SG 35 Liver Diseases

Question 1

What are 7 parts of the liver function tests?

Answer 1

• Hepatocellular fxn (hepatitis)
  1. AST
  2. ALT
• Biliary
  3. Alk phos
  4. Total bilirubin
  5. GGT = gamma glutamile transferase
• Liver synthetic fxn
  6. Albumin
  7. INR // prothrombin time

Question 2

Most common causes of AST / ALT in 10,000s range

Answer 2

Toxic injury (acetaminophen)
Viral
Ischemic
Rare: auto-immune

Question 3

You suspect acetaminophen OD but labs for blood levels are normal with AST/ALT in 10,000s. Why? Treat?

Answer 3

Days after injestion - no longer blood levels, only liver damage
+ N-acetyl-cysteine
If doesn’t improve, transplant

Question 4

What is a major complication you should be worried about in acute liver failure cases?

Answer 4

Cellular and vasogenic BRAIN edema

Can lead to brain herniation -> DEATH

Question 5

Diagnose non-alcoholic fatty liver disease

Answer 5

History and exclusion - no direct dx tests

See fat on US or CT

Question 6

Which viral hepatitis can be chronic?

Answer 6

B & C

Question 7

Why would a pt with chronic Hep B present with hematemesis or abdominal distension?

Answer 7

Cirrhosis -> portal HTN

Varices, ascities, hepatic encephalopahy, splenomegaly, TCP

Question 8

Treat ascities

Answer 8

1. Diuretics + Na restriction

2. Paracentesis

Question 9

3 complications of ascities

Answer 9

1. Spontaneous bacterial peritonitis
2. Hepatic hydrothorax
3. Umbilical hernia w/ ulceration or rupture possibilty

Question 10

Test to dx PBC

Answer 10

AMA = anti-mitochondrial Ab
- Also see ↑alk phos
Disease is ummune mediated destruction of small intrahepatic bile ducts

Question 11

What other auto-immune diseases is PBC associated with

Answer 11

Thyroid diseases

Sjogren’s = dry eyes or mouth

Question 12

Is PBC intra or extra hepatic cholestatsis?

Answer 12

Intra

Problem of bile from from liver into common hepatic ducts

Question 13

Nutritional complication of cholestasis

Answer 13

Fat sol vitamin def: A, D, E, K
↓bile - less breakdown and absorption of fat
Other complications:
- Staetorrhea

Question 14

Why to cholestasis pts present with xanthoma

Answer 14

Liver compensating for loss of bile salt production by increasing cholesterol (precursor) production
↑cholesterol -> xanthoma

Question 15

What do you give PBC pts to stave off transplant as long as possible aka preserve existing fxn

Answer 15

Ursodiol = synthetic bile salt

Question 16

What disease is commonly associated with chronic ulceratic colitis?

Answer 16

Primary sclerosing cholangitis - PSC

Question 17

Dx tests for PSC

Answer 17

Biospy good but not dx
- WBC in portal tract
- Fibrosis round bile ducts in portal tract
\+ Cholangiogram 
- Dilation in bile ducts

Question 18

Treat PSC

Answer 18

Nothing until transplant

Be mindful of transplant if extrahepatic structures involved