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Clinical medicine > Liver diseases > Flashcards

Liver diseases Flashcards

1
Q

Signs of liver disease

A

palmar erythema, clubbing, flapping tremor, jaundice, spider angioma, gynecomastia, scant body hair, scratch marks, ascities, hepatomegaly, caput medusa, hemorrhoids, small testies

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2
Q

Liver disease tests

A

ALT, AST, alkaline phosphatase, bilirubin

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3
Q

less than 5x normal elevation, ALT

A

chronic heb B/C, acute A-E, EBV, CMV, steatosis, hemochromatosis, medications, toxins, autoimmune hepatitis, alpha-1-antitrypsin, wilson disease, celiac disease

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4
Q

Liver function tests

A

ALT, AST, alkaline phosphatase, bilirubin

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5
Q

ALT and AST

A

enzymes found in hepatocytes, released when liver is damaged, ALT specific for liver, AST also in skeletal and cardiac

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6
Q

less than 5x normal elevation, ALT

A

chronic heb B/C, acute A-E, EBV, CMV, steatosis, hemochromatosis, medications, toxins, autoimmune hepatitis, alpha-1-antitrypsin, wilson disease, celiac disease

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7
Q

less than 5 x normal elevation, AST

A

alcohol related, steatosis, cirrhosis

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8
Q

less than 5x normal elevation non-hepatic source

A

hemolysis, myopathy, thyroid disease, strenuous exerise

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9
Q

greater than 15 x AST/ALT

A

acute viral hepatitis, ischemic hepatitis, sepsis, hemorrhage, MI, autoimmune hepatitis, wilson disease, acute bile duct obstr, hepatic artery ligation, Budd-Chiari syndrome, toxins

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10
Q

Alkaline phosphatase

A

hepatocytes that line bile canaliculi, level raised in biliary obstruction, also in bone and placenta

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11
Q

Bilirubin

A

water insoluble product of heme metabolism, reticuloendothelial cells in spleen, liver and bone marrow produce, taken up by liver and conjugated to become water soluble

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12
Q

Common causes of jaundice

A

increase destruction of RBS, high free bilirubin in plasma, high urobilinogen in urine, obstruction of bile duct or damage to liver cells

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13
Q

Tests of liver function

A

prothrombin time/ INR, albumin

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14
Q

Prothrombin time/ INR

A

measure of VIt K dependent clotting factors, liver activates vit k so if clotting factors not produced liver is damaged

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15
Q

Hepatitis A

A

RNA virus, fecal oral, incubate 15-50 days, anti hepatitis A IgM, treat/prevent vaccine, immune serum globulin, good prognosis

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16
Q

Hepatocellular disease

A

increased transaminases, viral hep, drugs, alcohol, autoimmune, NASH, hemochromatosis

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17
Q

Cholestatic disease

A

increased alk phos/ bilirubin, maybe transaminases; gallstones, primary biliary cirrhosis, sclerosing cholangitis, pancreatic cancer

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18
Q

Acute vs chronic viral hepatitis

A

acute has IgM antibodies, chronic has IgG antibodies

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19
Q

Hepatitis A

A

RNA virus, fecal oral, incubate 15-50 days, anti hepatitis A IgM

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20
Q

Hepatitis B

A

DNA virus, surface and core, can present with arthralgias, glomerulonephritis, urticaria, parenteral or sexual route, bodies rxn to virus not vice versa

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21
Q

Hep B Immunized or previously exposed pt have

A

negative HBsAG and positive IgG antiHBcore

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22
Q

Hepatitis C

A

RNA virus, blood born, IV drug and blood transfusion, anti HCV antibody, 85% develop chronic

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23
Q

Complications of Hep C

A

cirrhosis, hepatocellular carcinoma (1-4% per year), cryoglobulinemia, prophyria cutanea tarda, alcohol increases risk

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24
Q

Management of Hep C

A

interferon alpha w/ ribavirin for 6-12 months clears virus ~40% pt

25
Q

Hepatitis E

A

acute hepatitis just like Hep A unless pregnant in which can progress to fulminant hepatitis

26
Q

What can cause acute hepatitis in immunocompromised?

A

EBV, CMV, Herpes

27
Q

Autoimmune liver diseases

A

autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis

28
Q

Autoimmune hepatitis

A

ANA postive, ant smooth muscle +, high bilirubin and ALT, norm Alk phos, necrosis w/ lymphocyte infiltration, treat with immunosupression/ liver transplant

29
Q

Primary sclerosing cholangitis symptoms

A

high bilirubin, high alk phos, neg antimitochondrial ab, jaundice, pruritis abdo pain and fatigue

30
Q

Primary biliary cirrhosis

A

inc Alk Phos and antimitochondrial antibodies +, damage to intralobular bile ducts by chronic granulomatous inflammation, unable to excrete bile

31
Q

Symptoms of primary biliary cirrhosis

A

malabsorption of fat soluble vits, lethargy, itching, hyperlipidemia

32
Q

Primary sclerosing cholangitis

A

inflammation, fibrosis, strictures of biliary tree causing beaded biliary tree on ERCP, leads to cirrhosis, mng w/ steroids, cholesyramine or ursodeoxycholic acid, liver transplant

33
Q

Non-alcoholic steatohepatitis

A

common cause of elevated LFT, pt have metabolic syndrome, progress to cirrhosis, treat by weight loss, control of lipids and diabetes

34
Q

Genetic liver disease

A

Wilson, hemochromatosis, alpha-a-antitrypsin deficiency

35
Q

Hemochromatosis

A

autosomal recessive, chromosome 6, increase Fe abs

36
Q

Symptoms of hemochromatosis

A

Bronze diabetes, artralgias, hepatosplenomegally, testicular atrophy, heart failure, high Fe and ferritin, low TIBC, low testosterone, diabetic, chondrocalcinosis

37
Q

Wilson Disease

A

autosomal recessive, chromosome 13, defective intrahepatic formation of ceruloplasmin, failure of biliary excretion and high total body and tissue level of Cu

38
Q

Wilson disease symptoms

A

high urinary Cu, cirrhosis, Kaiser-Fleischer rings, hypoparathyroidism, arthropathy, Fanconi syndrom, psychosis, mental retardation, seizures

39
Q

Treatment of wilson disease

A

copper chelation with penicillamine, can cure with liver transplant but CNS sequalae will not resolve

40
Q

Cirrhosis complications

A

portal htn causing variceal bleeding, splenomegally causing low platelets, ascites, encephalopathy, hepatorenal syndrome

41
Q

4 stages of cirrhosis

A

liver cell necrosis, inflammatory cell infiltrate, fibrosis, nodular regeneration

42
Q

Causes of cirrhosis

A

alcohol, viral B/C, cryptogenic, primary biliary cirrhosis, hemochromatosis, wilsons, alpha 1 antitrypsin, autoimmune, sclerosing cholangitis

43
Q

Cirrhosis complications

A

portal htn causing variceal bleeding, splenomegally causing low platelets, ascites, encephalopathy, hepatorenal syndrome

44
Q

Ascites

A

accumulation of free fluid in peritoneum, assessment involves taking sample of fluid and checking albumin content, SAAG (ascites albumin-serum albumin)

45
Q

SAAG >1.1,

A

> 1.1 portal hypertension, cirrhosis, alcoholic, CHF, hepatic mets

46
Q

Management of ascites

A

salt restriction, fluid restriction, diuretics, large volume paracentesis

47
Q

Variceal hemorrhage

A

varices in esophagogastric junction due to portal htn, BB reduce pressure and may prevent rebleeds, serial endoscopy and banding to obliterate varices also preventative

48
Q

Spontaneous bacterial peritonitis

A

10-20% cirrhotic pts w/ ascities, cell ct and culture of ascitic fluid should be performed in all pts, PMN >250 is diagnositic

49
Q

Acute pancreatitis

A

abrupt, deep epigastric pain, rad to back, hx of previous related to alcohol, or biliary tract disease, obstruction of ampulla of vater, or direct injury

50
Q

Encephalopathy

A

dec consciousness in pt w/ severe liver disease, always look for cause, usually inc serum ammonia, treat with lactulose

51
Q

Childs-pugh classification

A

used to determine how risky surgery will be based on bilirubin, albumin, ptt, ascites, and encephalopathy

52
Q

Acute pancreatitis

A

abrupt, deep epigastric pain, rad to back, hx of previous related to alcohol, nausea, vomiting, sweating, weakness, abd tenderness, distention and fever

53
Q

Acute pancreatitis exam and labs

A

UQ pain, often w/out gaurding, rigidity, or rebound, leukocytosis, elevated serum amylase, elevated serum lipase

54
Q

Acute pancreatitis symptoms

A

nausea, vomiting, sweating, weakness, abd tenderness, distention, and fever

55
Q

Ranson criteria

A

used to predict severity of acute pancreatitis, based on age, WBC, glucose, lactate dehydrogenase, hematocrit, calcium, BUN, pO2, fluid sequestation

56
Q

Pancreatic necrosis

A

elevated serum creatinine level at 48 hrs

57
Q

Imaging of acute pancreatitis

A

ultrasonography not helpful, unenhanced CT is useful for demonstrating enlarge pancreas when uncertain

58
Q

Management of pancreatitis

A

oral intake of fluids and foods resumed when pt largely free of pain and has bowel sounds, clear liq given at first, followed by gradual advancement to low fat diet, guided by pts tolerance and absence of pain

Clinical medicine (19 decks)

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