Trigger - LIver 1 Flashcards
what is the result of accumulation of bile salts in liver disease
pruritus
what is the result of the excess estrogen seen in liver disease
spider nevi and palmar erythema
also menstrual irregularities in women
impaired cholesterol synthesis seen in liver disease results in what
testicular atrophy and gynecomastia in males
symptoms include confusion, tremor, coma
hepatic encephalopathy d/t build up of ammonia
AST>ALT OF >2
Chronic alcoholic liver disease
AST>ALT of 1-1.99
chronic NASH/ non alcoholic cirrhosis
ALP>4x UNL
hepatic cholestasis
less than 4x is non hepatic/non cholestatic cause
elevated ALP and GGT
hepatobilliary obstruction
first enzyme to rise in obstructive billiary disease
ALP
elevated GGT but normal ALP
alcohol/medication
elevated AST/ALT compared to ALP
elevated total billirubin
elevated direct billirubin
normal GGT
hepatocellular damage
elevated ALP compared to AST/ALT
elevated GGT
elevated or normal total bilirubin
elevated direct bilirubin
obstructive disease of the liver
albumin and PT are markers of what
synthetic hepatic function
elevated serum globulin levels
autoimmune hepatitis
MC in young to middle aged women
autoimmune hepatitis
insidious onset of fulminant hepatitis after viral illness, drug exposure or postpartum
autoimmune hepatitis
- otherwise healthy person w spider nevi, cutaneous striae, acne and hepatomegaly
- may have arthritis/thyroiditis or other auto conditions
otherwise healthy person w spider nevi, cutaneous striae, acne and hepatomegaly
autoimmune hepatitis
- insidious onset of fulminant hepatitis after viral illness, drug exposure or postpartum
- may have arthritis/thyroiditis or other auto conditions
AST/ALTRR elevations of 1.5x-50x ULN
elevated total bilirubin
autoimmune hepatitis
also see:
Elevated ANA
PANCA
Anti-SLA
occasionally co-exists w primary biliary cirrhosis or sclerosing choalngitis
autoimmune hepatitis
Tx w prednisone +/- azothiaprine
autoimmune hepatitis
liver transplant is last resort
NV, diaphoresis, pallor, lethargy and malaise w normal lab findings
stage 1 of acetaminophen induced hepatitis
RUQ pain w hepatomegaly and tenderness.
ALT>AST elevation.
PT elevated
Bilirubin elevated
stage 2 acetaminophen induced hepatitis
AST/ALT > 10k
Prolong PT/INR
Hyperammonemia
Hypoglycemia
stage 3 acetaminophen induced hepatitis.
also see reappearance of stage 1 s/s with hepatic encephalopathy. acute renal failure, multi organ failure and death can occur
NV, diaphoresis, pallor, lethargy and malaise w proolonged PT/INR, AST/ALT >10 and hypoglycemia
stage 3 acetaminophen induced hepatitis
also see hyperammonemia
acute renal failre
death
treat with N-acetylcysteine or activated charcoal
acetaminophen induced hepatitis
macrocytic anemia
steatohepatitis
also see mild AST/ALT elevations
AST/ALT elevations
hypoalbuminemia
anemia
alcoholic cirrhosis
also see:
- elevated total bilirubin >10
- PT/INR prolongation
- later on see lyte abnorm and elevated BUN Cr
Biopsy showing macrovesicular fat and PMN infiltration with hepatic necrosis
definitive diagnosis for alcoholic liver disease
Treat with methylprednisolone
alcoholic hepatitis
if severe can use pentoxifyline
tx with pentoxifylline
alcoholic hepatitis (severe)
normal tx w methylprednisolone
MC risk factor is obesity
NA fatty liver disease
tx includes Vit E and TZDs
Non alcoholic fatty liver disease
also use metformin and weight loss agents
tx inludes metformin and weight loss agents
non alcoholic fatty liver disease
also includes Vit E and TZDs
liver w fibrosis and nodules
cirrhosis
ascities with Worsening abd pain, Fever and Leukocytosis
bacterial peritonitis (caused by e coli)
tx w cefotaxime
bacterial peritonitis
treat prophylactically w FQs
treat with oral flouroquinolones
prophylaxis of bacterial peritonitis
tx for bacterial peritonitis is cefotaxime ( caused by ecoli)
tx includes dereasing protein and taking lactulose
hepatic encephalotpathy
also take abx such as rifamixin or metro
tx includes rifaximin or metro
hepatic encephalopathy
also:
eat less protein
take lactulose to metabolize ammonia
refiaxiMIN because you MINIMIZE ammonia build up
coffee, tea and statins
reduce risk of rapid decompensation from cirrrhosis
didnt do the last like 10 cards
