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Session 3 CM- GI-6

CM- GI-6- EtOH hepatitis

QuestionAnswer
What is the major site of drug metabolism in the body Liver
What are the main functions of the liver involved in metabolic functions of glucose, proteins, fats, bile, cholesterol, hormones and drug metabolism
what do the hexagonal shaped liver lobules form they are the structural and functional units of the liver made of hepatocytes with portal triads found at each of the six corners of each lobule
what do the portal triads consist of bile duct, hepatic artery, hepatic portal vein
what function do the hepatocytes carry out production of bile, process blood borne nutrients, store fat soluble vitamins and detoxification
This condition occurs w// macro vesicular infiltration of liver cells w/ triglycerides then neutrophilic infiltration leading to hepatocyte death Alcoholic Steatosis
How much alcohol needs to be consumed to cause liver disease 4-8 drinks daily for 10 yrs
What will your liver enzyme profile typically be in alcoholic hepatitis AST>ALT
What is the progression of s/sx w/ alcoholic hepatitis liver cell death, jaundice, loss of liver function and potentially development of Acute Liver Failure (ALF). If patient doesn't stop drinking after developing steatosis (fatty liver) they can progress to cirrhosis rapidly
What are contributing factors for developing alcoholic liver disease Women>Men, Poor diet/nutrition, Obesity, concurrent hepatitis C or B infection
what are the s/sx of alcoholic liver disease pruritis, nausea, vomiting, anorexia, fever, abdominal pain, agitation/anxiety due to ETOH withdrawal, confusion
What will you see in ACUTE alcoholic hepatitis s/sx Jaundice, Fever, Encephalopathy (severe Cases), seizures/tremors, tender hepatomegaly, splenomegaly
if pt has spider nevi, facial telangectasia, collateral veins on abdominal walls (caput medusa), portal venous bruits, esophageal varices, ascites, gynecomastia, testicular atrophy, palmer erythema, paroitd hypertrophy what do these s/sx corrolate with signs of advanced liver disease
How can you differentiate between alcoholic hep and viral hep ALT is preferentially increased in active hep C, biopsy will reveal cause, serology
What will help you differentiate between toxic/drug induced hep and ETOH hep history of exposure, abnormal LFTs, drugs can compound ETOH induced hepatitis such as acetaminophen
What is nonalcoholic steatohepatitis fat liver and inflammation w/ no hx of ETOH, important cause of cirrhosis and liver failure
What will you likely see on liver function test in nonETOH steatohepatitis ALT>AST, bilirubin normal, elevated serum ferritin,
What is nonalcoholic steatohepatitis associated with associated with noninsulin dependent diabetes, and hyperlipidemia
How can you tell hemochromatosis from other causes of hepatitis especially nonalcoholic steatohepatitis both have elevated serum ferritin, but NASH has more elevated ALT>AST than hemochromatosis, biopsy will have increased iron staining in hemochromatosis
What are s/sx of acute ETOH withdrawal tremor, nausea, sweating, irritability, auditory and visual hallucinations
What is Wernicke Korsakoff syndrome memory loss, confabulation, wide base gait, past pointing, opthalmoplegia, nystagmus, peripheral neuropathy (from malnutrition) and is associated with alcoholic hepatitis
What is fulminant hepatic failure pt develops impaired brain function within 8 weeks from increased intracranial pressure in previously healthy patient or one with unrecognized or stable liver dysfunction
Apart from affecting the liver what other areas of the body does ETOH abuse affect Can cause spontaneous bacterial peritonitis, malabsorption, pancreatitis, esophageal varices, endocrine problems- hypogonadism, impotence, gynecomastia, pseudo Cushing's, hypoglycemia, HTN, anemia
How does ETOH abuse cause spontaneous bacterial peritonitis poor nutrition plus direct effects of alcohol impairs mucosal barrier
If AST:ALT ratio is 2-3 what is the likely cause alcoholic hepatitis
Apart from liver disease what else can cause an elevation of AST that actually is false disorder of Cardiac, skeletal muscle, kidney, or hemolysis of specimen
What lab tests will you want to evaluate in liver disease AST:ALT, Bilirubin, Albumin, PT, glucose, sodium, CBC, Ammonia, liver biopsy (if called for), Abdominal ultrasound,
Why do you want to look at albumin when evaluating liver decreased albumin shows low protein synthesis of liver caused by inadequate nutrition or loss (common in ETOH liver problems)
Why would abdominal ultrasound be helpful in ETOH hep can show enlarged/small liver, fatty liver, decreased protal vein flow, cirrhosis, splenomegaly, and masses and cysts
What is the tx for ETOH liver disease ABSTINENCE, rehab, counseling, aggressive nutrition, folic acid, thiamine w/ glucose (to avoid Wernicke Korsakoff syndrome)
Pt has ETOH liver disease and encephalopathy, prolonged PT time and elevated bilirubin what tx are you going to order for them prednisolone, lactulose (inpatient), antibiotics if sepsis is present
What can you give to help with ETOH withdrawal Benzodiazepines
Pt has severe ascites as a complication of their ETOH liver disease what treatment would you order paracentesis
Pt has esophageal varices that are bleeding what tx would you order balloon tamponade or transjugular intrahepatic portosystemic shunt if they don’t respond to tx
What does pentoxifylline do for ETOH liver disease inhibits TNF Alpha, decreases mortality and hepatorenal failure
What is the prognosis for your pt if their PT test is >3 seconds above control limits w/ acute ETOH liver disease their mortality rate rises 20%, if PT test prohibits biopsy mortality rate is >40% at one year
What is the mortality rate for severe acute ETOH hepatitis mortality rate of 50% at one month
When should you refer pt for live transplant very high bilirubin, elevated creatinine, increased INR and ascites or encephalopathy (have short term prognosis), hepatic failure
Why is ETOH abstinence so important after a pt has had an episode of mild to moderate ETOH hepatitis if they continue to drink 50% will develop cirrhosis and 40% of them will die within 5 yrs
What are common causes of liver cirrhosis ETOH liver disease, Viral Hep, fatty liver w/ obesity and NASH, hepatic congestion drugs- methotrexate, methyldopa, hemachromatosis, primary biliary cirrhosis, Wilson's disease, cystic fibrosis, shisto,
What are some genetic causes of liver cirrhosis Hemachromatosis, Wilson's disease, Alpha -1 antitrypsin deficiency
What is cirrhosis fibrosis and nodular regeneration of liver after hepatocellular injury
What are common s/sx of cirrhosis most are asymptomatic until can't compensate further, will show anorexia, nausea, vomiting, diarrhea, fatigue, weakness, fever, jaundiced, pruritis, pale stools, dark urine
What s/sx of the skin and nails would you look for indicating possible cirrhosis these s/sx are variable jaundice, palmar erythema, spider telangiectasias, ecchymosis, caput medusa, xanthomas, clubbing
What abdominal signs point toward cirrhosis of liver ascites, venous hum over periumbilical veins, hypogonadism, enlarged or small nodular liver, tender hepatomegaly, palpable spleen (portal hypertension)
What neurologic signs indicate possible cirrhosis tremor of asterixis, choreoathetosis, dysarthria (Wilson's disease)
what are Dupuytren's contractures fibrous change of palmar fascia affects ring fingers possible sign of cirrhosis of liver
What is the tx for cirrhosis dc ETOH, aggressive nutrition, sodium restriction, vitamin supplementation and mostly treat complications, portal hypertension, ascites, Wilson's disease, encephalopathy
What is hepatopulmonary syndrome liver doesn't clear circulation pulmonary vasodilators so you get intrapulmonary vascular dilation leading to dyspnea, and decreased oxygen saturation, Tx is liver transplant
When is liver transplant indicated irreversible progressive chronic liver disease, acute hepatic failure and metabolic diseases of the liver survival rate is 80% 5 yr
Created by: Max Smith Max Smith on 2010-03-19



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