP) is a tumor marker for
Hepatocellular carcinoma
alpha-Fetoprotein (AFP) is a tumor marker for
Hepatocellular carcinoma
also increased in viral hepatitis
Increased PT may be seen in cirrhosis? T/F
cirrhosis, vitamin K def.
Hypoalbuminemia
severe liver disease - cirrhosis
Can’t produce enough albumin!
Bilirubin Excretion
<20% indicates:
20-50% indicates:
>50% indicates:
<20% indicates: hemolysis
20-50% indicates: mixed hyperbilirubinemia (viral hepatitis)
>50% indicates: Conjugated hyperbilirubinemia (liver cholestasis, biliary tree obstruction)
Positive urine bilirubin
If bilirubin is found in your urine, it may be a sign that you have: A liver disease, such as hepatitis or cirrhosis. A blockage in your bile ducts, the small tubes that carry bile out of your live
Increased urine bilirubinogen
viral hepatitis or hemolytic anemia
Alcoholic liver disease, chronic viral hepatitis (B, C, D, but never A & E) , autoimmune hepatitis, hemochromatosis, wilson’s disease can all lead to what condition of the liver?
Cirrhosis
Cirrhosis can result from which viral hepatitis (A, B, C, D, E)
Hepatitis, B, B+D, C
NEVER A & C
A patient with a hx of Alcoholic liver dz. comes to office with pruritus, jaundice, and joint pain. PE revealed hepatosplenomegaly TPP.
Suspicion and Tx?
Cirrhosis
Tx: liver transplant if end disease
alcohol cessation, minimize hepatotoxic medication
Definitive diagnosis for cirrhosis
Liver biopsy is definitive, but start with U/S
CT for varices, nodular liver texture, splenomegaly, ascites
Which Hepatitis?
Patient presents to clinic with jaundice, fever, n/v, arthralgia. Mhx indicates no hx of hepatitis. Traveled to Africa 6 weeks ago and accidentally drank river water.
Diagnosis approach and tx?
Hepatitis A “drank poop”
- Fecal oral transmission
- JAUNDICE is common
Dx: Anti-HAV-IgM/IgG
M = ACTIVE
G = protective antibody “you’re good”
Tx
- Hep A vaccine for prophylaxis tx and tx close contacts
Which Hepatitis?
Patient presents to clinic with jaundice, fever, n/v, arthralgia. Mhx indicates no hx of hepatitis. Traveled to Africa 6 weeks ago and accidentally drank river water.
Diagnosis approach and tx?
Hepatitis A “drank poop”
- Fecal oral transmission
- JAUNDICE is common
Dx: Anti-HAV-IgM/IgG
M = ACTIVE
G = protective antibody “you’re good”
Tx
- Hep A vaccine for prophylaxis tx and tx close contacts
Which Hepatitis?
Patient PTC with profound malaise, urticaria, and polyarthritis. Notes that she had several multiple partners in the past 6 months. Additionally, the patient had been sharing needles. PE revealed painful hepatomegaly.
Diagnosis approach and tx? Prognosis?
Hepatitis B
HBsAg
Prognosis: 90% recover if immunocompetent
Tx:
Interferon A, Nucleoside analogues (Adefovir), Vaccine
SpECiES
What is this mnemonic for
Hepatitis B serology
HBsAG: 2-8 weeks after exposure, first marker of infection, up to 5 month is acute
HBeAG & HBV-DNA: infective
Anti-HBc-IgM: ‘window period’ remains active during acute infections
Anti-HBe: Past infection
Anti-Hbs: immunized!
Which Hepatitis?
Patient PTC with mild malaise, and nausea. Notes that she had several multiple partners in the past 10 weeks. Additionally, the patient had been using intranasal cocaine.
Diagnosis approach and tx? Prognosis?
Hepatitis C
Gold standard = HCV RNA via PCR
Severity determined by biopsy
Tx: Avoid alcohol, oral interferon-free regimen, liver transplant
Prognosis: 80% become chronic, 20% cirrhosis
Liver cancer commonly metastasis to which organ
Lungs
Besides Hepatitis B/C and alcoholic cirrhosis, what else can increase the risk for liver cancer significantly?
OCPs, steroids, Aflotoxins from Aspergillus mold in grains and pain (carcinogen)
Aflatoxins from Aspergillus mold in grains and pain increase the risk for?
Hepatocellular cancer
Why is the prognosis of liver cancer poor?
1/3 are asymptomatic so late detection
if symptomatic - ASCITES with blood, hepatomegaly, fever. jaundice, weakness, weight loss
Imaging procedures for liver cancer
MRI angiography
US, MRI, CT
Black pigment gallstones are sign of?
hemolytic anemia anemia
Brown pigment gallstones are sign of? which population is this seen commonly in?
bile duct infection
Cholesterol stones are common in which population
Northern Europeans
A 45-year-old Pima Indian female PTC with rapid weight loss, but has been mostly asymptomatic of everything else. Medication includes OCP. Recently, she noticed steady pain in the epigastrium and RUQ that radiates to her right shoulder for minutes to hours, a crescendo-decrescendo pattern, usually after dinner eating fatty foods. What do you suspect?
Cholelithiasis
- most are asymptomatic
What are the 4 protective factors for cholelithiasis?
Hint: drug, supplement
Statins
Vitamin C
Coffee
Exercise
Work up for gall stones?
US → gallbladder wall thickening >4mm, edema, gallbladder sludge, pericholecystic fluid, sonographic Murphy’s sign
Normal blood work
Sonographic Murphy Sign
Cholelithiasis, cholecystitis,
CA 19-9 elevation
GB adenocarcinoma and pancreatic cancer
Work up for acute cholecystitis?
US
A 55 yo Native American F PTC with SEVERE epigastric and RUQ pain accompanied by n/v, anorexia, and low grade fever. PE positive for Murphy’s sign and jaundice. Lab shows ABSOLUTE NEUTROPHILIC LEUKOCYTOSIS with left shift (WBC >12,000) and elevated markers for pancreatic, liver, and biliary markers.
What do you suspect? Tx?
Acute cholecystitis
Tx: ED! hydrate, analgesic, antibiotics (ampicillin or Cipro), cholecystectomy
Gall bladder adenocarcinoma dominant in which population? Etiology mostly due to? Mode of the initial image? Tx?
Elderly women with poor prognosis
Cholelithiasis
US standard in pt with RUQ pain 5-FU adjunct to radiation
