Medicine (Liver) Flashcards
What is the function of the liver?
-Maintaining homeostatic, immunological and synthetic processes
What is viral hepatitis?
-An inflammatory mediated process with active hepatocellular damage and necrosis with a lobular inflammatory response
-5 forms of viral (A, B, C, D, E)
-Acute forms are characterized by inflammation that lasts 6 months or less
-Chronic hepatitis leads to liver fibrosis
What is hepatitis A?
-An RNA viral inflammatory mediated process with active hepatocellular damage.
-Typically self limiting and acute
-Patient with malaise, myalgias, vomiting, diarrhea
-Fecal-oral transmission, sewage contaminated shellfish
-Treat with supportive care, avoid hepatotoxic agents
What is hepatitis B?
-A DNA Viral inflammatory mediated process with active hepatocellular damage
-Prevented with hepatitis B vaccine
-Transmitted mother to fetus, percutaneous, sexual
-Similar clinical features: Malaise, myalgias, vomiting, diarrhea
-20% can progress to cirrhosis
What is hepatits C?
-An RNA Viral inflammatory mediated process of active hepatocellular damage
-Percutaneous transmission (IV drug use, tattoos, piercings)
-Cirrhosis occurs 20%, risk of hepatocellular carcinoma and non-Hodgkin lymphoma
-No vaccine, treat with antiviral medications and interferon
What is alcoholic liver disease?
-Excessive alcohol intake leading to a fatty liver, followed by hepatitis and cirrhosis
-Spectrum of disease from alcoholic steatosis, alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma
-Acute or chronic inflammation leading to parenchymal necrosis of the liver. At alcoholic steatosis this is reversable with alcohol cessation
What is nonalcoholic fatty liver disease?
-Aggregation of hepatic fat that is not due to alcohol use
-Metabolic syndrome, Type 2 DM predisposing factors
-Treat by managing primary medical problem
What is autoimmune hepatitis?
-Destruction of hepatocytes by T-cell and autoantibody mediated molecules
What is primary biliary cirrhosis?
-Chronic autoimmune destruction of small intrahepatic bile ducts and cholestasis
-At risk for hepatocellular carcinoma
-Treat with ursodeoxycholic acid
What is cirrhosis?
-Progression of chronic liver disease of hepatic inflammation and fibrosis
-Patients are unable to synthesize coagulation factors and metabolize toxic chemicals
What are possible sequelae of cirrhosis?
-Hepatorenal syndrome
-Hepatic encephalopathy
-Hepatopulmonary syndrome
-Portopulmonary hypertension
-Hematologic abnormalities
Why are there coagulation abnormalities in cirrhosis patients?
-Inability to synthesize clotting factors
-Diminished clearance of anticoagulants (protein C)
How is cirrhosis managed?
-Abstinence from alcohol
-HAV, HBV, pneumococcal, influenza vaccines
-Management of varicies/ascites
How is hepatic encephalopathy treated?
-Lactulose to decrease systemic ammonia levels
How is severity of cirrhosis assessed?
-MELD score: Predicts 90 day mortality. Based on sodium, INR, bilirubin, creatine
-Child-Turcotte-Pugh score (CTP): Predicts survival rate up to 2 years. Based on bilirubin, albumin, PT/INR, ascites, and hepatic encephalopathy. Categorized as A, B, or C. Class C has an 80% chance of mortality with surgery
