Unrein: Hepatitis, Cirrhosis, Bugs Flashcards
PBC
Primary Biliary cirrhosis: destruction of small to medium bile ducts in the liver - see pruritis and jaundice that develop late
- Primarily a disorder of middle-aged females
- AMAantibody ;
- alkaline phosphatase and cholesterol are usually elevated.
PSC
Primary Sclerosing Cholangitis:
- see beading ddx on ERCP- as there is cholestasis w/ fibrosis of bile ducts
- males ages 20-50
- ulcerative colitis.
- PANCA elevation
- watch for cholangiocarcinoma
ddx with ERCP
Wilson’s disease
= high copper levels due to impaired biliary excretion of copper
- mutation in ATP7B
- causes liver disease and fulminant hepatitis: affects liver, eye, brain
- male predominance
- Autosomal recssive
- Kayser-Fleishcer rings
- Parkinson’s like tremor
- Alk phos is low (Zinc is a cofactor in the production of alk phos and is competitively inhibted by copper)
ddx: abased on ceruloplasmin level and increased copper urine excretion
test to confirm wilson disease?
urine copper level assay
or
ceruloplasmin (APR, less specific)
serum ascitic albumin gradient is low, while ascites total protein is high
in malignant cirrhosis
see albumin in ascites
if have high SAAG and ascites total protein
think cardiac ascites
no fibrotic process, still see albumin in blood as well as in the ascites
if SAAG is high and ascites total protein is low
due to cirrhotic process
fibrotic process results in albumin not being able to get into the blood, but lots present in ascites
ASMA = Anti-smooth mm. Ab
AI Hepatitis
A diagnosis 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.
60% have other forms of AI diseases : Sjogrens, UC, RA
intrahepatic cholestasis of pregnancy
occurs during the second or third trimester, characterized by mild elevations of bilirubin and alkaline phosphatase
HELLP syndrome
(Hemolysis, Elevated Liver enzymes, and low platelets): this is a life threatening complication of pregnancy typically occurring in the third trimester and requires urgent delivery.
- see abdominal pain, nausea, vomiting
- seen in 10% of pts. w/ preeclampsia (HTN, proteinuria, edema)
- elevated ALT/AST, platelets<100,000, hemolytic anemia
Acute fatty liver of pregnancy
this leads to liver failure with elevated transaminases and an abnormal INR
- see naysea, vomiting and abdominal pain w/ elevated ALT/AST, Bili>5, prolonged PT time
- rare
- microvesicular fatty change
only tx is delivery
hereditary hemochromatosis
An iron overload state as the body has no inborn method of iron removal, it is associated with iron deposition on the pancreas, heart, and skin that can lead to diabetes, arrhythmias, and hyperpigmented skin – Bronze Diabetes.
= hyperpigmentation, diabetes, liver cirrhosis, heart problems
DDx w/ transferrin saturation (TIBC)
- preferred over ferritin which is an APR
d/t mutations in C281Y, H63D Responsible for HFE protein
elevated ceruloplasmin
wilson’s disease
non-alcoholic steatohepatitis
- fatty liver change in the absence of EtOH - affects 25% of american adults w/ truncal obesity
- se increased Transaminases: AST<ALT, alk phos and GGT are mildly elevated
- make sure that alcohol ingestion is less than 20 g/day
- can progress to fibrosis/cirrhosis
ddx: reqs. liver biopsy
most sensitive marker for acute hep B
Anti-HBc IgM
alcoholic liver
AST>ALT by 2.0 - 2.5 times is alcoholic etiology until proven otherwise.
Gamma-glutamyltransferase is often elevated disproportionately compared to other enzymes.
often see hyperammonemia, along with flapping tremor
tx of delerium: lactulose
Lactulose helps trap the ammonia (NH3) in the colon.It does this by using gut flora to acidify the colon, transforming the freely diffusible ammonia into ammonium (NH4+) which can no longer diffuse back into the blood
Spontaneous bacterial peritonitis
notice sudden increase in abdominal girth - common disease in those w/ cirrhosis and ascites
tx: Abs
