Approach To Liver Disease Flashcards
(24 cards)
In dark skinned individuals, how is icterus examined?
Mucous membranes below the tongue can demonstrate jaundice
At what bilirubin level is jaundice detectable?
2.5 mg/dL (43 micromol)
May remain detectable at this level during recovery from jaundice (because of protein and tissue binding of conjugated bilirubin)
True of spider angiomata
Superficial, tortuous arterioles that typically fill from the center outward (unlike simple telangiectasias)
Occur only in the arms, face and upper torso
Pulsatile
Maybe difficult to detect in dark-skinned individuals
How is ascites best appreciated in the setting of advanced liver disease?
Shifting dullness by careful percussion
Other factors that contribute to edema formation in advanced liver disease
Hypoalbuminemia
Venous insufficiency
Heart failure
Medications
Major criterion for diagnosis of fulminant hepatitis and indicates a poor prognosis
Appearance of hepatic encephalopathy during acute hepatitis
Examinations done in assessing hepatic encephalopathy
Trail- making test - series of 25 numbered circles that that patient is asked to connect as rapidly as possible using a pencil
Normal range for the connect the dot test: 15-30seconds
Longer in encephalopathic patients
Other tests: Drawing of abstract objects Comparison of a signature from previous examples EEG Visual evoked potentials
Sign of advanced liver disease
Consists of collateral veins radiating from the umbilicus and results from the recanulation of the umbilical vein
Caput medusae
Occurs in patients with long-standing cirrhosis and portal hypertension
Defined by the triad of liver disease, hypoxemia and pulmonary arteriovenous shunting
Characterized by platypnea, orthodeoxia: oxygen desaturation that occur paradoxically upon the assumption of an upright position
Hepatopulmonary syndrome
Characteristics of hepatopulmonary syndrome
Platypnea
Orthodeoxia: shortness of breath and oxygen desaturation that occur paradoxically upon the assumption of an upright position
Typical skin manifestation of cryoglobulinemia of chronic hepatitis C
That can also occur in chronic Hep B
Mucocutaneous vasculitis with palpable
Golden brown copper pigment deposited in Descemet’s membrane at the periphery of the cornea
Kayser-Fleischer rings
Dupuytren contracture and parotid enlargment are suggestive of
Chronic alcoholism and alcoholic liver disease
Liver biopsy is usually not needed in the diagnosis of acute liver diseases
When is it useful in acute cases?
Drug-induced liver disease
Acute alcoholic hepatitis
Diagnosis remains unclear despite thorough clinical and laboratory investigation
In chronic liver diseases, in which cases does liver biopsy play an important role?
Autoimmune hepatitis
Primary biliary cirrhosis
Nonalcoholic and alcoholic steatohepatitis
Wilson’s disease (with a quantitative hepatic copper level in the last instance)
Imaging modality of choice for visualization of the biliary tree
MRCP
ERCP
Advantages of MRCP over ERCP
- no need for contrast media or ionizing radiation
- images can be acquired faster
- procedure is less operator dependent
- carries no risk for pancreatitis
In which cases is ERCP > MRCP?
Evaluation of ampullary lesions and primary sclerosing cholangitis
Permits biopsy, direct visualization of the ampulla and CBD, and intraductal sonography
Provides therapeutic options in px with obstructive jaundice, such as sphincterotomy, stone extraction, and placement of nasobiliary catheters and biliary stents
Procedures of choice for the identification and evaluation of hepatic masses, the staging of liver tumors, and perioperative assessment
Multidetector or spiral CT and
MRI with contrast enhancement
The size of the liver biopsy sample is an important determinant of reliability. What is the specimen length is necessary for accurate assessment of fibrosis?
1.5-2cm
CAGE QUESTIONS
C. Have you ever felt like you ought to cut down on your drinking?
A. Have people annoyed you by criticizing your drinking?
G. Have you ever felt guilty or bad about your drinking?
E. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over (eye-opener)?
Most often the first indication of worsening fibrosis
Mild thrombocytopenia
Noninvasive variables used in the computation of MELD score (Model for End Stage Liver Disease)
INR
Serum bilirubin level
Serum creatinine
More objective the Child-Pugh
Less center-to-center variation
Wider range of values
Currently used as a priority listing for liver transplantation in the US
Child Pugh score reflecting decompensation and indicates cirrhosis
Child Pugh Score of >= 7 (ClassB)
Accepted criterion for listing a patient for liver transplantation
