Patient Presentation, Tests and Alcoholism Flashcards
What are the important risk factors?
o Alcohol intake o Drug use o Travel o Blood transfusions o Tattoos o Unprotected sexual activity
What is important to identify on examination?
o Fever, cachexia o Hepatic encephalopathy / flap o Signs of chronic liver disease o Scars off surgery – cholecystectomy o RUQ / epigastric pain o Hepatomegaly o Splenomegaly and ascites
What is cachexia?
Extreme weight loss and muscle wasting
When should you suspect cancer in a patient?
- Looking cachectic
- Have lymphadenopathy
diseased lymphnodes causing them to become enlarged and unequal in size - Hard, craggy liver edge
- Unintentional weight loss
What is the most common cancer in this region of the abdomen?
Carcinoma of the head of the pancreas
When should you exclude carcinoma of the head of the pancreas in patients?
- > 40 yrs
- Have painless, obstructive jaundice
What is liver cancer usually caused by?
- Metastases from other primary cancers (lung cancer)
When would you suspect cholangiocarcinoma (cancer of the gallbladder)?
When you can palpate the gallbladder on examination
What condition is primary hepatocellular cancer is more common in?
Cirrhosis
How would you test for primary hepatocellular cancer?
- Ultrasound
- Raised Alpha-fetoprotein (AFP)
What are liver function tests?
- INR / Prothrombin time
- Albumin
What are liver enzyme tests?
- Transaminases (AST, ALT)
- Alkaline phosphatase
- GGT (Gamma-GT)
What is prothrombin time / INR?
A laboratory measurement of how long it takes blood to form a clot. It is used to determine the effects of oral anticoagulants on the clotting system.
What does a rise in ALT, AST»_space; rise in alkaline phosphate indicate?
Hepatocellular damage
What does a rise in ALT, AST «_space;rise in alkaline phosphate indicate?
Obstructive cause