Things professors have said will be on the test Flashcards
What drug should be administered to a patient with cirrhosis and an active bleed upon admission, and why?
Octreotide. Is a vasoconstrictor, so can lessen the wall pressure and reduce the chances of a bleed/rupture.
What information does the Serum Ascites Albumin Gradient give you?
How is it calculated?
SAAG can give an indication of the cause of the ascites. It correlates well with the hepatic venous pressure gradient.
Greater than 1.1 is a pressure about 11. Remember that greater than 12 will show varices, etc.
SAAG = Serum albumin - the ascites albumin.
What is the pattern of albumin and SAAG that might indicate ascites due to cirrhosis? Why?
SAAG above 1.1
Low total albumin in the ascites fluid.
The sinusoids are cirrhotic so the protein can’t leak out.
What is the ascites albumin and SAAG that might indicate cardiogenic ascites?
SAAG below 1.1
High albumin in the ascites fluid.
Sinusoids are normal so protein leaks out.
DDX for ascites (in descending order)
1) CIRRHOSIS
2) Peritoneal malignancy
3) Heart failure
4) Other (Bacterial infection, Budd Chiari, Pancreatic, Nephrogenic)
5) Peritoneal tuberculosis
What is the generic combination called Bactrim?
What is a severe consequence (rare) of this drug?
Trimethoprim-sulfamethoxazole.
Liver damage.
Ursodeoxycholic acid is used to treat what condition? How does it work?
Primary Biliary Cirrhosis. Derived from bear bile. Helps slow the progression of PBC and normalizes the liver enzymes.
What medication should be given to reverse hepatic encephalopathy?
What other indication does this medication have?
Lactulose. NH3–> NH4+ for removal.
Also acts as an osmotic laxative.
Hepatitis A diagnosis is by detection of serum Ig___ against HAV.
IgM
IgA is fecal oral with passage by contaminated strawberries. T/F
True. There is a vaccine.
Hepatocellular carcinoma is most commonly caused by which hepatitis? Is there a vaccine?
B. Yes vaccine.
The majority of hep C progress to chronic disease transmitted by blood and body fluids. T/f
True on both counts. (80-85% of the time)
Hep C is an RNA or DNA virus? Is there a vaccine?
RNA. No vaccine.
Hep E
Transmitted fecal oral, does not cause chronic disease, RNA virus.
Hep E is assx with HIGHER mortality in pregnant women.
Alpha 1 antitrypsin
PAS positive diastase resistant globules in hepatocytes (misfolded proteins gumming up the works, pink globules on histology)
Emphysema
No gender bias
Primary Biliary Cirrhosis
Elevated IgM
Anti-mitochondrial antibody (also IgM)
Middle-aged women
Female predominance
Granulomatous lymphocytic cholangitis/florid duct lesion
Presents with itching early, later jaundice
–Despite the name, does not necessarily mean there is cirrhosis present
Autoimmune hepatitis
Elevated IgG
Anti-smooth muscle antibodies
PLASMA CELL rich interface and centrilobular hepatitis
Female predominance
Primary Sclerosing Cholangitis
Cholangiography with large bile duct strictures
Assx with UC (80% of PSC have UC)
Male predominance
Cholangiocarcinoma
Malignant neoplasm of bile ducts
Gland forming tumor with marked desmoplasia
ASSX with PSC
Hepatocellular carcinoma (aka hepatoma)
Proliferation of hepatocytes
Malignant
Almost all occur in patients with cirrhosis
Most common primary malignant hepatic tumor (metastatic disease is the most common)
Unpaired arteries with thickened hepatic plate
Hepatocellular adenoma
Proliferation of hepatocytes
Benign
FEMALE predominance (reproductive age, oral contraceptive use, steroid use)
Paired arteries with normal thickness hepatic plate
Hemangioma
Tumor of blood vessels
Most common tumor found in livers (1-2 %)
Benign
Focal nodular hyperplasia
Proliferation of hepatocytes
Benign
Central scar and malformed blood vessels
Plasma cell hepatitis word association:
Autoimmune hepatitis
