What is the worst possible Child-Pughs score?
What survival does it correspond to?
10-15% after 5 years.
What is asterixis? What is it a consequence of?
How would you treat this?
Flapping tremor of the hand upon wrist extension or gripping. A consequence of hepatic encephalopathy.
Treated with lactulose (trap ammonia, kill bacteria, clear them)
A chronic liver disease patient presents with a pleural effusion. What are two possible causes for this?
Which is more likely if this is unilateral?
Hepatopulmonary syndrome, hepatic hydrothorax (ascites spread through the diaphragm).
Hepatic hydrothorax presents often with right-sided unilateral effusion.
What two diagnostic criteria make for a hepatocellular carcinoma diagnosis?
Positive imaging for a lesion and an alpha-fetoprotein of >200.
What are the Milan criteria?
Criteria to determine if a patient with HCC is eligible for liver transplant.
Patients must have either one cancerous lesion <5cm or 2-3 with non exceeding 3cm.
What is the benefit of transarterial chemoembolization?
What can it be used for?
This procedure directs a payload of chemotherapy or radiation to a hepatic site, plugging up the artery it travels through to prevent backwash of the hazardous treatment.
Why should radiofrequency ablation be done away from bile ducts?
Away from vasculature?
It may burn bile ducts.
Vessels act as heatsinks, reducing efficacy.
What is the significance of osmotic diarrhea?
Indicates incomplete absorption of lumenal contents.
Indicates failed fat absorption; could be due to loss of bile or pancreatic lipase.
What genetic tests can be done to narrow a pancreatitis differential down?
Look at trypsin inhibitor genes (SPINK1, CFTR, PRSS1)
What could early satiety indicate?
(ignoring esophageal & gastric pathologies)
Mass effect due to pancreatic mass (cyst, pseudocyst, or tumor).
What makes pseudocysts "pseudo"?
They are not bound by an epithelium, and are therefore not true cysts.
What lab signs can indicate a pancreatic adenocarcinoma?
What imaging signs?
Labs: Increased carbonic anhydrase 19-9
Imaging: Besides a large honking mass, look for the "double-duct" sign.
Why are DVTs seen in pancreatic adenocarcinomas?
Any cancer can cause hypercoagulable state (by consuming anticoagulant factors or upregulating procoagulant factors)
How is a case of acute pancreatitis treated?
Supportive only! Give fluids, pain management, and (presumably parenteral) nutrition. Antibiotics if needed.
What is the most common infectious cause of hepatocellular carcinoma in the western world?
How can it be treated?
Hepatitis C infection.
ALCOHOL ABSTINENCE, pegylated interferon, and antivirals (eg ribavirin)