Liver lesion, NAFLD, SBP, LFTs Flashcards
Ix for Solid liver lesion
- Bloods
- Imaging
- Tissue
- Bloods - AFP, LFT, Hep serology
- Imaging - multiphase CT, MRI, Contrast enhanced USS
- FNA - risk of bleeding and seeding
- Surgical resection
Most common organism SBP
Polymicrobial consideration
E coli, Klebsiella
Poly - ?perf viscous
SBP
Diagnosis
Mx
Diagnosis - ascitic tap - elevated WCC and neut
Mx - IV Cef 2g + albumin
*Albumin lowers risk of hepatorenal syndrome
SBP
Prophylaxis
Bactrim
Consider in
- previous SBP
- Cirrhosis + ascites + either CKD or liver failure CP B/C
Definitions and differences
NAFLD
NASH
NASH cirrhosis
NAFLD - fatty liver without significant ETOH intake, no inflammation
NASH - hepatocellular injury, balloting, evidence of fibrosis –> risk of cirrhosis
NASH cirrhosis - radiological evidence of cirrhosis
NASH
Dx
LFTs
AST: ALT <1 (AFLD >2)
Imaging - MRI is most accurate, USS less sensitive
Liver bx
LFTs:
- ETOH hepatitis
- Viral hepatitis
- Autoimmune hepaitis
- ETOH hepatitis
AST and ALT elevated, usually <500s
AST:ALT >1 (usually >2)
Think waASTed = ETOH - Viral hepatitis
ALT>AST, can be very high - Autoimmune hepaitis
can be veryyy elevated
LFTs
Cholestasis
- elevated GGT + ALP
- if >1000 then think of other things - infiltrating tumours, fungal infections
- gallstones can have initial rise in AST/ALT too
Bilirubin
Conjugated - causes
Unconjugated - causes
Conjugated
- obstruction, pregnancy
- infection
Unconjugated
- over production
- -> hemolysis, TTP, HUS etc - Gilberts syndrome - deficiency in UGT1A1 enzyme
- Crigler Najjar - NO production of UGT1A1 enzyme, often fatal
NAFLD -
other than supportive management, most effective intervention:
Weight loss
Mediterranean diet
NAFLD - most common cause of death
CVD
