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Clin Med 3 > E2: Alcohol Related And Liver Cancer > Flashcards

E2: Alcohol Related And Liver Cancer Flashcards

(46 cards)

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1
Q

What are the 3 patterns of injury associated with ALD?

A

1) fatty liver
2) Alcoholic hepatitis
3) Chronic hepatitis with fibrosis or cirrhosis

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2
Q

What are the risk factors for ALD?

A
  • Daily drinking above the threshold of 1/day (women) or 2/day for men
    • women develop more severe ALD at lower doses with shorter duration
  • Increased BMI
  • Genetic factors
  • Co-existing CLD
  • Smoking
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3
Q

Is fatty liver reversible?

A

Yes, reversible with abs intense from alcohol after about 4-6 weeks

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4
Q

What is the treatment of fatty liver?

A

Lifestyle modifications and alcohol cessation

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5
Q

What is alcohol related hepatitis?

A

-Inflammation of the liver characterized by necrosis and fibrotic scarring, most likely to occur in chronic or current heavy alcohol consumption

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6
Q

What are the clinical features of alcohol hepatitis?

A
  • fever, leukocytosis
  • hepatic encephalopathy
  • spider angiomas
  • jaundice
  • hepatosplenomegaly with liver tenderness
  • edema
  • ascites
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7
Q

What finding on liver histology is consistent with Alcoholic hepatitis?

A

Mallory Denk body and neutrophilic lobular inflammation

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8
Q

How is a definite diagnosis of alcoholic hepatitis made?

A

Clinical diagnosis with liver biopsy confirmation

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9
Q

What is the management of alcoholic hepatitis?

A
  • Hospitalize with severe AH
  • in severe AH, treat with steroids with patients that are eligible and without contraindications
  • Discontinue alcohol, complete abstinence is essential in all patients
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10
Q

What is the most important factor is improving survival for patients with alcoholic hepatitis?

A

Discontinue alcohol use

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11
Q

What is hepatic encephalopathy?

A

-Failure of the liver to detoxify noxious agents of gut origin because of hepato-cellular dysfunction and portosystemic shunting

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12
Q

What is the best known neurotoxin that can precipitate hepatic encephelopathy?

A

Ammonia

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13
Q

How is hepatic encephalopathy treated?

A

Lab tulles for acute overt hepatic encephalopathy and secondary prophylactic therapy for an indefinite period of time

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14
Q

What are are the symptoms of grade I HE?

A

Changes in behavior, mild confusion, slurred speech, disordered sleep pattern

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15
Q

What are the signs of grade II HE?

A

Lethargy, moderate confusion, asterixsis

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16
Q

What are the symptoms of grade III HE?

A

Marked confusion, incoherent speech, and sleeping but can arouse

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17
Q

What are the symptoms of Grade IV HE?

A

Coma and unresponsive to pain

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18
Q

What is a stroop test used for?

A

The stroop test is a brief cognitive screening tool that evaluates psychomotor speed and cognitive flexibility
-Able to diagnose minimal hepatic encephalpathy with excellent sensitivity and specificity

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19
Q

What medications are given to treat hepatic encephelopathy?

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A

Lab tulles and rifaximin

20
Q

What does the Lillie model do?

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A

Calculates the likelihood of patients response to steroids

21
Q

What does an Maddreys Discriminant function (MDF) ≥32 predict?

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A

Predicts 30-50 mortality at 28 days

22
Q

What does the model for End stage liver disease (MELD) do?

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A

Calculates mortality rate in 90 days

23
Q

What is cirrhosis?

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A

-Widespread destruction and regeneration of liver tissue and a marked increase in fibrotic connective tissue

24
Q

What is compensated cirrhosis characterized by?

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A
  • Portal pressure <10
  • Median survival ~ 12 years
  • Clinical manifestations splenomegaly, thrombocytopenia, leukopenia, anemia, and AST elevation
25
What is decompensated cirrhosis characterized by?
- Increased portal pressure, decreased Liver function - medial survival is ~2 years - portal HTN, Porto-systemic shunting
26
What is portal Hypertension?
- Increased pressure within the portal venous system, commonly seen in decompensated cirrhosis and acute alcoholic hepatitis - Increased pressure promotes collateral circulation
27
What are the 3 possible sites of obstruction to flow in portal hypertension?
- Pre-hepatic: portal vein thrombosis - Intrahepatic: Cirrhosis - Post hepatic: CHF,
28
What is the treatment for ascites?
- adherence to less then 2g sodium per day - Lasix or spironolactone - fluid restriction
29
How much albumin do you need to replace when performing a paracentesis?
6-8 grams of albumin for each liter >5 removed to prevent kidney injury
30
When should you refer for liver transplant if a patient has cirrhosis?
If decompensated cirrhosis or a MELD ≥15
31
What is the prognosis for alcoholic fatty liver?
-Complete resolution may occur if alcohol is stopped for 4-6 weeks
32
What is the prognosis for alcoholic hepatitis?
Prognosis depends on severity. Mild cases are often reversible. Need to discontinue alcohol
33
What are the possible complications of cirrhosis?
- Portal HTN - Spontaneous bacterial peritonitis - Hepatic encephalopathy - Hepatomegaly syndrome
34
What is the diagnostic criteria of Hepatorenal syndrome?
- Signs of decompensated liver disease - absence of shock - renal impairment - no improvement with correction of volume status and albumin for ≥ 2 days - absence of other causes of AKI
35
What are the clinical features of hepatorenal syndrome?
-Progressive rise in serum creatinine -azotemia -very low urine sodium concentration -
36
What is type 1 hepatorenal syndrome?
- Rapidly and progressive renal failure with severe multi organ failure - median survival is ≤4 weeks
37
What is type 2 hepatorenal syndrome?
Associated with refractory ascites | -median survival is 6 months
38
How Is hepatorenal syndrome prevented?
- use albumin IV with large volume paracentesis - Protect against GI bleeding with EGD surveillance or beta blocker use - No NSAIDs - SBP prophylaxis with ABX with Cipro or Bactrim
39
What are the 4 types of benign liver lesions that do not require intervention?
- Cavernous hemangioma <4cm - focal nodular hyperplasia - Simple cyst and asymptomatic - focal fatty change/sparing
40
What are the benign liver lesions that require management?
- Adenoma (malignant potential) - Liver abscess - inflammatory pseudo tumor - atypical/complex cyst and large symptomatic cysts
41
What are the 3 malignant liver lesions?
- Mets - Lymphoma - Primary liver neoplasm
42
What are the 3 types of primary liver neoplasm?
- HCC - Cholangiocarcinoma - other rare tumors
43
What are neoplasms arising from parenchyma cells called?
HCC
44
What are neoplasms arising from ductal cells called?
Cholangiocarcinomas
45
What patients have a high risk for HCC?
Cirrhotic patients and non-cirrhotic Hep B
46
What lab is often elevated in HCC?
Alpha fetoprotein

Clin Med 3 (17 decks)

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