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GI 3 > Non-viral liver disease > Flashcards

Non-viral liver disease Flashcards

1
Q

NAFLD: stage 1

A
  • fatty liver

- steatosis

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2
Q

NAFLD: stage 2

A
  • fatty liver with inflammation

- NASH

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3
Q

NAFLD: stage 3

A
  • NASH with septal fibrosis
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4
Q

NAFLD: stage 4

A
  • cirrhosis
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5
Q

clinical sequelae associated with NAFLD

A
  • insulin resistance and type II DM
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6
Q

treatments for NAFLD

A
  • 10% weight loss at 1-2 pounds per week
  • gemfibrozil - lower TGs and FAs
  • vitamin E- antioxidant effect
  • metformin - decrease insulin resistance
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7
Q

genetic screening for hemochromatosis

A
  • if two 282Y genes or 1 282Y and 1 H63D then you have the disease
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8
Q

clinical sequelae of hemochromatosis

A
  • arthritis in MCP joins, “bronze diabetes”
  • worse with EtOH or HCV
  • more risk for cancer than with wilsons
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9
Q

iron stores associated with hemochromatosis

A
  • normal iron is 4 gms

- hemochromatosis can get to 15-40

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10
Q

diagnosis of hemochromatosis

A
  • 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
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11
Q

treatment for hemochromatosis

A
  • phlebotomy

- if cant tolerate, use deferoxamine

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12
Q

chronic autoimmune hepatitis antibodies

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

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

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13
Q

chronic autoimmune hepatitis diagnosis

A
  • interface hepatitis on biopsy
  • increased globulins to >3, usually IgG
  • autoantibodies present
  • may be false positive HCV by ELISA II due to hypergammaglobulinemia
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14
Q

diagnosis of wilsons

A
  • high index of suspicion
  • low ceruloplasmin
  • Kayser-Fleischer rings
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15
Q

symptoms of wilsons

A
  • hemolysis
  • Parkinsons rigidity
  • tremor
  • osteopenia
  • sunflower cataracts
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16
Q

treatment for wilsons

A
  • D-penicillamine
17
Q

diseases cured with liver transplant

A
  • wilsons

- A1AT

18
Q

lab tests normally elevated in pregnancy

A
  • alkaline phosphatase
  • AST and ALT within normal range
  • GGTP unchanged or decreased
19
Q

protein changes during pregnancy

A
  • albumin, antithrombin III, hatoglobin decrease

- ceruloplasmin, fibrinogen, TBG, CSBG and transferrin increase

20
Q

biliary changes during pregnancy

A
  • bilirubin increased

- bile salts normal

21
Q

normal PE during pregnancy

A
  • liver is not palpable

- spider angioma and palmar erythema common due to estrogen

22
Q

acute viral hepatitis

A
  • 17% mortality with hepatitis E
23
Q

intrahepatic cholestasis of pregnancy

A
  • pruritus
  • usually 3rd trimester
  • begins on palms and soles and works proximally
  • cholestasis, occasional jaundice, abdominal pain
24
Q

acute fatty liver of pregnancy

A
  • only in 3rd trimester
  • N/V, fatigue, malaise, vomiting
  • jaundice, encephalopathy, bleeding
  • DIC is common
25
Q

pre-eclampsia

A
  • HTN with proteinuria and edema in 5-10% of pregnancies
26
Q

eclampsia

A
  • pre-eclampsia findings + seizure (possibly renal failure, coagulopathy, hemolytic anemia)
27
Q

HELLP syndrome

A
  • hemolysis, elevated liver enzynes, low platelets

- may be severe form of eclampsia

28
Q

hyperemesis gravidarum

A
  • 1st trimester
  • jaundice, dark urine, occasional prurutis
  • hyperbilirubinemia, transaminase 2-3X normal
  • liver disease most likely secondary to dehydration or malnutrition
29
Q

treatment of hyperemesis gravidarum

A
  • control the emesis

- fluid and electrolyte balance

30
Q

labs in intrahepatic cholestasis of pregnancy

A
  • transaminases 2-10X normal

- bile acids 100X normal

31
Q

labs in acute fatty liver of pregnancy

A
  • hyperbilirubinemia
  • increased alkaline phosphate
  • mildly increased transaminases
  • leukocytosis

GI 3 (12 decks)

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