Non-viral liver disease Flashcards
NAFLD: stage 1
- fatty liver
- steatosis
NAFLD: stage 2
- fatty liver with inflammation
- NASH
NAFLD: stage 3
- NASH with septal fibrosis
NAFLD: stage 4
- cirrhosis
clinical sequelae associated with NAFLD
- insulin resistance and type II DM
treatments for NAFLD
- 10% weight loss at 1-2 pounds per week
- gemfibrozil - lower TGs and FAs
- vitamin E- antioxidant effect
- metformin - decrease insulin resistance
genetic screening for hemochromatosis
- if two 282Y genes or 1 282Y and 1 H63D then you have the disease
clinical sequelae of hemochromatosis
- arthritis in MCP joins, “bronze diabetes”
- worse with EtOH or HCV
- more risk for cancer than with wilsons
iron stores associated with hemochromatosis
- normal iron is 4 gms
- hemochromatosis can get to 15-40
diagnosis of hemochromatosis
- iron saturation: >60% men and >50% women
- ferritin 500-6000 ng/ml
- liver biopsy is gold standard with iron circulation of iron index, if 1.9 - then disease present
- CT: liver is white
- MRI: liver is black
treatment for hemochromatosis
- phlebotomy
- if cant tolerate, use deferoxamine
chronic autoimmune hepatitis antibodies
- type 1: ANA, Anti-SMA P-ANCA antibodies
- common in celiac disease, anti-IgA antibodies will be present
chronic autoimmune hepatitis diagnosis
- interface hepatitis on biopsy
- increased globulins to >3, usually IgG
- autoantibodies present
- may be false positive HCV by ELISA II due to hypergammaglobulinemia
diagnosis of wilsons
- high index of suspicion
- low ceruloplasmin
- Kayser-Fleischer rings
symptoms of wilsons
- hemolysis
- Parkinsons rigidity
- tremor
- osteopenia
- sunflower cataracts
treatment for wilsons
- D-penicillamine
diseases cured with liver transplant
- wilsons
- A1AT
lab tests normally elevated in pregnancy
- alkaline phosphatase
- AST and ALT within normal range
- GGTP unchanged or decreased
protein changes during pregnancy
- albumin, antithrombin III, hatoglobin decrease
- ceruloplasmin, fibrinogen, TBG, CSBG and transferrin increase
biliary changes during pregnancy
- bilirubin increased
- bile salts normal
normal PE during pregnancy
- liver is not palpable
- spider angioma and palmar erythema common due to estrogen
acute viral hepatitis
- 17% mortality with hepatitis E
intrahepatic cholestasis of pregnancy
- pruritus
- usually 3rd trimester
- begins on palms and soles and works proximally
- cholestasis, occasional jaundice, abdominal pain
acute fatty liver of pregnancy
- only in 3rd trimester
- N/V, fatigue, malaise, vomiting
- jaundice, encephalopathy, bleeding
- DIC is common
pre-eclampsia
- HTN with proteinuria and edema in 5-10% of pregnancies
eclampsia
- pre-eclampsia findings + seizure (possibly renal failure, coagulopathy, hemolytic anemia)
HELLP syndrome
- hemolysis, elevated liver enzynes, low platelets
- may be severe form of eclampsia
hyperemesis gravidarum
- 1st trimester
- jaundice, dark urine, occasional prurutis
- hyperbilirubinemia, transaminase 2-3X normal
- liver disease most likely secondary to dehydration or malnutrition
treatment of hyperemesis gravidarum
- control the emesis
- fluid and electrolyte balance
labs in intrahepatic cholestasis of pregnancy
- transaminases 2-10X normal
- bile acids 100X normal
labs in acute fatty liver of pregnancy
- hyperbilirubinemia
- increased alkaline phosphate
- mildly increased transaminases
- leukocytosis
