Flashcards in Noninfectious Hepatobiliary Disease Deck (45):
1
What are the three "patterns" to think of when evaluating elevated liver function tests?
1) Hepatocellular pattern
2) Hyperbilirubinemia
3) Cholestatic pattern
2
What tests truly test the function of the liver?
INR
Albumin
3
What enzymes are used in the evaluation of the liver?
Aminotransferases
Alkaline phosphatase
GGT
4
What is the most important part of the evaluation of a patient with elevated LFTs?
History
5
What is a prominent feature of patients with long-standing alcoholic liver disease?
Temporal and proximal muscle wasting
6
What does a Virchow's node or Sister Mary Joseph's nodule suggest?
Abdominal malignancy
7
What does JVD suggest?
Hepatic congestion
8
When are right pleural effusions seen?
Advanced cirrhosis
9
What is the hepatocellular pattern of elevated LFTs?
Elevated aminotransferases
10
What are the common diseases that cause the hepatocellular pattern of elevated LFTs?
Alcohol
Hemachromatosis
Fatty Liver
Medications
Supplements
Viral Hepatitis
11
What is the enzyme pattern that is specific for alcoholic liver disease?
AST greater than ALT (2:1)
12
What is the effect of alcohol on GGT?
Alcohol induces GGT
13
What does an AST greater than 300 indicate?
An additional problem in addition to alcoholism
14
What is the difference between alcoholic hepatitis and cirrhosis?
Hepatitis:
- Cell injury and hepatocellular swelling
Cirrhosis:
- Regenerative nodules and fibrosis
15
What is the treatment for Alcoholic Liver Disease?
1) Abstinence
2) Liver transplant
16
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
17
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
18
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
19
How do you treat ascites?
1) Na+ restriction
2) Spironolactone and Furosemide
3) Paracentesis
4) TIPS procedure
20
What lab should you check in a patient with suspected hepatic enchalopathy?
Ammonia
21
How can hepatic encephalopathy be treated?
1) Treat the underlying cause
2) Titrate Lactulose, which changes the colonic pH
22
What is Spontaneous Bacterial Peritonitis?
Ascitic fluid infection
- Advanced cirrhosis
- Caused by gut flora overgrwoth (E.coli and Klebsiella)
23
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)
24
What is the treatment of choice with a ruptured esophageal varice?
Endoscopy followed by:
1) Balloon tamponade
2) TIPS
25
What is Hepatorenal Syndrome?
Acute renal failure in the face of underlying advanced liver disease
26
What is the utility of the discriminant function?
Determines the prognosis of alcoholic hepatitis
27
What does the discriminant function determine?
Determine whether or not to give PREDNISOLONE
28
What is the magic number for the discriminant function?
32--greater than 32 give PREDNISOLONE
29
When should you NOT give prednisolone?
1) Infection
2) GI Bleed
30
Describe the skin pigmentation seen in patients with Hemochromatosis?
"Gray" NOT bronze
31
What do patients with Hemochromatosis have an increased risk for?
Hepatocellular Carcinoma
32
What are the labs that are typical of Hemochromatosis?
- High serum iron
- High ferretin
- High transferrin
*Classically, the Transferrin saturation is greater than 45%
33
What is the liver enzyme elevation pattern seen in NAFLD?
ALT is higher than AST
34
What is the treatment for NAFLD?
1) Weight loss
2) Control of DM and hyperlipidemia
3) Low fat diet
4) Alcohol avoidance
35
What is the presentation that would lead you to consider Autoimmune Hepatitis?
- Young to middle aged woman
- Elevated tranaminases with no cause
36
How does Wilson's Disease typically present?
Adolesecent with neurologic or psychiatric dysfunction
37
What PE finding is a hallmark for Wilson's Disease?
Kayser-Fleischer rings
38
What lab finding is characteristic of Wilson's Disease?
Ceruloplasmin
39
What type of hyperbilirubinemia is seen in Gilbert Syndrome?
UCB
40
What is the typical presentation of Gilbert Syndrome?
1) Healthy young adult
2) Hyper-UCB
3) No evidence of hemolysis
41
What lab elevation is associated with the "Cholestatic pattern?"
ALP (and GGT)
42
If you have a UC patient with an elevated ALP, what diagnosis should come to mind?
Primary Sclerosing Cholangitis
43
What is pathogmnemonic for PSC on biopsy?
1) Beaded appearance of biliary ducts
2) Onion skin on liver biopsy
44
What patient population is PBC most commonly seen in?
Middle aged women
45