Hepatobilliary Dz Flashcards by Alex Maxted

fibrosis → disruption of liver
architecture → portal HTN +
impaired biosynthetic function
→ multiple complications

How to make Dx?

chirrosis

liver biopsy

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WHat causes varices

portal HTN → dilated
veins in butt (hemorrhoids), gut
(esophageal varices), and caput
(caput medusae)

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Ppx against varicies

Beta blockers

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treatment for bleeding esophageal varicies

band the varices
correct coagulopathy
IV octreotide to lower portal pressure
→ if bleeding continues, repeat banding → if bleeding continues, TIPS or gastric balloon tamponade

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MC etiologies of chirrosis

alcohol > HBC and HCV

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What is Childs classifications?

stratifies risk of surgery in pts w/ liver failure:
measure 3 labs (albumin,
bilirubin, PT) and 3 clinical
findings (encephalopathy,
ascites, nutrition)

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pathophys of ascities

portal HTN + hypoalbuminemia –> fluid collection in abd cavity

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how to Dx and treat acites

Dx PE (shifting dullness, fluid wave) + paracentesis (to determine cause)

Tx salt restriction + loop diuretic

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pathophys of hepatic encephalopathy + s/s

Tx?

↓NH4 metabolism → ↑NH4 → CNS toxicity → ∆MS, asterixis,
rigidity, hyperreflexia, fetor
hepaticus

Tx lactulose (prevents NH4 absorption) + neomycin (kills GI flora that make NH4) + low protein diet

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pathyphys of hepatorenal syndrome + tx?

end stage liver dz → renal vein vasoconstriction → progressive
renal failure (despite normal
kidneys)

liver txp

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acites + abd pain, fever, n/v,
rebound tenderness

how to dx and tx?

apontaneous bacterial peritonitis

Dx paracentesis (↑WBC)
Tx IV abx + repeat paracentesis in 2-3 days

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Estrogen inc or dec in chirrosis? What are the consequences of this?

elevated E 2/2 to dec E metabolism –> spider angiomas, palmar erythema, gynecomastia,
testicular atrophy

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treatment for coagulopathy in cirrhotics?

FFP transution (vit K wont work bc they cannot make clotting factors)

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consequence of AR ∆ceruloplasmin

wilsons disease = copper
accumulation in liver (cirrhosis),
corneas (Kayser-Fleischer rings),
brain (movement d/o), RBCs
(schistocytes)

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how to dx and treat wilsons dz

Dx ↓ceruloplasmin, ↑AST/ALT, liver bx

Tx D-penicillamine (copper chelating agent) + zinc (copper uptake competition)

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(cirrhosis), heart (restrictive
CM), joints (arthritis), skin
(bronze suntan), pancreas (DM

hemachromatosis

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how to dx and treat hemachromatosis

Dx ↑ferritin, ↓TIBC, liver bx

* Tx repeated phlebotomies

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etiology of 1/1 vs 2/2 hemachromatosis

1° hemochromatosis: AR dz that ↑GI iron absorption
2° hemochromatosis: ↑iron 2/2
multiple transfusions or chronic
hemolytic anemia

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anabolic steroids or OCP use + usually asx, can present as hypovolemic shock and distended abdomen if ruptured

hepatic adenoma

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how is hepatic adenoma dx and treated

Dx CT scan or U/S

* Tx d/c OCP, if it persists → Tx resection due to possibility of rupture

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MC benign liver tumor

cavernous hemangioma

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what are etiologies od a cavernous hemangioma

VAT –
vinyl chloride
aflatoxin
thorotrast

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CT scan with central stellate scar or sunburst pattern in liver

tx?

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focal nodular hyperplasia

reassurance

ague RUQ pain and mass +
s/sx of chronic liver dz (portal
HTN, ascites, jaundice)

Dx? Tx?

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HCC

Dx with CT scan and inc aFP
Tx is resection as long as it has not spread

etiologies a/w HCC

cirrhosis (MCC), A1AT deficiency, hemochromatosis, Wilson dz, smoking, chemical carcinogens

fatty liver in a nonalcoholic pt, | usually asx with mild elevated ALT and AST

NASH

usually asx, but can present w/ mild jaundice after fasting + pathophys and treatment

Gilberts = AD ∆UDP-glucuronyltransferase --> elevated unconjugated/indirect bili bc there is dec enzyme that conjegates bili reassurance

What is hemobilia how is it dz and 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

What can cause hemobilia?

trauma (MCC), surgery (CBD exploration), tumors, infx

cyst in liver, what is on differential

1. ADPKD 2. hydatid cysts (Echinococcus granulosus (dog tapeworm) → multilocular cyst w/ calcified walls)

treatment for hydatid cyst

Tx inject hypertonic saline inside cyst and | • carefully excise it + post-op mebendazole

how do liver abcess prsent? tx?

fever, RUQ pain, jaundice multiple/small bacterial abscesses → Tx IV abx single/large bacterial abscess → Tx perc drain amebic abscess (in Mexicans) → Tx Flagyl

What is budd chiari syndrome? tx? etiology?

occlusion of hepatic vein outflow → hepatic congestion + portal HTN → hepatomegaly, RUQ pain, ascites, jaundice Tx TIPS as a “bridge to liver txp” Etiology: polycythemia vera (MCC), OCPs (#2)

↑AST/ALT (ALT>AST): ? ↑AST/ALT (AST>ALT): ? ↑↑AST/ALT: ? ↑↑↑AST/ALT: ? ↑AΦ + GGT nl: ? ↑AΦ + ↑GGT: ?

↑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 ↑AΦ + GGT nl: pregnancy or bone dz (e.g. Paget’s) ↑AΦ + ↑GGT: biliary obstruction

↑bilirubin (conjugated 50%): ?

↑bilirubin (conjugated 50%): obstructive jaundice (cancer, choledocholithiasis)

↓albumin: ?

chronic liver dz, nephrotic syndrome, malnutrition, inflammatory states

How are gallstones worked up?

US then get HIDA if inconclusive ERCP if choledocholithiasis/acute cholangitis

What is Boas sign?

referred right scapular pain of biliary colic

What is charcot triad?

RUQ pain Fever Jaundice

What is reynold's pentad

RUQ pain Fever Jaundice change in MS hypotension

what is acute cholangitis

stone in CBD + infection

what is gallstone pancreatitis tx

impacted stone in pancreatic duct --> reflux of pancreatic enzymes --> mid epigastric pain if amylase returns to normal → Tx lap chole if amylase elevated → ERCP to remove stone

what is billiary colic? tx?

cholelithiasis → RUQ pain after fatty meals ± n/v elective lap chole

tx for choledocholithiasis

Tx NPO, IVF, ±abx → ERCP to remove stone

where is stone in acute cholecystitis? tx?

cystic duct Tx NPO, IVF, abx → lap chole within 24 hrs

who usually gets acalculous cholecystitis tx?

ICU pts Tx NPO, IVF, abx → lap chole within 24 hrs; perc drain w/ cholecystostomy if nonsurgical candidate

what is porcelin GB? Why is it significant?

dystrophic calcification of GB has 50% risk of adenocarcinoma, take it out

What is gallstone ileus

gallstone enters bowel through cholecystenteric fistula → gets stuck in terminal ileum → SBO

thickening of bile duct walls → narrowed lumens → gradual jaundice and pruritus → liver failure, cirrhosis, portal HTN How is it Dx? Tx? Etiology?

1° sclerosing cholangitis (PSC) • Dx ERCP (beading of bile ducts) • Tx cholestyramine (helps w/ pruritus), liver txp (definitive) • Etiology: idiopathic, but highly associated w/ UC

destruction of intra-hepatic bile ducts → gradual jaundice and pruritus → liver failure, cirrhosis, portal HTN Dx? Tx?

1° biliary cirrhosis (PBC) Dx screen w/ AMA (anti-mitochondrial ab), confirm w/ liver bx Tx ursodeoxycholic acid

what can cause 2° biliary cirrhosis?

(progressive cirrhosis 2/2 to biliary obst) sclerosing cholangitis, cystic fibrosis, biliary atresia

tumor of bile ducts → s/sx of obstructive jaundice (dark urine, clay stools, pruritus) how to make dx? tx? etiologies?

cholangiocarcinoma dx with ERCP Tx whipple if resectable etiologies: PSC (MCC US), Chlonorchis sinensis (MCC China)

What is Klatskin tumor?

tumor of proximal 1/3 of CBD, poor px since it’s not resectable

What are choledocal cysts and how do they present? How are they Dx and tx?

cystic dilation of biliary tree → RUQ mass/pain, jaundice, fever dx with ERCP Tx with resection

iatrogenic injury → s/sx of obstructive jaundice (dark urine, clay stools, pruritus) Dx? Tx? complications?

billiary stricture Dx with ERCP Tx endoscopic stent > surgical bypass complications = 2° biliary cirrhosis, acute cholangitis, liver abscess

pathophys and presentaion of billiary dyskinesia dx? tx?

motor dysfxn of sphincter of Oddi → recurrent biliary colic w/o stones HIDA scan (fill up GB w/ contrast and give CCK to determine ejection fraction) lap chole

Hepatobilliary Dz Flashcards

(56 cards)