Day 2 Flashcards
jaundice begins gradually, pruritus is common
• Large, smooth, nontender liver, pale stools, steatorrhea. Dark urine- positive for bilirubin. Elongated prothrombin time
Marked elevated of alkaline phosphate
Mild LFT
normal albumin
Intrahepatic cholestasis
o Stone, stricture or tumor blocks flow of bile w/I extrahepatic biliary tree
o Patient may have hx of gallstone, biliary tract surgery, malignancy
o Liver is usually enlarged
o Dark stool, pale urine
o Sudden onset of pain from stones
hihg alkaline phosphatase
moderate high LFTs
Extrahepatic obstruction
o Hepatitis + anorexia, nausea, abdominal pain, malaise before jaundice
o Hepatic tenderness and some hepatomegaly
o Ecchymoses may be presents
o Transaminases may become very elevated
o Hep C and alcoholism transaminases only 5x normal
o Dark urine, pale stools
Hepatocellulcar injury
No bilirubin in urine, but jaundice
Unconjugated hyperbilirubinemia
is cirrhosis symptomatic?
usually not
common cause of cirrhosis
Alcohol consumption
Hep C
Nonalcoholic fatty liver
most common autosomal condition for cirrhosis. Excessive iron overload.
Hemochromatosis
Other causes of cirrhosis
Wilson’s
Gaucher’s (lyposomal storage disorder)
Primary biliary cirrhosis
Fanconi’s (kidney problem)
if a person presents with varices, ascities, hypersplenism, encephalopathy, peripheral edema. Have GI bleeding, abdominal discomfort, confusion, early satiety.
Chronic viral or alcoholic hepatitis
Women presents with hepatomegaly, jaundice, hyperlipdemia, excoriation what do you suspect? Elevated alk phos, SED. Anti-Mito Antibody
Primary biliary cirrhosis
Gold standard of diagnosis for liver cirrhosis.
Liver biopsy
Patient presents with dyspnea, arthritis, skin discoloration, fatigue. Have damage to liver, heart, pancreas and gonads. Will look grey or bronze like. Elevation transferrin saturation and ferritin
Hemochromatosis
What does TIPS stand for?
transjugular intrahepatic portosystemic shunt
takes pressure off the portal system
Tx for primary biliary cirrhosis
transplant
diet- Vit A, D, K, zinc
meds- (a variety)
caused by HBV (most common) HCV, cirrhosis, hemochromatosis.
Elevated alpha-fetorprotein
will ahve hemorrhage, necrosis
Hepatocellucular carcinoma
Tx for hepatocellular carcinoma
curative resection
transplant
Uncommon in cirrhotic liver
hematogenous, lymphatic or direct spread
will have hemorrhage and replacement of hepatocytes by malignant cells
metastatic carcinoma
cancer due estrogens or anabolic steroids. will ahve hemorrhage, necrosis.
Hepatocellcular adenoma
tx of hepatocellular adenoma
discontinue estrogens/ androgens
resect if possible
do periodic imaging
Presents with URQ pain, ascities. occlusion of hepatic veins or inferior vena cava caused by hematogenous disease. Dx via doppler US
budd chiari syndrome
Due to congenital problems, estrogens. Is a blood filled cysts lined single layer of flat epithelium.
Cavernous hemangioma
Thin walled cyst with clear fluid. Has simple cuboidal endothelium. no co-existing liver dz, congenital. Tx with percutaneous aspiration or surgical
Simple liver cyst
Present with fever, RUQ colicky pain that radiates. N/V
acute cholecystitis
will have fatty food intolerance, jaundice, pale feces, pruritus, weight loss
chronic cholecystitis
