Liver disease

Question 1

What indicates hepatocellular injury?

Answer 1

AST/ALT elevation

Question 2

What is the lab pattern for cholestasis?

Answer 2

elevation in alkaline phosphatase, with or without increased bilirubin

Question 3

elevation in alkaline phosphatase, with or without increased bilirubin - what pattern of liver abnormality is this?

Answer 3

cholestasis. if there is no bilirubin elevation, confirm the alk phos is from the liver with elevated GGT or 5’nucleotidase

Question 4

pattern of labs for alcoholic hepatitis?

Answer 4

super high bilirubin.

AST more than double ALT. (ALT normally higher in other conditions.)

Question 5

pattern of labs for ischemic colitis?

Answer 5

extreme elevation of AST/ALT (in the 1000’s), after a severe drop in blood pressure.

Only other thing that causes such high elevations is acute hepatitis.

Question 6

T/F: AST/ALT levels corrrelate with level of liver injury.

Answer 6

FALSE

Question 7

2 most common diseases for mild hepatocellular injury (

Answer 7

• Non alcoholic fatty liver disease

- chronic viral hepatitis.

Question 8

DDx for cholestatic pattern liver disease

Answer 8

• primary biliary cholangitis (PBC)
• primary sclerosing cholangitis (PSC)
• drugs
• biliary obstruction
• infiltrative process (TB, amyloid)

Question 9

High bilirubin, slightly elevated alk phos. High DIRECT bilirubin component. Diagnosis?

Answer 9

-high direct bilirubin = sepsis!

Question 10

High bilirubin, slightly elevated alk phos. High INDIRECT bilirubin component. Diagnosis?

Answer 10

Gilbert’s syndrome or hemolysis.

Question 11

when should you tap /test ascites?

Answer 11

“the sun should never set on untapped ascites”

• confirm etiology or rule out infection.
• ANY evidence of clinical deterioration.

Question 12

T/F: coagulopathy is a contraindication to paracentesis of ascites, wait for PT/PTT to normalize before doing it.

Answer 12

FALSE. not a contraindication.

Question 13

tests to run on ascites paracentesis

Answer 13

• serum albumin vs. ascites album gradient (SAAG)

- CBC/diff (for infection)

Question 14

What SAAG (serum ascites-albumin gradient) means portal hypertension?

Answer 14

1.1 or above.

Question 15

how many PMNs in ascitic fluid is evidence of SBP - spontaneous bacterial peritonitis?

Answer 15

> 250

-cultures are negative 50% of the time, so you need to rely on the WBC count!!

Question 16

treatment for ;spontaneous bacterial peritonitis

Answer 16

cefotaxime and IV albumin

Question 17

treatment of ascites

Answer 17

• sodium restricted diet** = most importan
• spironolactone and furosemide (oral, NOT IV)
• fluid restriction not needed

Question 18

treatment of hepatic encephalopathy

Answer 18

identify and correct the precipitating cause!

-also, give lactulose and rifaximin

Question 19

what is the MELD score?

Answer 19

score based on the total bilirubin, prothrombin time, and the creatinine.
Predicts 3 month mortality for transplants

Question 20

signs of cirrhosis

Answer 20

• fatigue
• volume overload / ascites/edema
• nodular liver
• enlarged spleen

Question 21

T/F: People usually die of HCV-hepatitis within 10 years.

Answer 21

FALSE! cirrhosis is not a death sentence! In HCV hepatitis, 75% have NOT
decompensated by 10 years after diagnosis.

Question 22

what 3 blood tests should you do (in addition to hemoglobin/ MCV) if you are evaluating someone for blood loss in the gut?

Answer 22

• ferritin
• iron
• transferrin