GI-Cirrhosis Etiologies

Question 1

Viral Hepatitis

Answer 1

Path: Hep B (both) - immuno decreased
Hep C (chronic)

Pt: IVDA = Hep C
Sex = Hep B

Dx: Hep C Ab
Hep B Ab

Tx: direct acting agonists
Ribavirin + IFN

Question 2

Wilsons Disease

Answer 2

Path: Copper depositions in basal ganglia, eyes, and liver

Pt: Basal ganglia = chorea
Liver = cirrhosis
Eyes = kayser-fleischer rings; ceruloplasmin

Dx: 1st slit lamp
then: Ceruloplasmin, urine Cu
Best = Bx = increased copper liver

tx: Penicillamine
Transplant

F/u: Cirrhosis + picture of eye = Wilsons

Question 3

Hemochromatosis

Answer 3

Path: Iron absorption, Iron overload

Pt: Bronze diabetes = DM, Cirrhosis, and hyperpigmentation

Dx: 1st iron studies
- Ferritin > 1000
- Transferrin > 50%
Best: Biopsy = increased iron

Tx: Phlebotomy, Deferoxamine

Question 4

Alpha 1 Anti-trypsin Deficiency

Answer 4

Path: Above (same as hemochromatosis?)

Pt: COPD and cirrhosis

Dx: Bx = PAS + Macrophages

Tx: Transplant

Question 5

Primary Sclerosing Cholangitis

Answer 5

Path: extrahepatic, goes w UC, IBD

Pt: Men present w pruritis and jaundice, age 30-50

Dx: MRCP = beads on a string
ERCP = Bx= Onion skin fibrosis

Tx: Transplant
Ursodeoxycholic acid

Question 6

Primary billiary cirrhosis

Answer 6

Path: intrahepatic, no association w UC, IBD

Pt: women w pruritus and jaundice, 30-50 yrs old

Dx: AMA
Imaging = Normal
Best = Biopsy
Tx: Transplant

Question 7

Alcohol

Answer 7

Path, Pt, Dx: Alcohol

Tx: stop alcohol, transplant

Question 8

NASH/NAFL

Answer 8

Path: fatty liver disease

Pt: Cirrhotic changes and there isnt another cause you can find.
Obese ppl w “obese limits”

Dx: 1st ultrasound
best: biopsy

Tx: Transplant