2- Alcoholic liver disease & Liver CA Flashcards by Colleen Cahill

What are the 3 main patterns of injury associated w/ ALD?

Fatty liver, alcoholic hepatitis, chronic hepatitis w/ fibrosis or cirrhosis

How well did you know this?

Not at all

Perfectly

What classifies a “heavy drinker”?

60 g/d x 2 wks

How well did you know this?

Not at all

Perfectly

What is the relationship b/w alcohol consumption and risk of liver injury?

Dose dependent (not linear)

How well did you know this?

Not at all

Perfectly

The following are risk factors for what?

Increased alcohol consumption
Beer or spirits > wine
Drinking outside of meal times
> 1 drink/ day in F or > 2 drinks/day in M
Pattern of consumption
Increased BMI
Genetics
CLD
Smoking

RF for ALD

How well did you know this?

Not at all

Perfectly

How is binge drinking defined?

4 drinks over 2 hrs in F VS 5 drinks over 2 hrs in M

How well did you know this?

Not at all

Perfectly

What is classified as “safe drinking”?

1 drink/day in F VS 2 drinks/day in M

How well did you know this?

Not at all

Perfectly

What disease is a due to an accumulation of fat in cytoplasm of liver cells?

Fatty liver (hepatic steatosis)

**Mallory-Denk bodies + neutophilic lobar inflammation

Clinical dx w/ liver biopsy confirmation

How well did you know this?

Not at all

Perfectly

How does a pt w/ fatty liver typically present?

Asymptomatic and self limited

How well did you know this?

Not at all

Perfectly

Is fatty liver disease reversible if a pt stops drinking?

Yes

How well did you know this?

Not at all

Perfectly

In what time frame can you expect to see reversal of the ALD if Pt stops drinking?

4-6 wks

How well did you know this?

Not at all

Perfectly

If pt w/ fatty liver disease continues to drink what is the disease progression?

Alcohol hepatitis + cirrhosis

How well did you know this?

Not at all

Perfectly

What is the tx for pt w/ FLD?

Lifestyle mod (weight loss and exercise) and alcohol cessation

How well did you know this?

Not at all

Perfectly

What disease is defined as inflammation of the liver characterized by necrosis and fibrotic scaring?

Alcohol hepatitis (AH)

How well did you know this?

Not at all

Perfectly

What is the biggest RF for AH?

Chronic or current heavy alcoholic consumption

(>2 drinks/day for women vs > 3 drinks/day men x 5 yrs)

How well did you know this?

Not at all

Perfectly

What will increase a pt w/ AH risk for permanent liver damage?

Continued alcohol abuse

How well did you know this?

Not at all

Perfectly

AH presents on a spectrum of mild to severe. What might you find on exam for a pt w/ severe AH?

Jaundice
Hepatic encephalopathy
Hepatosplenomegaly w/ liver TTP
Edema (scrotal or LE)
Ascites
Variceal bleeding

How well did you know this?

Not at all

Perfectly

What are the lab findings for pt w/ AH?

Leukocytosis, macrocytosis, thrombocytopenia,

AST/ALT ≥ 1.5 (AST 2-6 ULN), hyponatremia, hypokalemia, elevated: bili (>3), PT/INR, GTP + low albumin + folate

How well did you know this?

Not at all

Perfectly

What will histology show for pt w/ AH?

Mallory-Denk Bodies

Neutophillic lobular inflammation

How well did you know this?

Not at all

Perfectly

What is probable AH?

Clinically dx w/o confounding factors

*confounding factors: Pt denies ETOH abuse, hx of ischemic hepatitis (drug abuse), atypical labs

How well did you know this?

Not at all

Perfectly

What is possible AH?

Clinically dx w/ confounding factors

*confounding factors: denies ETOH abuse, hx of ischemic hepatitis (drug abuse), atypical labs, hx metabolic liver disease (Wilson’s)

How well did you know this?

Not at all

Perfectly

What does the “model for end stage liver disease” (MELD) calculate?

Mortality rate in 90 days

How well did you know this?

Not at all

Perfectly

What dose Maddrey’s discriminant function (mDF) calculate?

MDF ≥ 32 predicts 30-50% mortality @ 28 days

How well did you know this?

Not at all

Perfectly

What does the Lille Model calculate?

Response to steroids

How well did you know this?

Not at all

Perfectly

What is the tx for severe AH (MELD score > 20, mDF ≥ 32)

Hospitalize
40 mg prednisolone +/- IV n-acetylcysteine (if steroids determined appropriate by Lille model)
Stop BB

How well did you know this?

Not at all

Perfectly

What is the single MOST important factor for survival in all pts w/ AH and ALD

Cessation + complete abstinence of alcohol

What disease is failure of the liver to detoxify noxious agents of gut origin, because of hepatocellular dysfunction and portosystemic shunting resulting in pairment of brain function?

Hepatic encephalopathy

What is the best known neurotoxin that can precipitate HE?

Ammonia

What are the sx of Grade I HE?

Changes in behavior, mild confusion, slurred speech, disordered sleep pattern (encephalopathy)

What are the sx of Grade II HE?

Lethargy, moderate confusion

What are the sx of Grade III HE?

Marked confusion (stupor), incoherent speech, sleepy but can arouse

What are the sx of Grade IV HE?

Coma, unresponsive to pain

What is Asterixisis? What disease is it a sx of?

Visible tremor when UE in flexion in shoulders in wrists. | Hepatic encephalopathy

What is the Stroop test used to evaluated in pts w/ HE?

Cognitive screening tool used to evaluated psychomotor speed and cognitive flexibility

Variceal bleeding, ascites, and jaundice are sx of what?

Severe alcoholic hepatitis (≥ 32 or MELD > 20)

What is the tx for AH?

TX alcohol withdrawal Diuretics (lasix, Spironolactone)/ Sodium restricted diet TX Hepatic encephalopathy: Lactulose, Rifaximin Steroids if severe

What is the next step if pt w/ AH is not responsive to steroid tx by day 7?

D/C => Liver transplant

What liver pathology is characterized by widespread destruction and regeneration of liver disease w/ marked increased in fibrotic connective tissue?

Cirrhosis

What is compensated cirrhosis and how does it present?

Portal pressure < 10 | Splenomegaly

What is the median survival for compensated cirrhosis?

12 yrs

What is decompensated cirrhosis? How does it present?

``` Increased portal pressure w/ decreased liver function resulting in porto-systemic shunting Esophageal and rectal varices Dilated abdominal veins (caput medusae) Jaundice Encephalopathy ```

What is the median survival decompensated cirrhosis?

2 yrs

If compensated cirrhosis is left untx, it will progress to what?

Decompensated cirrhosis

Portal hypertension is associated with what liver pathology?

AH and decompensation cirrhosis

What is portal HTN?

Increased pressure w/in the portal venous system

What are the 3 possible sites of obstruction to flow in the portal venous system?

1. Pre-hepatic: portal vein thrombosis 2. Intrahepatic: cirrhosis 3. Post-hepatic: CHF, pericarditis

What is the tx for cirrhosis?

TX/ prevent complications of portal HTN and cirrhosis - Variceal surveillance (EGD) - Hepatocellular CA surveillance (US q 6 mos + AFP) - BB prophylaxis to prevent variceal bleeding (avoid if SBP < 90)

What is the tx for ascites?

- Low NA diet - Diuretics (Lasix, Spironolactone) - Fluid restriction ONLY if NA M 125

What is TIPS procedure? When it is done?

Transjugular intrachepatic portosystemic shunt | Reduces ascites, variceal hemorrhage, improves QoL - 75% success rate

What is given to pts that have > 5 L removed in a therapeutic paracentesis for ascites? Why?

6-8 g of albumin for each liter drained to prevent kidney injury

When is liver transplant considered?

Pt w/ decompensated cirrhosis, MELD ≥ 15

What is required for pt to be eligible for liver transplant

Abstinence from alcohol before and after transplant

What is the prognosis for pt w/ alcoholic fatty liver disease?

Complete resolution in 4-6 weeks IF alcohol is stopped

What is the prognosis for alcoholic hepatitis?

Based on severity. | Need to d/c ETOH before disease becomes irreversible

What is the prognosis for alcoholic cirrhosis?

If pt continues to drink, 4 yrs survival < 20%

All pts w/ cirrhosis should be screen for esophageal varices w/ what?

EGD

All pts w/ cirrhosis should be screen q 6 mos with what imaging and AFP?

Abd US

Spontaneous bacterial peritonitis is a complication of what?

Cirrhosis

What is the dx criteria for heptarenal syndrome?

1. Decompensated liver disease/liver failure 2. Absence of shock 3. Renal impairment 4. No improvement w/ correction of volume status + albumin x ≥ 2 days 5. Absence of other AKI causes

Labs for pt w/ hepatorenal syndrome will show what?

Azotemia (increased BUN)

What is hepatorenal syndrome?

Functional renal failure in the setting of decompensated liver disease/liver failure

How is Type 1 hepatorenal syndrome defined?

Rapid + progressive renal failure w/ severe multi-organ failure - survival ≤ 4 wks - ≥ 2x increase in serum Cr (>2.5) in less than 2 wks

How is Type 2 hepatorenal syndrome defined (less severe than Type 1)?

Associated w/ refractory ascites- Median survival 6 mos

What is used to prevent HRS?

- IV albumin if > 5 L drained in paracentesis - EGD surveillance + BB to protect against GI bleeding - ABX prophylaxis for SBP

What is NOT used in the prevents on HRS?

NSAIDs or supplements

When should ABX prophylaxis be given for SBP? What is typically given?

``` Bactrim DS or Cipro 500 mg QD if pt w/ - Previous dx of SBO - Ascetic protein < 1.5 IV Ceftriaxone if pt w/ - Variceal bleed x 3-7 days ```

What imaging findings are associated w/ a benign liver lesion that don't require any intervention?

Cavernous hemangioma < 4cm Focal nodular hyperplasia Simple ASX cyst Focal fatty change/sparring

What imaging findings are associated w/ a benign liver lesion that require intervention/GI referral?

Adenoma (associated w/ OCP) Liver abscess Inflammatory pseudotumor Atypical/complex cyst

What are malignant liver lesions?

``` Metastases Lymphoma Primary liver neoplasms - HCC - Cholangiocarcinoma - Rare tumors (cystadenocarcinoma, angiosarcoma) ```

What malignant liver lesion arises from the parenchymal cells?

Hepatocellular carcinoma (HCC)

What malignant liver lesion arises from the biliary duct cells?

Cholangiocharcinomas

What is the most common form of liver cancer?

Hepatocellular carcinoma

If cirrhotic or non-cirrhotic Hep B pt presents w/ liver imaging on lesion. What should you be suspicious for?

HCC *Screen all cirrhosis pts. Pts w/ Hep B screen q 6 most + AFP

What are the sx of HCC?

Unintentional weight loss, sudden onset ascites, elevated AFP

How is HCC dx?

CT *If non-diagnostic then triphasic MRI w/ gadolinium contrast Liver biopsy is diagnostic BUT risk of tumor seeding

Who do you screen for HCC?

All pts at high risk for liver CA

If pt w/ known cirrhosis is found to have 2 cm solid liver lesion. What is your next step?

Triphasic CT scan

Is coffee good for the liver?

YES

2- Alcoholic liver disease & Liver CA Flashcards

(77 cards)