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clin med III, exam 2 > Alcohol liver > Flashcards

Alcohol liver Flashcards

1
Q

portal vein carried blood from what organs to what organ

A
  • GI tract and spleen to the liver
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2
Q

what structures make up portal triad

A
  • bile duct
  • portal vein
  • hepatic artery
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3
Q

what are the three main patterns of injury associated with alcoholic liver disease

A
  1. fatty liver (simple steatosis)
  2. alcoholic hepatitis
  3. chronic hepatitis with fibrosis or cirrhosis
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4
Q

List the risk factors for alcoholic liver disease

A
  • amount of alcohol ingested
  • drinking outside of meal times
  • women
  • African american
  • Obesity
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5
Q

What pathology is characteristic of fatty liver (hepatic steatosis)

A

accumulation of fat in the cytoplasm of liver cells

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6
Q

can fatty liver (hepatic steatosis) be reversed? can it progress?

A
  1. May be completely reversible with abstinence in 4-6 weeks
  2. continued alcohol use -> cirrhosis
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7
Q

symptoms of fatty liver (hepatic steatosis)

A
  • usually asymptomatic and self limited
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8
Q

the following is characteristic of

  • fatty infiltration
  • neutrophil infiltration around clusters of necrotic hepatocytes
  • clumps of intracellular material (“Mallory bodies”)
  • fibrosis around hepatic venules
A

alcoholic hepatitis

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9
Q

How does alcoholic hepatitis lead to hepatic encephalopathy

A
  • failure of the liver to detoxify noxious agents of gut due to hepato-cellular dysfunction
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10
Q

what is the best known neurotoxin that can precipitate hepatic encephalopathy

A
  • ammonia
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11
Q

What is used to tx acute overt hepatic encephalopathy and secondary prophylactic therapy for an indefinite period of time

A

Lactulose

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12
Q

what is a test that uses brief cognitive screening tools to evaluate psychomotor speed and cognitive flexibility in the assessment of hepatic encephalopathy

A

Stroop test

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13
Q

what is Asterixis

A
  • tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings
  • sign of end stage liver failure
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14
Q

spider angiomas, ascites, and jaundice can all be signs of

A

alcoholic hepatitis

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15
Q

What CBC results would you expect with symptomatic alcoholic hepatitis

A
  • leukocytosis with left shift
  • Macrocytosis (MCV elevated)
  • Thrombocytopenia
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16
Q

What AST/ALT ratio would you expect with symptomatic alcoholic hepatitis

A
  • AST/ALT ratio > 2 (classic for ALD, definitely greater than 1)
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17
Q

what bilirubin level would you expect with symptomatic alcoholic hepatitis

A

bilirubin elevated (direct > indirect)

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18
Q

when does alcoholic hepatitis require hospitalization? what risk assessment calculators are available?

A
  • hospitalize if seriously ill
    • Model of end stage liver disease: ​MELD score > 18
    • Modified discriminant factor: MDF score > 32
19
Q

treatment options for alcoholic hepatitis

A
  • **discontinue all alcohol/complete abstinence is essential
  • diurectis: lasix + spironolactone
  • severe disease: MDF > 32 -> consider steroids or pentoxifylline (anti-cytokine therapy)
20
Q

What is portal pressure in compensated cirrhosis? median survival of compensated cirrhosis

A
  • portal pressure < 10
  • median survival 9 years
21
Q

clinical manifestations of compensated cirrhosis

A
  • splenomegaly
    • ​thrombocytopenia
    • leukopenia
    • anemia
    • AST elevated
22
Q

What happens in decompensated cirrhosis

A
  • increased portal pressure
  • microvasculature distorted -> hepatic blood flow bypasses vascular scars -> portal hypertension, porto-systemic shunting
    • ​esophageal varices
    • splenomegaly
    • ascites
    • hepatic encephalopathy
  • median survival 1.6 yrs
23
Q

What are the three possible sites of obstruction to flow causing portal hypertension

A
  • Prehepatic: portal vein thrombosis (can co-exist in cirrhosis)
  • intrahepatic: cirrhosis
  • posthepatic: CHF
24
Q

What are common clinical manifestations of portan hypertension

A
  • caput medusae
  • varices
  • ascites
25
Q

How is variceal surveillance done with cirrhosis

A
  • EGD
26
Q

why does a patient with cirrhosis need a US every 6 months with a AFP

A
  • surveillance for hepatocellular carcinoma
27
Q

What is TIPS and what is it used for

A
  • transjugular intrahepatic portosystemic shunt
    • reduces ascites
    • recurrent variceal hemorrhage
28
Q

patients with cirrhosis who don’t respond to diuretics (lasix + spironolactone) get what treatment

A
  • therapeutic paracentesis (with albumin)
  • TIPS
29
Q

What patients with cirrhosis are considered for liver transplant

A
  • decompensated cirrhosis
    • requires 6 months abstinence before consideration
30
Q

what effect can abstinence have on alcoholic cirrhosis

A
  • may slow the decline from compensated to decompensated cirrhosis
31
Q

List the 4 main complications from cirrhosis

A
  • portal hypertension
  • spontaneous bacterial peritonitis
  • hepatic encephalopathy
  • hepatorenal syndrome
32
Q

what is hepatorenal syndrome

A
  • functional renal failure in setting of decompensated cirrhosis
33
Q

list the diagnostic criteria for hepatorenal syndrome

A
  1. cirrhosis with ascites
  2. absence of shock
  3. renal impairment Cr >1.5 mg/dl
  4. no improvement with correction of volume status + albumin
  5. absence of other causes of AKI
34
Q

What is the key clinical feature of hepatorenal syndrome

A
  • Azotemia -> increased BUN
35
Q

List the types of benign liver lesions that require no intervention

A
  • cavernous hemangioma
  • focal nodular hyperplasia
  • simple cyst
  • focal fatty change
36
Q

List the types of benign liver lesions that referral to GI

A
  • adenoma
  • liver abscess
  • atypical, complex cysts
37
Q

neoplasms arising from parenchymal cells are called

A

hepatocellular carcinomas

38
Q

neoplasms arising from biliary duct cells are called

A

cholangiocarcinomas

39
Q

what are the greatest risk factors for hepatocellular CA

A
  • cirrhosis
  • hepatitis B
    • but any chronic liver disease increases risk
40
Q

Who should be screened with US with AFP every 6 months for HCC

A
  • cirrhotic pts
  • chronic hep B
    • Asian > 40 if male, > 50 if female
    • any age if FH of HCC
    • Africans > 20 yo
41
Q

what marker is elevated in 70% of people with HCC

A

alpha-fetaprotein

42
Q

what imaging modality if preferred in assessment of HCC

A
  • 4-phase MDCT scan or dynamic contrast enhanced MRI
43
Q

What is diagnostic for HCC? is it always needed?

A
  • liver biopsy
    • may not be needed if imaging study is typical and AFP is elevated

clin med III, exam 2 (6 decks)

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