Upper GI 2 + Lower GI 1 Flashcards
Liver fibrosis:
Dx:
excessive CT acumulation in response to chronic liver cell injury
Dx by biopsy
Liver fibrosis - causes:
drugs
chemicals
alcohol
disorders affecting liver/hepatic blood flow
Liver fibrosis - ssx:
Asx
any sx secondary to primary disorder
Liver cirrhosis:
late stage of hepatic fibrosis, widespread distortion of architecture
Cirrhosis - ssx:
non-specific (anorexia, fatigue, wt loss)
late: portal HTN
Cirrhosis - PE:
Abd: Ascites, splenomegaly
Skin: Jaundice, pallor, petechiae, purpura
Extremities: clubbing
bleeding
Cirrhosis - workup:
Prognosis:
Labs: LFT often normal, PT, CBC, viral assay
Biopsy
Irreversible; transplantation
Primary biliary cirrhosis:
AI, progressive destruction of intrahepatic bile ducts, leads to cholestasis, cirrhosis, liver failure
Primary biliary cirrhosis - classic sx:
middle aged woman unexplained pruritus fatigue - insidious dry mouth RUQ pain jaundice
Primary biliary cirrhosis - work up:
GGT - elev
Alk phos - elev
AST, ALT - minimally abn
Enti-mitochondrial Ab - elev (AI)
confirm by biopsy
Primary biliary cirrhosis - PE:
enlarged, firm, non-tender liver
mb splenomegaly
Vascular disorders of the liver:
hepatic ischemia
congestive hepatopathy
hepatic artery disorders (occlusion, aneurysm)
hepatic vein disorders (budd-chiari, occlusive)
portal vein disorders
peliosis hepatitis
Ischemic hepatitis:
causes:
diffuse liver damage d/t inadequate blood or O2
most often systemic -
impaired perfusion (chf, acute hypoTN)
hypoxemia (resp failure, CO2 toxicity)
Increased metabolic demand (sepsis)
Ischemic hepatitis - ssx:
N/V
HM - TTP
Ischemic hepatitis - work up:
Clinical eval LFTs: very high aminotransferases mod inc. in bilirubin LDH inc w/in hrs Procedure: US, MRI, arteriography
Ischemic cholangiopathy:
focal damage to the biliary tree d/t disrupted flow from hepatic artery via peribiliary arterial plexus
Ischemic cholangiopathy - ssx:
pruritis
dark urine
pale stool
Ischemic cholangiopathy - work up:
Labs - cholestasis
Img - US initially, MRCP, ERCP
Ischemic cholangiopathy - causes:
vascular injury during procedure:
liver transplant, laparoscopic cholecystectomy, radiation, chemoembolization, etc
resulting bile duct injury
Congestive hepatopathy:
diffuse venous congestion in the liver resulting from RCHF (via IVC)
Congestive hepatopathy - ssx:
most asx
RUQ discomfort
severe congestion - massive jaundice
Congestive hepatopathy - PE:
Work up:
ascites
hepatomegaly
+ hepatojugular reflex
LFTs - mod elev
Hepatic artery occlusion - causes:
thrombosis emboli iatrogenic vasculitis eclampsia cocaine sickle cell crisis
Hepatic artery occlusion - ssx:
Work up:
asx w/o infarction or ischemic hepatitis
infarct -> RUQ pain, fever, N/V, jaundice
US (mb Doppler), followed by angiography
Hepatic aneurysm - causes:
Work up:
infection
arteriosclerosis
trauma
vasculitis
if they occur - tend to be saccular & multiple!
US, followed by contrast CT
Budd-Chiari syndrome:
causes:
obstruction of the hepatic venous outflow from small hepatic veins inside the liver to the IVC
hyper coagulable states
clot
Budd-Chiari - ssx:
PE:
Asx to fulminant liver dz acute: fatigue RUQ pain N/V jaundice hepatomegaly - ttp ascites
chronic: fatigue
HM
abd pain
LE edema
Budd-Chiari - work up:
prognosis:
LFTs
vascular img
most die <3 yrs if untx
Veno-occlusive dz:
causes:
caused by endothelial injury, leading to non-thrombotic occlusion of the terminal hepatic venues and hepatic sinusoids
irradiation
graft vs. host dz
hepatotoxins
Veno-occlusive dz - ssx:
PE:
work up:
sudden jaundices
ascites
tender, smooth HM
LFTs
US, liver bx
Portal vein thrombosis - causes:
surgery hyper coagulable states cancer cirrhosis trauma
leads to GI bleeding from varices (usu eso/stomach)
Portal vein thrombosis - ssx:
Work up:
Asx unless assoc w/other dz (pancreatitis)
LFTs
US - usu dx
Peliosis hepatitis:
causes:
multiple blood-filled cystic spaces develop randomly in the liver (mm - 3cm)
damage to sinusoidal lining cells from use of hormones (OCPs, anabolic steroids), tamoxifen, vit A
Peliosis hepatitis - ssx:
Dx:
Usu asx occasionally cysts rupture -> hemorrhage, mb death jaundice HM liver failure
often found incidentally on US or CT
Portal HTN:
increased resistance to blood flow, commonly arises from dz w/in the liver
uncommon - from blockage of splenic or portal vein, or impaired venous output
Portal HTN - causes:
cirrhosis
schistosomiasis
hepatic vascular abnormalities
leads to eso varices, portal-systemic encephalopathy
Portal HTN - ssx:
PE:
often asx
sx from complications (hemorrhage)
low systolic BP SM ascites, peripheral edema caput medusa, dilated abd wall veins jaundice spider angioma
Portal HTN - work up:
prognosis:
transjugular catheter (invasive) US or CT
mortality d/t hemorrhage >50%
Portal-systemic encephalopathy:
causes:
neuropsychiatric syndrome
fulminant hepatitis caused by virus, drug, toxin
commonly - cirrhosis, portal HTN
metabolic stress (inf, electrolyte imbalance, dehydration, diuretics)
gut protein d/o (GI bleed, high protein intake)
non-specific cerebral depressant (alcohol, sedative, analgesic)
Portal-systemic encephalopathy - pathophys:
absorbed products that would otherwise be detoxified through the liver end up in systemic circulation where they may be toxic to the brain
Portal-systemic - ssx:
Work up:
constructional apraxia
agitation, mania (uncommon)
“liver flap” (asterixis)
psychometric eval
CMP - electrolytes, albumin, LFT
EEG - diffuse slow wave activity
Post-op liver dysfunction:
mild liver dysfunction following major surgery, in the absence of pre-existing d/o. 3 types: post-op jaundice post-op hepatitis post-op cholestasis
Hepatic cysts:
commonly found incidentally on US or CT
usu asx, no clinical significance
polycystic liver assoc. w/polycystic kidneys (rare)
Benign liver tumors:
common, asx
ssx: HM
RUQ discomfort
intraperitoneal hemorrhage
LFTs normal to slight abn
often found incidentally on US, CT; may need Bx
Most common primary liver cancer:
hepatocellular carcinoma
more common outside US (E. Asia, sub-saharan Africa)
usu. pts with cirrhosis; common in HepB/C
