Flashcards in Noninfectious Hepatobiliary Disease Deck (45)
What are the three "patterns" to think of when evaluating elevated liver function tests?
1) Hepatocellular pattern
3) Cholestatic pattern
What tests truly test the function of the liver?
What enzymes are used in the evaluation of the liver?
What is the most important part of the evaluation of a patient with elevated LFTs?
What is a prominent feature of patients with long-standing alcoholic liver disease?
Temporal and proximal muscle wasting
What does a Virchow's node or Sister Mary Joseph's nodule suggest?
What does JVD suggest?
When are right pleural effusions seen?
What is the hepatocellular pattern of elevated LFTs?
What are the common diseases that cause the hepatocellular pattern of elevated LFTs?
What is the enzyme pattern that is specific for alcoholic liver disease?
AST greater than ALT (2:1)
What is the effect of alcohol on GGT?
Alcohol induces GGT
What does an AST greater than 300 indicate?
An additional problem in addition to alcoholism
What is the difference between alcoholic hepatitis and cirrhosis?
- Cell injury and hepatocellular swelling
- Regenerative nodules and fibrosis
What is the treatment for Alcoholic Liver Disease?
2) Liver transplant
Explain the etiology of ascites seen in alcoholic liver disease.
1) Cirrhosis causes portal HTN
2) Splanchnic vasodilation and renal vasoconstriction
3) RAA activated--Na+ and H20 retained
4) ADH secreted--retain water
What do you need to remember in terms of dietary and medication restriction in alcoholic liver disease?
1) Limit Na+ (water follows Na+)
2) No NSAIDs-- will shut down kidneys
What is the utility of the SAAR?
Determining the etiology of ascites
- SAAR greater than 1.1= portal HTN
- SAAR less than 1.1= NOT portal HTN
How do you treat ascites?
1) Na+ restriction
2) Spironolactone and Furosemide
4) TIPS procedure
What lab should you check in a patient with suspected hepatic enchalopathy?
How can hepatic encephalopathy be treated?
1) Treat the underlying cause
2) Titrate Lactulose, which changes the colonic pH
What is Spontaneous Bacterial Peritonitis?
Ascitic fluid infection
- Advanced cirrhosis
- Caused by gut flora overgrwoth (E.coli and Klebsiella)
How do you approach the management of SBP?
1) If you suspect, paracentesis
2) Measure ascitic neutrophils
3) Neutrophils greater than 250--start abx (Ceftiaxone)
What is the treatment of choice with a ruptured esophageal varice?
Endoscopy followed by:
1) Balloon tamponade
What is Hepatorenal Syndrome?
Acute renal failure in the face of underlying advanced liver disease
What is the utility of the discriminant function?
Determines the prognosis of alcoholic hepatitis
What does the discriminant function determine?
Determine whether or not to give PREDNISOLONE
What is the magic number for the discriminant function?
32--greater than 32 give PREDNISOLONE
When should you NOT give prednisolone?
2) GI Bleed