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GI 2 Exam 2 > Clinical DSA 5: Hepatobiliary - Chronic Liver Disease and Cirrhosis > Flashcards

Clinical DSA 5: Hepatobiliary - Chronic Liver Disease and Cirrhosis Flashcards

(58 cards)

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1
Q

Primary complication of chronic hepatitis

A

Cirrhosis => ascites, variceal bleeding, encephalopathy, coagulopathy, hypersplenism (thrombocytopenia)

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2
Q

Complications of chronic HBV infection

A

Cirrhosis
HCC
Polyarteritis nodosa

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3
Q

Who is at the highest risk of developing chronic HBV?

A

Babies who are born to HBsAG+ mothers have 90% risk of chronic HBV

*perinatal transmission

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4
Q

Complications of chronic HCV infection

A

Cirrhosis
HCC
Mixed cryoglobulinemia

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5
Q

HCV prevention

A

If HCV+ do not share razors or toothbrush and practice safe sex

*no HCV vaccine

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6
Q

Diagnosis?

Chronic, progressive liver disease
*Appears healthy with stigmata of cirrhosis
Association with other autoimmune disease
*ASMA+ or ANA+
Hypergammaglobulinemia
AST/ALT > 1000, hyperbili
*Female 30s-50s
Extrahepatic manifestations (rash, arthralgias, keratoconjuctivitis, thyroiditism hemolytic anemia, nephritis, UC)

A

AIH Type 1

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7
Q

Diagnosis?

Chronic, progressive liver disease
*Appears healthy with stigmata of cirrhosis
Association with other autoimmune disease
*Anti-liver/kidney microsomal Abs (anti-LKM)
AST/ALT > 1000, hyperbili
*Children
Extrahepatic manifestations (rash, arthralgias, keratoconjuctivitis, thyroiditism hemolytic anemia, nephritis, UC)

A

AIH Type 2

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8
Q

Treatment for AIH

A

Glucocorticoids
Azathioprine
Monitor LFTs
Possible liver transplant

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9
Q

Continuum of alcohol induced liver disease

A

Steaosis => Steatohepatitis => Cirrhosis

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10
Q

Diagnosis?

Asymptomatic hepatomegaly and mild elevations in ALP and bili
AST>ALT 2:1
CBC shows leukocytosis or leukopenia
Macrocytic anemia
Signs of liver failure (dec albumin, coagulopathy)
History of alcohol abuse

A

Fatty liver (steatosis) phase of alcohol induced liver disease

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11
Q

Diagnosis?

Asymptomatic progresses to signs of liver failure
AST>ALT 2:1
CBC shows leukocytosis or leukopenia
Macrocytic anemia
Signs of liver failure (dec albumin, coagulopathy)
History of alcohol abuse

A

Alcoholic hepatitis (steatohepatitis) phase of alcohol induced liver disease

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12
Q

Diagnostic imaging for alcohol induced liver disease

A

US to rule out gallstones
CT with IV contrast or MRI
US elastography (look for fibrosis)

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13
Q

Liver biopsy finding in alcoholic hepatits and non-alcoholic steatohepatitis (NASH)

A

Mallory-Denk bodies (alcoholic hyaline)

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14
Q

Alcohol induced liver disease treatment and management

A 
Abstinance from alcohol
Daily multivitimin
Thiamine 100 mg
Folic acid 1 mg
Zinc
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15
Q

Special consideration of hypoclycemia management in alcohol induced liver disease

A

Administer glucose and thiamine at same time

otherwise may precipitate Wernicke-Korsakoff syndrome

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16
Q

Maddrey’s discriminant function (DF) is a prognostic indicator for _______________

calculated using __ and _______

Values >___ associated with poor prognosis and may benefit from steroids

A

Maddrey’s discriminant function (DF) is a prognostic indicator for alcohol induced liver disease

calculated using PT* and bilirubin*

Values >32* associated with poor prognosis

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17
Q

Glasgow Alcoholic Hepatitis score is a prognostic indicator for _______________

calculated using age, bili, BUN, PT, WBC count

Values >___ associated with poor prognosis and may benefit from glucocorticoids

A

Glasgow Alcoholic Hepatitis score is a prognostic indicator for alcohol induced liver disease

calculated using age, bili, BUN, PT, WBC count

Values >9* associated with poor prognosis

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18
Q

Model for End Stage Liver Disease (MELD/MELD-Na) score >___ is associated with significant mortality in alcoholic hepatitis

A

Model for End Stage Liver Disease (MELD/MELD-Na) score >21 is associated with significant mortality in alcoholic hepatitis

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19
Q

Treatment for severe alcoholic hepatitis (DF ≥ 32 or MELD >21 or GAW ≥ 9)

A

Steroids and pentoxifylline

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20
Q

Liver transplant requirement in alcohol induced liver disease

A

must abstain from alcohol for 6 months to be considered

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21
Q

Diagnosis?

Patient with alcoholic liver disease
Mental status changes
Ataxia
Involuntary eye movements

A

Wernicke encephalopathy

Tx with thiamine

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22
Q

Diagnosis?

Patient with alcoholic liver disease
Severe memory issues
Confabulations/make-up stories

A

Korsakoff syndrome (permanent)

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23
Q

Diagnosis?

Asymptomatic or mild RUQ discomfort
Hepatomegaly
Metabolic syndrome***
Insignificant alcohol history

A

NAFLD

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24
Q

Prevention of NAFLD

Study These Flashcards
A

Regular physical activity and coffee consumption

25
Treatment for NAFLD
Lifestyle modification (diet, exercise, vit E, gastric bypass) Liver transplant in advanced cirrhosis
26
Diagnosis of NAFLD
Liver biopsy is diagnostic Predominantly shows macrovesicular steatosis, no inflammation or fibrosis, Mallory-Denk bodies *NASH and alcoholic steatohepatitis indistinguishable histologically
27
Diagnosis? Liver disease and panacinar emphysema Most commonly presents in children
alpha 1 antitrypsin deficiency
28
Alpha 1 antitrypsin deficiency pathogenesis
Defective a1-AT gene => misfolded protein - Misfolded protein accumulates in liver leading to liver damage - Decreased functional a1-AT leads to disinhibition of proteases leading to pulmonary emphysema a1-AT is a protein that inactivates proteases
29
Adult smoker presentation of a1-AT deficiency
Liver disease COPD/emphysema of upper lobes *tx is smoking cessation
30
Child presentation of a1-AT deficiency
Liver disease Panacinar emphysema of lower lobes *tx is liver transplant in severe cases (most common cause of child liver transplant)
31
a1-AT phenotypes
PiZ or PiZZ have severe deficiencies PiS have mild deficiency Pim is phenotypically normal Pi gene on c14
32
Complications of a1-AT deficiency
Emphysema at young age | Micronodular cirrhosis => HCC risk
33
Diagnosis? ``` Cirrhosis with hepatomegaly Bronze skin Diabetes mellitus Cardiac dysfunction >45% transferrin saturation ``` HFE gene mutation Increased iron absorption in duodenum Hemosiderin (iron) deposits in organs
Hemochromatosis
34
Progression of hemochromatosis
Early: nonspecific symptoms (fatigue, arthralgia) Later: Cirrhosis with hepatomegaly, Bronze skin, Diabetes mellitus, Cardiac dysfunction, arthropathy
35
Hemochromatosis treatments
Phlebotomy In hemochromatosis due to transfusions use Deferoxamine (chelating agent)
36
Hemochromotosis complications
Cirrhosis, diabetes mellitus, heart failure Infection risk for siderophilic organisms (Y. enterocolitica, V. vulnificus, L. monocytogenes)
37
Hemochromotosis screening
Test for HFE mutation in any patient with iron overload Iron studies and HFE testing in all first degree family members
38
Diagnosis? Child or young adult (<40) presents with neurologic and psychiatric problems Kayser-Fleischer rings Low serum ceruloplasmin Coombs - hemolytic anemia Copper accumulation in liver, brain, eyes ATP7B mutation
Wilson disease AR disorder, impaired copper excretion into bile and failure to incorporate copper into ceruloplasmin
39
Wilson disease treatment
Oral penicillamine (increases urinary excretion of chelated copper) Liver transplant in severe case (cirrhosis)
40
Diagnosis? Elevated AST/ALT Elevated BNP Hepatojugular reflux is present Nutmeg liver
Right heart failure
41
Diagnosis? Rapid and striking elevation in ALT/AST over 5000 Rapid rise in LDH
Ischemic hepatitis (shock liver) *caused by acute MI, arrhythmia, septic/hemorrhagic shock
42
Initial imaging study for cirrhosis
RUQ US + Doppler of hepatic/portal veins
43
Complications of cirrhosis
Risk of HCC | Portal HTN
44
Survival prognostic scores for cirrhosis
Child-Turcotte-Pugh score (A,B,C with C being most severe) MELD/MELD-Na score (>10 is worsening, >14 for transplant list)
45
Tests to order for MELD/MELD-Na score
``` Bili Creatinine Na INR Dialysis recently? ```
46
Tests to order for Child-Turcotte-Pugh score
Bili Albumin PT/INR PE for encephalopathy and ascites
47
Screening for HCC in cirrhosis pts
alpha fetoprotein and US every 6 months
48
Diagnosis? Abdominal distension in chronic liver disease, portal HTN Abdominal US shows fluid in peritoneum Shifting dullness on percussion (requires 1500 mL of fluid)
Ascites
49
SAAG score
serum albumin - ascites fluid albumin >1.1 indicates ascites due to portal HTN
50
Who gets paracentesis?
Pt with new onset ascites Pt admitted to hospital with known cirrhosis and ascites Pt with known cirrhosis and ascites deteriorates quickly
51
How to diagnose spontaneous bacterial peritonitis
Paracentesis of ascites fluid WBC with diff of fluid PMN (total neutrophils) >250 = neutrocytic ascites highly sus
52
Treatment and prevention of spontaneous bacterial peritonitis (SBP)
Abx (prophylactic or treatment)
53
Prevention of esophageal varicieal bleeding/rebleeding
beta blockers band ligation (30% chance of rebleed)
54
Treatment for bleeding esophageal varicies
Resuscitation in ICU Emergent EGD with banding IVF +/- blood products Correct coagulopathy Abx, octreotide, TIPS, liver transplant
55
Grades of hepatic encephalopathy
1. mild confusion 2. drosiness 3. stupor 4. coma
56
Diagnosis? Alteration of mental status in the presence of liver failure Elevated ammonia (no correlation of amount to severity of mental status change) GI bleeding Constipation
Hepatic encephalopathy
57
Treatment of hepatic encephalopathy
Lactulose (produce 2-3 soft stools per day) acidifies colon and traps ammonium for excretion
58
Diagnosis? Cirrhosis Cachexia, abdominal pain, fever, jaundice Abnormal LFTs Abnormal US or rising alpha fetoprotein
HCC

GI 2 Exam 2 (7 decks)

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