Flashcards in GI Liver more Deck (24):
Cilastozol used in peripheral artery disease
TZDs can help NASH
B/c reduces insulin resistance maybe
Spider telangectasia can happen in liver failure/cirrhosis from high estrogen
What is budd chiari? Tx?
Thrombosis of hepatic vein or IVC. Presents with:
Ascites (BIG CLUE)
RUQ pain, and the rest happening
Anticoag or shunting!
What is SAAG? What is cutoff?
Serum Albumin - Ascites Albumin
(Serum-Albumin Ascites Gradient)
1.1 is cutoff. If more than that it is low ascites in albumin. So FROM PORTAL HTN
If less than that, high albumin in ascites, or low albumin in serum. Cancer, Tb in peritoneum, pancreatitis, Nephrotic...
Ascites has high albumin and high LDH?
Means cancer caused it. Do workup for cancer
Spontaneous bacterial peritonitis tx?
Albumin and 3rd gen ceph
Portal HTN tx?
SPironolactone and furosemide
Abd pain, testiculur atrophy, arhtralgia, polydipsea, has what kind of cardiomyopathy?
Hemochromatosis (test atrophy is from deposition in pituitary)
Dilated more common than restrictive
Screening test for hemochromatosis? Aut rec
Then biopsy is to see extent
Phlebotomy is tx once per week or so
avoid booze b/c always avoid it in liver disease
Complications of hemochromatosis?
Cirrhosis, hep carcionoma, CHF, diabetes, hypopituitarism (all makes sense)
Wilson caused by what
impaired copper secretion. You will find low ceruloplasm for screening (not the cause of it, but you find it)
Builds in liver, brain, cornea
Depression, personality change, loss of coordination, parkinsonian like symptom, tremor
Jaundice, hepatomegaly, cirrosis
Keyser flescher rings in cornia
Trientine or penicillamine to chelate copper
Vit B6 supplements
Alpha1 antitrypsin does what? Who you suspect?
inhibits elastase. So breaks down elastin in lungs
In liver, it Alpha 1 antitrypsin accumulate in liver, and that is toxic
Codominant, one bad gene, might get COPD in a smoke at a young age. If double bad genes bad early on (before 30)
Antibodies in autoimmune hepatitis? Tx?
Anti-smooth muscle (classic type 1)
Liver kidney microsomal LKM antibodies
Tx with azothiprine and steroids
Benign liver issues associated with what?
OCP use. Hep adenoma, focal nodular hyperplasia, hemangioma, hep cyst
What is associated with hepatic adenoma?
Steroids use (trend with hormones)
Glycogen storage disease
Can have mass effect and pain
Malignant transformation in 10%
Tx of hepatic adenoma?
AFP screening or serial imaging after stopping OCP
Resection if grows b/c 10% goes malignant
What do you do if hepatic cancer?
DO CT TO FIND WHERE METS CAME FROM
Aflatoxin ingestion is risk for what?
Infected grain products
Bruit over liver?
Consider cancer b/c lots of revascularization
SO TRY NOT TO BIOPSY B/c it will bleed
Tx liver carcinoma?
Surger, chemo, transplant, ready to block bleeding
Paraneoplastic stuff with hepatocarinoma?
Refractory watery diarrhea