MTB 2 Flashcards
Tx for ascites
- Na+ and H2O Restriction
- Spironolactone
- Loops - no more than 1 L/day if renal fnc OK
- Frequent abdominal paracentesis
What is the SAAG?
Serum ascites albumin gradient
SAAG < 1.1 g/dL in what dz?
Infxn - NOT SBP
Cancer
Nephrotic syndrome
SAAG > 1.1 g/dL in what dz?
Portal HTN
CHF
Hepatic vein thrombosis
Constrictive pericarditis
Spontaneous Bacterial Peritonitis (SBP)
What is it?
Ass’d bugs?
Infxn w/out perforation of bowel
E.coli, anaerobes, pneumococcus
Best initial test for SBP?
Cell count with > 250 Neutrophils - start tx
>500 WBCs
TX for SPB?
Cefotaxime, Ceftriaxone
What is the most accurate test for SBP?
Fluid culture
Presentation of SBP?
Pt presents with fever, abdominal pain, AMS
How does hepatopulmonary syndrome present?
Liver failure causes lung disease and hypoxia
Orthodexia - hypoxia sitting upright
Most accurate test for alcoholic liver dz?
Liver Bx
How does Primary Biliary Cirrhosis present?
Women 40's-50's Fatigue and itching Normal BR Elevated Alk Phosph Xanthelesma/xanthoma Osteoporosis
Most accurate test for PBC?
Liver Bx
Most accurate blood test for PBC?
Antimitochondrial Ab
Tx for PBC?
Ursodeoxycholic acid
How does Primary Sclerosing Cholangitis present?
Women 40's-50's Pruritis Elevated Alk Phosph and GGTP Elevated BR UC in 80%
Most accurate test for PSC?
ERCP shows beading, narrowing, strictures
Tx for PSC?
Cholestyramine
Ursodeoxycholic acid
Alpha 1 Antitrypsin Deficiency
Liver dz
Emphysema (COPD)
Young pt < 40
Nonsmoker
Hemochromatosis Pathophysiology?
Genetic disorder - mutation C282y gene
Overabsorption of iron in duodenum
Presentation of hemochromatosis?
Male earlier than female (menstruation delays) 50's mild elevation in AST and Alk Phos Fatigue Pseudogout = joint pain ED men, Amenorrhea women Skin darkens DM Cardiomyopathy - restrictive, dilated, conduction abnormalities Hypothyroidism
Best initial test for hemochromatosis?
Iron studies
Increased serum Iron and Ferritin and Transferrin saturation
Decreased TIBC
Most accurate test for hemochromatosis?
Liver Bx
When is iron chelation used in hemochromatosis?
Pt cannot be managed w/phlebotomy
Anemic and have hemochromatosis from overtransfusion (thalassemia)
Wilson Disease pathophysiology?
Abnormally decreased Copper excretion
Genetic = ATP 7B Dysfunction
Decrease in ceruloplasmin, copper accumulates in liver, kidney, RBCs and CNS
Pt presents w/cirrhosis, hepatic insufficiency, neuro sx’s, Coombs Negative HA, RTA or nephrolithiasis?
Wilson Disease
Neuro sx’s in Wilson?
psychosis tremor dysarthria ataxia seizures rigidity catatonia
Best initial test for Wilson?
Slight-light exam for Kayser Fleischer rings = brownish ring around eye
What test is used for staging Wilson?
Liver Bx
Most specifid blood test for Wilson
Low Ceruloplasmin
Most accurate dx test for Wilson?
Increased amt of copper excretion into urine after penicillamine administration?
Tx for Wilson Dz?
Penicillamine = chelates copper, removes from body
Zinc - interferes w/intestinal copper absorption
Trientine - alternative copper-chelating compound
What is seen on liver Bx in hepatic failure w/Wilson?
Inflammation Portal fibrosis hepatocyte necrosis macrovesicular steatosis vacuolated hepatocellular nuclei Mallory bodies
Autoimmune hepatitis presentation
Young woman
Liver inflammation
+ ANA
microsomal abs
Anti-smooth muscle abs in what dz?
AI hepatitis
These are anti liver kidney microsome abs
Most accurate test for AI hepatitis?
Liver Bx
Tx for AI hepatitis
Prednisone
Azathiorpine
Labs with AI hepatitis?
Elevated AST, ALT in thousands
Elevated AP
Ass’d with other AI dz - elevated IgG 1.5X Normal, Protein elevated, Albumin decreased
Nonalcoholic Fatty Liver Dz or Nonalcoholic Steatohepatitis
Ass'd with metabolic syndrome TPN Cushings Steroid use DM
Most accurate test for NASH?
Percutaneous liver Bx shoes microvesicular fatty deposits
Si/Sx’s in NASH?
Hepatomegaly
Labs: mild increase in AP, AST/ALT <1
What is Reye syndrome?
ASA in children
Hepatic encephalopathy
Presentation of Reye?
Children N/V, HA, delirium, hypoglycemia, liver failure, CNS
Sudden onset of mental status changes, emesis, liver dysnfunction, taking aspirin?
Reye syndrome
Labs seen with Reye syndrome?
Elevated LFTs
Elevated ammonia
Elevated PT
Metabolic Acidosis
Treatment for Reye syndrome?
Glucose with FFP
Mannitol to decrease cerebral edema
Rapid, massive increase in liver enzymes (thousands) with modest elevation in total BR and AP
Ischemic Hepatic Injury/Shock Liver
