Other Liver

Question 1

Cirrhosis

-clinical features based on decreased protein synthesis (2)

Answer 1

1. Edema from hypoalbunemia
2. Coagulopathy from decreased clotting factor synthesis

Question 2

Cirrhosis:

-clinical features can be divided into what 3 general categories?

Answer 2

1. Portal HTN
2. decreased detoxyfication
3. decreased protein synthesis

Question 2

Primary sclerosing cholangitis

-what blood marker is characteristically elevated, and what other GI disorder also has it?

Answer 2

• elevated P-ANCA
• ulcerative colitis

(Churg-strauss, microscopic polyangiitis)

Question 2

Hepatocellular carcinoma

-risk factors include (3 general categories)

Answer 2

1. chronic hepatitis
2. cirrhosis (eg alcohol, NAFL, hemochromatosis, wilson’s, A1AT deficiency)
3. Aflatoxins from Aspergillus – some countries have higher rate b/c they store grain for extended periods of time

Question 3

Hepatic adenoma

• what is it
• assoc with what drug use
• feared complications

Answer 3

• benign tumor of hepatocytes
• assoc with oral contraceptive use (tumors grow with estrogen exposure)
• risk of rupture and intraperitoneal bleeding, esp during pregnancy

Question 5

Cirrhosis

-clinical features based on decreased detoxification (3)

Answer 5

1. hepatoencephalopathy from increased ammonia
   - mental status changes, asterixis, coma
2. hyperestrinism
   - gynecomastia, spider angiomata, palmar erythema
3. Jaundice

Question 6

Metastatic cancer to liver

• more/less common than primary liver tumors?
• how can you detect on physical exam?

Answer 6

• more common that primary liver tumors
• may be detected as hepatomegaly with nodular free edge of liver (bumps on exam)

Question 7

Hepatocellular carcinoma

• increased risk for what syndrome
• what is serum tumor marker?

Answer 7

Budd-Chiari syndrome

• liver infarct secondary to hepatic vein obstruction
• painful hepatomegaly, ascites
• alpha-fetoprotein

Question 9

Cirrhosis

-clinical features based on Portal HTN (4)

Answer 9

1. Ascites
2. congestive splenomegaly (causes thrombocytopenia and leukopenia by sequestering them)
3. portosystemic shunts (esophageal varices, hemorrhoids, caput medusae)
4. hepatorenal syndrome (splanchnic vasodilation decreases systemic blood volume, inducing RAAS and constricting renal arteries)

Question 10

Primary Sclerosing Cholangitis

• what is it
• etiology
• appearance (2)
• clinical presentation
• increased risk of what

Answer 10

• inflamm and fibrosis of intrahepatic/extrahepatic bile ducts
• etiology unknown, assoc with UC
  1. perdiuctal fibrosis, ‘onion skin’ appreaearnce
  2. ‘beaded’ appearance on contrast b/c uninvolved regions are dilated.
• obstructive jaundice, cirrhosis is late complication
• increased risk for cholangiocarcinoma