Flashcards in Chronic Hepatitis And Cirrhosis Deck (22):
Spontaneous bacterial peritonitis? How common?
Bacterial infection of ascitic fluid without any intra-abdominal source of infection. Occurs 10% to 20% of cirrhotic patients with ascites.
Patient with ascites caused by portal hypertension as a complication of hepatic cirrhosis. Next step?
Perform a paracentesis to evaluating ascitic fluid and evaluate for spontaneous bacterial peritonitis
The most common causes of chronic hepatitis?
1. Hepatitis B and C
3. Autoimmune hepatitis
4 chronic exposure to drugs toxins
Less common causes of chronic hepatitis?
2. Wilson disease
3. Alpha-1 antitrypsin deficiency
Test for autoimmune hepatitis?
AMA, anti-LKM (liver kidney microsome)
Test for hemachromatosis?
High transferrin saturation, High ferritin
Test for Wilson's disease?
Low serum ceruloplasmin
Ways to test for hepatitis C?
1. ELISA test to detect anti-HCV antibody
2. PCR to detect HCV RNA
Percentage of patients who will develop chronic hepatitis from HCV infection? Percentage who will develop cirrhosis? Percentage who will develop hepatocellular carcinoma?
70 to 80% within 10 years
20% within 20 years
After getting cirrhosis, 1% to 4% annually develop HCC
Treatment of choice for chronic hepatitis C? The side effects?
Pegylated alpha interferon (Flu like symptoms and depression) and ribavirin (Hemolysis)
Symptoms of cirrhosis?
1. Portal Hypertension
2. Decreased liver function (jaundice, impaired synthesis of albumen, clotting factors, steroid hormone binding proteins)
3. Hepatic encephalopathy
Portal hypertension: clinical presentation? Diagnosis? Treatment?
Ascites, splenomegaly, hypersplenism, encephalopathy, bleeding varices
Evaluation of portal bloodflow using Doppler ultrasound
Nonselective beta blockers (propranolol), Octreotide causes splanchnic vasoconstriction
Ascites: clinical presentation? Diagnosis? Treatment?
Abdominal distention with peripheral edema
Finding free peritoneal fluid on physical exam
Sodium restriction, spironolactone, loop diuretics, Paracentesis
Spontaneous bacterial peritonitis: clinical presentation? Diagnosis? Treatment?
Abdominal pain, fever, extension, decreased towel sounds
Ascitic fluid contains >250 polymorphonuclear neutrophils and confirmed with positive culture
IV antibiotics (cefotoxime or ampicillin/sulbactam)
Most common organisms that cause spontaneous bacterial peritonitis?
E. coli, Klebsiella, enteric flora, enterococci, pneumococci
Liver cirrhosis leads to a decrease steroid hormone binding globulin. Effect?
Increased amounts of free estrogen which lead to formation of
1. Spider angiomaya
2. Palmer erythema
Most common cause of ascites?
Portal hypertension as a consequence of cirrhosis
Pathogenesis of ascites?
1. Decrease effective circulatory blood volume because of portal hypertension (underfill theory)
2. Inappropriate renal sodium retention being to hyperlipoidemia (Overfill theory)
3. Decreased plasma oncotic pressure
Serum ascites albumin gradient?
Serum albumin - ascitic albumin
If >1.1 caused by portal hypertension (Cirrhosis, portal vein thrombosis, Bud-Chiari syndrome, CHF, constrictive pericarditis)
If <1.1 Non-portal hypertension (Peritonitis, pancreatic ascites, bowel obstruction, serositis, nephrotic syndrome)
End stage developments of hemochromatosis?
Diabetes, cirrhosis of the liver, hypogonadisn, arthropathy, cardiomyopathy, bronze skin
Patient with ulcerative colitis presents with liver problems. Cause?