Vignettes

Question 1

How to use LDH in evaluation of abnormal liver tests?

Answer 1

When the liver tests are >1000, then can use ALT:LDH ratio to help differentiate.
ALT:LDH ratio>1.5 is acute viral hepatitis
ALT:LDH<1.5 is toxin related, drug induced, or ischemic

Question 2

What does a hemangioma look like on imaging? Do you need to biopsy

Answer 2

well circumscribed lesions
progressive centripetal (from periphery to center) fill in
Biopsy not needed- very bloody

Question 3

Large liver mass with DIC

Answer 3

Kasaback Merritt syndrome = giant hemangioma (being tumor the liver that is found commonly, but when >5 cm they are termed giant)

Question 4

When should a hemangioma be followed up?

Answer 4

when sub capsular should be followed up since this location confers a higher risk of bleeding upon tumor enlargement

Question 5

How do you treat isolated gastric varies?

Answer 5

Usually from splenic vein thrombosis–> so spleen swells, and come out the gastric vein

tx is splenectomy

Question 6

hyperthermia + acute hepatitis+ muscle rigidity/bruxism

Answer 6

MDMA/ectasy

Question 7

Elevated liver tests+ young woman+ abdominal pain + pleuritisS

Answer 7

Fitx Hugh Curtis, do a pelvic exam, pelvic infection spreads to abdomen, involves peritoneal surfaces, gives rise to purulent, fibrinoid exudate around the liver

Pleuritisi

Question 8

What zone does BCS affect?

Answer 8

Starts with zone 3 (pericentral), which is already least oxygenated
Zone 1 is periportal
Zone 2 is intermediate

Question 9

What paO2 and AA gradient suggests HPS? What other modality besides saline TTE can be used?

Answer 9

PaO2<70, AA gradient >20

techneium macroaggregates of albumin >4% uptake in the brain is indicative of intrapulmonary shunting

Risk factors ca n be u sed to identify HPS:patients with severe shunting who may not reverse after liver transplantation:
(1) PaO2 <50 mm Hg (severe hypoxemia);
(2) in ability to cor rect hypoxemia with 100% O2;
(3) TcMAA >40% brain uptake (high shunt fraction)