Non-viral liver disease Flashcards Preview

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Flashcards in Non-viral liver disease Deck (31):
1

NAFLD: stage 1

- fatty liver
- steatosis

2

NAFLD: stage 2

- fatty liver with inflammation
- NASH

3

NAFLD: stage 3

- NASH with septal fibrosis

4

NAFLD: stage 4

- cirrhosis

5

clinical sequelae associated with NAFLD

- insulin resistance and type II DM

6

treatments for NAFLD

- 10% weight loss at 1-2 pounds per week
- gemfibrozil - lower TGs and FAs
- vitamin E- antioxidant effect
- metformin - decrease insulin resistance

7

genetic screening for hemochromatosis

- if two 282Y genes or 1 282Y and 1 H63D then you have the disease

8

clinical sequelae of hemochromatosis

- arthritis in MCP joins, "bronze diabetes"
- worse with EtOH or HCV

- more risk for cancer than with wilsons

9

iron stores associated with hemochromatosis

- normal iron is 4 gms
- hemochromatosis can get to 15-40

10

diagnosis of hemochromatosis

- iron saturation: >60% men and >50% women
- ferritin 500-6000 ng/ml
- liver biopsy is gold standard with iron circulation of iron index, if 1.9 - then disease present
- CT: liver is white
- MRI: liver is black

11

treatment for hemochromatosis

- phlebotomy
- if cant tolerate, use deferoxamine

12

chronic autoimmune hepatitis antibodies

- type 1: ANA, Anti-SMA P-ANCA antibodies

- common in celiac disease, anti-IgA antibodies will be present

13

chronic autoimmune hepatitis diagnosis

- interface hepatitis on biopsy
- increased globulins to >3, usually IgG
- autoantibodies present

- may be false positive HCV by ELISA II due to hypergammaglobulinemia

14

diagnosis of wilsons

- high index of suspicion
- low ceruloplasmin
- Kayser-Fleischer rings

15

symptoms of wilsons

- hemolysis
- Parkinsons rigidity
- tremor
- osteopenia
- sunflower cataracts

16

treatment for wilsons

- D-penicillamine

17

diseases cured with liver transplant

- wilsons
- A1AT

18

lab tests normally elevated in pregnancy

- alkaline phosphatase
- AST and ALT within normal range
- GGTP unchanged or decreased

19

protein changes during pregnancy

- albumin, antithrombin III, hatoglobin decrease
- ceruloplasmin, fibrinogen, TBG, CSBG and transferrin increase

20

biliary changes during pregnancy

- bilirubin increased
- bile salts normal

21

normal PE during pregnancy

- liver is not palpable
- spider angioma and palmar erythema common due to estrogen

22

acute viral hepatitis

- 17% mortality with hepatitis E

23

intrahepatic cholestasis of pregnancy

- pruritus
- usually 3rd trimester
- begins on palms and soles and works proximally
- cholestasis, occasional jaundice, abdominal pain

24

acute fatty liver of pregnancy

- only in 3rd trimester
- N/V, fatigue, malaise, vomiting
- jaundice, encephalopathy, bleeding
- DIC is common

25

pre-eclampsia

- HTN with proteinuria and edema in 5-10% of pregnancies

26

eclampsia

- pre-eclampsia findings + seizure (possibly renal failure, coagulopathy, hemolytic anemia)

27

HELLP syndrome

- hemolysis, elevated liver enzynes, low platelets
- may be severe form of eclampsia

28

hyperemesis gravidarum

- 1st trimester
- jaundice, dark urine, occasional prurutis
- hyperbilirubinemia, transaminase 2-3X normal
- liver disease most likely secondary to dehydration or malnutrition

29

treatment of hyperemesis gravidarum

- control the emesis
- fluid and electrolyte balance

30

labs in intrahepatic cholestasis of pregnancy

- transaminases 2-10X normal
- bile acids 100X normal

31

labs in acute fatty liver of pregnancy

- hyperbilirubinemia
- increased alkaline phosphate
- mildly increased transaminases
- leukocytosis