Flashcards in Liver Diseases CIS Deck (69):
-ALT and AST
IgM and IgG
liver fxn tests
PT and serum albumin
ascites- caused by? risk factors?
-portal HTN from chron liver dz
-ETOH, transfusions, tattoos, IVDU, viral hepatitis
fatty liver (hepatic steatosis)- caused by
-alcoholic related fatty liver dz
NAFLD- sx, etiology
-usually asymptomatic- RUQ pain, hepatoemgaly
-obesity, DM, hypertriglyceridemia, metabolcic syndrome
-coffee reduces risk of fibrosis and cirrhosis
-protective- physical activity
-NASH (nonalcoholic steatohepatitis)- macrovesicular steatosis and focal infiltration by PMN's and Mallory hylain
NAFLD- imaging, tx
-US- can see macrovascular steatosis
-liver bx- diagnostic
-tx- weight loss, dietary fat restriction, exercise, vit E, gastric bypass
do what test for ascites?
if abd pain, ascites, and fever- must rule out what? via?
spontaneous bacterial peritonitis
-via Paracentesis!!- run WBC count with differential!
-if malnourished- run adenosine deaminase- for tb!!
spontaneous bacterial peritonitis- caused by? presentation?
-ascitic fluid infection w/o an apparent source
-translocation of gut bacteria- gram neg (E coli or Klebsiella) or gram + (strep pneumo, viridans, enterococcus)
-10-20% of known cirrhotic pts- present with decompensation- encephalopathy, fever, abd pain, worsening renal fxn!!!!
spontaneous bacterial peritonitis- lab test
-paracentesis- WBC count with diff
-PMN > 250 with 75% of all white cells!!!- highly suggestive
-if elevated WBC count and lymphocyte predominance- think TB or peritoneal carcinomatosis
-serum albumin - ascitic fluid albumin
->1.1 = a portal HTN cause
-<1.1= non portal HTN cause!!
causes for ascites
Portal HTN (SAAG >1.1)- most common
-portal v occlusion
Hypoalbuminemia (SAAG <1.1)
alcoholic- follow up for?
EGD- esophageal varices
Hepatitis A- Dx, Tx
-inc aminotransferases- inc Alk phos and bilirubin
-fecal-oral transmission- international travel is a risk factor!!
-Dx- IgM anti-HAV
-Tx- self limited
Had Hep A but not anymore
Had Hep C but not anymore
-Anti-HCV with neg HCV RNA
acute HBV infection- window period
-b/w HBsAg disappearing and HBsAb appearing
-only detectable with HBcAb IgM
*important for screening blood donations
-acute or chronic
-inc aminotransferases- elevated Alk phos and billirubin
-transmitted- infected blood, sexual contract, mother to baby at delivery!!- asia!
Acute HBV- presentation
-asymptomatic-> fulminant dz and death (<1%)
-aminotransferase levels > HAV
-can become chronic
HBV- window period- lab
-Anti-HBc IgM +
HBV-Acute Infx- lab
-Anti-HBc IgM +
-HBV DNA +
HBV- prior infection- lab
-Anti-Bc IgG +
(ASIA- maternal transmission)
HBV- chronic infection- lab
-Anti-HBc IgM +
-Anti-HBc IgG +
-HBV DNA +
HBV- immunization- lab
Chronic HBV- where?
-90% of infants with maternal transmission
-risk of HCC and cirrhosis
HDV (delta agent)
-acute or chronic
-only in assoc with HBsAg
-immigrants from endemic areas
-50% by IV drug use
-risk factors- body piercing, tattoos, hemodialysis
-sexual and maternal-fetal transmission is LOW
-enzyme immunoassay for Anti-HCV
-confirmed by HCV RNA
-+anti-HCV in serum but neg HCV RNA = recovery from past infection
-lichen planus, autoimmune thyroiditis, idiopathic pulm fibrosis
-inc risk for Non-Hodgkin lymphoma!
-HCV genotype 3- hepatic steatosis
-dec in serum chol and LDL
-cirrhosis and HCC
-screen ppl born b/w 1945-1965
-vaccinate against HAV and HBV
-check for co infection with HBV and HIV
-safe sex practice
Chronic HCV- cirrhosis progression inc in?
-after 20 yrs of dz
-drink > 50g of ETOH daily
-acquire infx after 40 yo
-tobacco and cannabis smoking
*Af Am- higher rate of chronic HCV but lower fibrosis
-coffee- slows progression
-risk of cirrhosis and HCC
-HCV is curable!
HEV- in who? dx?
-acute hepatitis in Asia, Africa
-waterborne- pets, swine
-transplant recipients- those treated with tacrolimus!!!
-Dx- IgM anti-HEV
Acute Liver Failure- causes
-idosyncratic drug rxn
*risk inc with DM, outcome worse in the obese
acute liver failure- sx
-fulminant = hepatic encephalopathy within 8 wks and coagulopathy
-labs= severe hepatocellular damage!
-acetaminophen toxicity- AST/ALT > 5000
-ammonia level elevated- encephalopathy and intracranial HTN
-treat with NAC if in toxicity area
-get a 4 hr acetaminophen level!!
-empiric treatment if ingestion is unknown- acetylcysteine
Autoimmune hepatitis- who? labs?
-young-mid age women
-+ANA and/or smooth m AB (type I)
-Anti-LKM1 (type II)
-AST/ALT can be >1000
-inc risk of cirrhosis and HCC
Autoimmune hepatitis- tx
steroids +/- azathioprine
alcoholics- what vit def?
-thiamine (B1)- wernicke korsakoff syndrome
-encephalopathy- confusion, ataxia, involuntary abnormal eye movements
-syndrome- memory issues, confabulate/make up stories
Alcoholic Liver Disease- labs
-AST 2x > ALT
-when total bili > 10 and PTT > 6 sec = severe alk hep with 50% mortality; susceptible to infections
Alcoholic Liver Disease- effects
-dec platelets- direct effect on megakaryocytes prod or hypersplenism
-inc hepatic iron stores
-most common precursor to cirrhosis in US!
-risk of HCC
Alcoholic Liver Disease- Bx, Tx
-polymorphonuclear infiltration with hepatic necrosis (Mallory bodies) and perivenular/perisinusoidal fibrosis
-abstinence from alcohol!!
-nutritional support for anorectic pts- glucose admin increases the thiamine requirement!!
-6 month abstinence before liver transplant
Risk of alcoholic cirrhosis
->50 grams daily for over 10 yrs
Maddrey Discriminant function- used for?
-disease severity and mortality risk in pts with alcoholic hepatitis
->32 = high short-term mortality- may benefit from tx with glucocorticoids!!
Glascow alcoholic hepatitis score (GAH)
-predicts mortality in alcoholic hepatitis
->9 who received glucocorticoids- higher survival rates than those who didnt receive glucocorticoids!!
-no survival benefit with glucocorticoids <9
Cirrhosis- who? caused by? risk factors?
-fibrosis and regenerative nodules
-Mex Ams and Af Ams > whites
-causes- alcohol, chronic HCV, HBV, NAFLD, hemochromatosis
-risk factors- heavy alcohol use, obesity, iron overload
-coffee and tea consumption reduces risk
-methotrexate and vit A assoc with fibrosis and cirrhosis
-asymptomatic for a long time
-fatigue, disturbed sleep, m cramps, weight loss
-others- gynecomastia, spider telangiectasias, palmar erythema, dupuytren contractures, asterixis
-portal HTN- varices, ascites, hyperdynamic circulatory state
-liver insufficiency- cant syn albumin, coag factors, and cant excrete bilirubin
-macrocytic anemia- folic acid def, hemolysis (hypersplenism)
-dec WBC (hypersplenism)
-thrombocytopenia- marrow suppression, sepsis
-prolongation of prothrombin time
-elevation of AST, Alk phos, T bilirubin
-dec in albumin
-inc risk of DM!!
-vit D def
-US- liver size, ascites, nodules
-contrasted CT- nodules- biopsy
-fibrosure- low/high excludes/predicts advanced fibrosis
-detect varices or causes of bleeding in esophagus, stomach, duodenum
-Upper Gi bleeding- portal HTN gastropathy, gastroduodenal ulcer, varices
-SBP (spontaneous bacterial peritonitis)
Ascites- caused by?
-secondary to portal HTN!
-found in 50% of pts with cirrhosis
-1/3 will develop upper GI bleeding
-upper endoscopy- dx!
Child Pugh score
estimates cirrhosis severity!
-ascites, encephalopathy, bilirubin, albumin, PT time
-Class A- 5-6
-class B- 7-9
-Class C- 10-15
(model for end-stage liver dz)
-predict survival in pts with cirrhosis
-serum bilirubin, creatinine, INR
-inc of 2 in first wk- predict in-hospital mortality
PBC (primary biliary cholangitis)- lab, assoc with? risk factors? tx
-autoimmune destruction of small intrahepatic bile ducts and cholestasis
-isolated elevated Alk phos!!!
-IgM elevated, inc chol
-assoc HLA DRB1 and DQB1
-asoc with Sjogren, autoimmune thyroid, raynaud, scleroderma, celiac
-risk factors- smoking
-TX- ursodeoxycholic acid
Absorption- colon, duodenum, ileum
-ileum- vit B12, bile salts
Hemochromatosis- caused by?
-HFE mutation- C282Y
-iron accum- liver, pancreas, heart, adrenals, testes, pituitary, kidneys
-usually not until fifth decade!!
-cirrhosis, HF, hypogonadism, arthritis, skin pigmentation, DM
-avoid food rich in iron (Red meat), alcohol, vit C, raw shellfish, supplemental iron
-PPI- reduces intestinal iron abs
-Deferoxamine- chelating agent
Wilson disease- sx, tx
-autosomal recessive, <40
-copper deposition- brain, kidney, liver
-tx- oral penicillamine, liver transplant
Wilson dz- lab findings
-serum ceruloplasmin- low
-urinary excretion of copper- high
-hepatic copper- high
-RUQ pain, painful hepatic enlargement, ascites, HSCM, jaundice
-occlusion of hepatic v or ICV
-complicated by HCC!
-prominent caudate lobe!!
-screening- Doppler ultrasonography
-direct venography- "spider web" pattern!
-Bx- centrilobular congestion! (nutmeg liver)
assoc with oral contraception