HEPATOBILIARY/PANCREATIC Flashcards
(43 cards)
Child’s classification?
stratifies risk of surgery in pts w/ liver failure
measure 3 labs (albumin, bilirubin, PT) and 3 clinical findings (encephalopathy, ascites, nutrition)
Varices ppx in pts w/ cirrhosis?
Tx for bleeding varices?
beta blockers
band the varices, correct coagulopathy, IV octreotide to lower portal pressure
(if bleeding continues, repeat banding; if more, TIPS or gastric balloon tamponade)
Pathophys of ascites in cirrhosis?
portal HTN + hypoalbuminemia
Hepatic encephalopathy:
pathophys?
presentation?
tx?
↓NH4 metabolism → ↑NH4 → CNS toxicity
∆MS, asterixis, rigidity, hyperreflexia, fetor hepaticus
lactulose (prevents NH4 absorption) + neomycin (kills GI flora that make NH4) + low • protein diet
Hepatorenal syndrome:
pathophys?
tx?
end-stage liver dz → renal vx vaso-constriction → progressive renal failure (despite normal kidneys)
Tx liver txp
Spontaneous bacterial peritonitis (SBP) =
presentation?
dx?
tx?
infx of ascitic fluid → abd pain, fever, n/v, rebound tenderness
Dx paracentesis (↑WBC)
Tx IV abx + repeat paracentesis in 2-3 days
Hyperestrinism in cirrhosis is a/w:
↓estrogen metabolism → ↑estrogen → spider angiomas, palmar erythema, gynecomastia, testicular atrophy
Wilson’s disease:
dx?
tx?
Dx ↓ceruloplasmin, ↑AST/ALT, liver bx
Tx D-penicillamine (copper chelating agent) + zinc (copper uptake competition)
Hemochromatosis:
dx?
Dx ↑ferritin, ↓TIBC, liver bx
Hepatic adenoma: presentation? dx? tx? a/w...
usually asx, can present as hypovolemic shock and distended abdomen if ruptured
Dx CT scan or U/S
Tx d/c OCP, if it persists → resection due to possibility of rupture
a/w OCP and anabolic steroid use
Cavernous hemangioma:
dx?
tx?
etiology?
Dx CT scan or U/S
reassurance
VAT – vinyl chloride, aflatoxin, thorotrast
(MC benign liver tumor)
Focal nodular hyperplasia: what will imaging show?
CT scan = central stellate scar or sunburst pattern
Hepatocellular carcinoma:
presentation?
dx?
tx?
vague RUQ pain and mass + s/sx of chronic liver dz (portal HTN, ascites, jaundice)
Dx CT scan, ↑αFP
Tx resection w/ negative margins (as long as there’s no mets)
Gilbert’s disease:
pathophys?
presentation?
AD ∆UDP-glucuronyltransferase  
usually asx, but can present w/ mild jaundice after fasting
Hemobilia:
pathophys/presentation?
dx?
tx?
injury to liver or biliary tract → blood drains into duodenum via CBD → UGIB, jaundice, RUQ pain
Dx arteriogram (gold std); EGD shows bleeding from ampulla of Vater
Tx supportive care, stop bleeding if severe
Hydatid cysts: tx?
inject hypertonic saline inside cyst and • carefully excise it + post-op mebendazole
Budd-Chiari syndrome:
pathophys/presentation?
tx?
mcc?
occlusion of hepatic vein outflow → hepatic congestion + portal HTN → hepatomegaly, RUQ pain, ascites, jaundice
Transjugular Intrahepatic Portosystemic Shunt (TIPS) as a bridge to liver transplant
polycythemia vera
 ↑AST/ALT (ALT>AST) =
chronic viral hepatitis (virALT)
↑AST/ALT (AST>ALT) =
acute alcoholic hepatitis (toAST)
↑↑AST/ALT =
acute viral hepatitis
↑↑↑AST/ALT =
severe hepatic necrosis
↑AlkP + GGT nl =
pregnancy or bone dz (e.g. Paget’s)
↑AlkPhos + ↑GGT =
biliary obstruction
Etiology of…
↑bilirubin (conjugated 50%) =
↑bilirubin (conjugated 50%): obstructive jaundice (cancer, choledocholithiasis)
