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DU PA Liver Disease

Duke PA Liver Disease

product of heme metabolism bilirubin
__ bilirubin is water insoluble unconjugated
__ bilirubin is bound to glucuronic acid and is therefore water soluble for elimination by the liver and kidney conjugated
increase in conjugated bilirubin is caused by obstruction of the outflow tract or in the liver
increase in uncomjuagated bilirubin is caused by hemolysis
progression to liver failure in less than 14 days in patient with no history of liver disease, develop coagulopathy (INR>2), encephalopathy fulminant liver disease
clinical symptoms of liver disease malaise/fatigue, jaundice, light stools, dark urine, pruritis, GI bleeding, confusion, edema, wt loss, loss of appetite, N/V, fever
flapping tremor of the hand, can be a sign of hepatic encephalopathy, thought to be related to abnormal ammonia metabolism asterixis
AST/ALT can be normal in __ cirrhosis
__ can be released by the liver, bone, intestinal tract, placenta, kidney alkaline phosphatase
what does the liver actualy make albumin, clotting factors
what are true liver function tests (this is not what everybody means when they say liver function tests) albumin, prothrombin time/INR
__ tests for hepatocellular carcinoma and inflammation- not 100% specific alpha fetoprotein (AFP)
you have to be infected with __ for hepatitis D to matter hepatitis B
no vaccine available for __ hepatitis C
__ is due to infected drinking water hepatitis E
source of __ is feces hepatitis A and E
source of __ is blood/body fluids hepatitis B, C, and D
non-chronic hepatitis A and E
chronic hepatitis B, C, and D
incubation period of hepatitis A is average 30 days
complications of hepatitis A fulminant hepatitis, cholestatic hepatitis
chronic sequelae of hepatitis A none
hepatitis A post exposure immunoglobulin should be given withing __ after exposure 14 days
hepatitis B incubation period average 60-90 days
major cause of hepatitis worldwide HBV
who should be vaccinated for HBV household members with HBV, sexual partners with HBV, health care workers, prisoners, travelers to endemic areas visiting for 6 months or longer
incubatino period of hepatitis C average 6-7 weeks
#1 indication for liver transplant hepatitis C
responsible for the cirrhosis epidemic hepatitis C
excellent screening test for chronic infection with hepatitis C antibody test
good test for acute hepatitis C infection HCV RNA test
liver biopsy is generally advisable for patients with __, although it should not be mandatory. hepatitis C
treatment for hepatitis C peginterferon alfa, ribavirin
peginterferon AE flu-like symptoms, depression/anxiety, thyroid dysfunction, bone marrow suppression
ribavirin AE hemolytic anemia
symptoms of acute alcoholic hepatitis jaundice, fever, anorexia, nausea
treatment for sever alcoholic hepatitis supportive care, steroids for 30 days, pentoxifylline for 30 days
how much alcohol does it take to induce alcoholic hepatitis 80gm/day for 20 years (eight beers, 1 liter wine, 1/2 pint spirits)
pathologic diagnosis of cirrhosis fibrosis, regerated nodules, vascular distortion
complications of cirrhosis hepatorenal syndrome, hepatoma, portal hypertension
signs of portal hypertension varices, ascites, encephalopathy, GI bleeding
varices-prevention beta blockers, edoscopic ligation, nitrates
ascites management salt restriction, fluid restriction, diuretic therapy (aldactone, lasix), Large Volume Paracentsis (LVP) with albumin replacement, TIPS for refractory ascites
signs of encephalopathy euphoria, confusion, asterixis, coma, ammonia
encephalopathy treatment R/O infection, correct electrolytes, lactulose, Neomycin, Rifaximin
#1 indication for liver transplant in US hepatitis C
NASH non-alcoholic steatohepatitis
histologic evidence of chronic ETOH liver disease without significant ETOH consumption NASH
treatment of NASH wt loss, control hyperglycemia, control hyperlipidemia, stop offending meds
key to characterization of liver mass imaging
3 major benign solid liver masses hemangioma, adenoma, focal nodular hyperplasia
most common benign tumor of the liver, increased growth associated with high estrogen states, most are small, asymptomatic and found incidentally hemangioma
rare benign tumor of the liver, associated with long term estrogen use, can rupture and bleed hepatic adenoma
second most common benign liver lesion focal nodular hyperplasia (FNH)
Created by: bwyche