Unrein Hepatitis and Cirrhosis Flashcards
best tests for Wilson’s disease
not cerruloplasmin, it is not reliable
24-hour urine test is best
primary biliary cirrhosis
primarily a disorder of middle-aged females
associated with + Anti Mitochonrial Antibody;
alk phos and cholesterol usually elevated
primary sclerosing cholangitis
usually males 20-50 yrs
associated with ulcerative colitis
Wilson’s
slight male predominance
autosomal recessive
suspect in females with Kayser-fleischer rings and parkinson’s like features
usually dx-ed by age 40
alk phos low normal,
zinc is a cofactor in the production of alk phos and is competitively inhibited by the excess copper
hep A transmitted how?
fecal-oral pathogen
Hep B
transmitted by blood, bodily fluids and tissue.
SAAG
serum-ascitic albumin gradient is calculated by subtracting the albumin concentration of the ascitic fluid from the albumin concentration of a serum specimen obtained on teh same day. It correlates with sinusoidal pressure and is a function of oncotic-hydrostatic balance
In cirrhosis the SAAG is high and the ascites total protein is low
in malignant ascites the SAAG is low and the ascites total protein is high
in cardiac ascites both measurements are high
autoimmune hepatitis
dx of exclusion- notable is the absence of viral markers. Often presents with fulminant hepatic enzyme elevation, but not a cholestatic picture. This disorder is common in perimenopausal women
core antibody
first immune response you’ll see
intrahepatic cholestasis of pregnancy
occurs during the second or third trimester, characterized by mild elevations of bilirubin and alk phos
hyperemesis gravidarum
morning sickness
can have elevated transaminases in 50% of cases but not associated with cholestasis or itching
HELLP
hemolysis, elevated liver enzymes, and low platelets
life-threatening complication of pregnancy typically occuring in third trimester and requiring urgent delivery
acute fatty liver of pregnancy
leads to liver failure with elevated transaminases and an abnormal INR
hemochromatosis
iron overload state with an elevated transferrin. Clinical finding can be nonspecific buy hyperpigmentation is a common finding
acute cholecystitis
acute symptoms associated with eating fatty meals and females of late reproductive age who are overweight
diagnostic test of choice for primary sclerosing cholangitis?
Endoscopic retrograde cholangiopancreatography (ERCP)
you will see arborization of the biliary tree
magnetic resonsnance cholangiopancreatography
test to diagnose hemochromatosis?
transferrin saturation
not ferritin; it’s an acute phase reactant
irregular pulse with hemochromatosis?
other weirdness of hemochromatosis?
cardiomyopathy and atrial fibrillation
drinking and urinating more (diabetes)
hemochromatosis
iron overload
iron deposition on the pancreas, heart and skin –> diabetes, arrhythmias, and hyperpigmented skin.
“Bronze Diabetes”’
treatment for non-alcoholic steatohepatitis
weight loss and blood glucose control, with continued monitoring of the patient’s transaminases
inh toxicity
a well-known hepatocellular toxin that requires close monitoring of liver enzymes.
only time AST is usually greater than ALT
alcoholics
asterixis
a “flapping” tremor
often from alcoholism
ammonia-induced
treat alcoholic DT
lactulose
bacteria give off H+ that is added to ammonia
ascites + sudden increase in abdominal girth
likely spontaneous bacterial peritonitis
hepatorenal syndrome
decomposition of the kidneys, not the liver, and is characterized by activation of the RAAS system adn renal vasoconstriction as a result of systemic/ splanchnic vasodilation associated with cirrhosis
important effect of cancer
hypercoagulable state
Trousseau syndrome
CHF onset should be
relatively gradual
hepatomegaly, portal vein thrombosis, or new ascites in someone with chronic hep B is what until proven otherwise?
hepatocellular carcinoma
