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Liver Disease
CM Liver Disease
| Question | Answer |
|---|---|
| jaundice | yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body |
| At what bilirubin level is jaundice apparent? | total bili>2mg/dL |
| In dark skinned people, where should you look for jaundice? | under the tongue |
| water insoluble bilirubin | unconjugated (INDIRECT) |
| bilirubin bound to glucuronic acid | conjugated (DIRECT) |
| breakdown product of normal heme catabolism | bilirubin |
| Conjugated Bilirubin can be caused by | biliary obstruction, PBCs, Drugs and Toxins, NASH, Alcoholic hepatitis, Autoimmune and Viral Hepatitis, Dubin-Johnson, Cirrhosis |
| Unconjugated Bilirubin can be caused by | Hemolysis, CHF, Crigler-Najjar I and II, Gilbert's, Cirrhosis |
| What can cause both unconjugated and conjugated bilirubin increase? | Cirrhosis |
| If liver enzymes (AST, ALT) are greater than alkaline phosphatase, this suggests: | damage to hepatocyte damage rather than duct damage |
| Progression to liver failure in less than 14 days in pt with no history of liver disease; develop coagulopathy (INR>2), encephalopathy | Fulminant Liver Disease |
| Acute Liver disease | no prior hx of liver disease. |
| Clinical Sx of Liver Disease | Malaise/fatigue, jaundice, light stool, dark urine (tea colored), pruritus, GI bleeding, confusion, edema, weight loss, loss of appetite, N/V, Fever |
| Important HX for Liver Disease | HIV status, hepatitis contacts, blood transfusions, sexual hx, drug use (IV, Intranasal), Travel Hx, Meds (augmentin), Fam Hx (hemochromatosis, wilson's, etc), habits - alcohol, drugs |
| HEENT: Physical exam findings in Liver Dz | Icteric sclerae, Kayser-Fleischer rings (from wilson's) |
| Chest: Physical exam findings in Liver Dz | gynecomastia |
| Abdomen: Physical Exam findings in Liver Dz | ascites, small liver, splenomegaly, caput medusae |
| GU: physical exam findings in Liver Dz | Testicular atrophy |
| Extremities: Physical Exam findings in Liver Dz | Edema, Palmar erythema |
| Skin: Physical Exam Findings in Liver Dz | Spider angiomata |
| Neurological: Phsyical Exam Findings in Liver Dz | Encephalopathy, asterixis (flapping of outsretched hands), coma |
| When hepatocytes die, they release | AST and ALT |
| If AST and ALT >1000, think | viral hepatitis, shock, toxins |
| AST and ALT in ETOH abuse | <500. AST/ALT ratio 3:1 or 2:1. (aLt: Liquor is Lower!) |
| What is the next test after an alkaline phosphatase? | GGT |
| The liver makes | clotting factors (1,2,5, 7 & 9) which affects INR, and albumin |
| Child-Pugh Classification can give you an idea of | patient's mortality over the next year. |
| Low ceruloplasmin is seen in | Wilson's dz |
| Most common type of Acute Viral Hepatitis in the US | hepatitis A: 48%, Hepatitis B: 34% |
| There is no vaccination or tx for which type of heptatitis? | Hepatitis C |
| This type of hepatitis is caused by infected drinking water | Hep E |
| Hepatitis ___ is a superinfection on top of Hepatitis B | Hepatitis D |
| Which hepatitis types have fecal-oral transmission? | A and E |
| Which Hepatitis Types have percutaneous/permucosal transmission? | B, C and D |
| Who should be vaccinated for Hep. A | Travelers, homosexual and bisexual men, drug users, persons with chronic liver disease |
| Major cause of hepatitis worldwide | HBV |
| Which population has the highest prevalence of Hepatitis B | Asians |
| Peginterferon alfa and ribavirin are treatments for | Hepatitis C |
| Tx for alcoholic hepatitis | Supportive Care, if severe, then steroids for 30 days and possibly pentoxifylline for 30 days |
| Laennec cirrhosis is | alcohol induced cirrhosis. Histology makes the diagnosis |
| Causes of cirrhosis | alcohol, viral, toxin, fatty liver, portal htn, etc |
| evidence of portal htn | varices, ascites, encephalopathy, GI bleeding |
| Which junction of the esophagus is most affected by portal HTN? | GE. B/c vessels run superficially in the distal esophagus compared to the proximal esophagus |
| Emergent endoscopy, Octreotide and minnesota tubes are used for | varices tx |
| Tool used to evaluate ascites in cirrhosis patients | US |
| What cell count confirms the presence of spontaneous bacterial peritonitis? | >500 PMNs confirms to 97% specific |
| Ascites Treatment | Salt and fluid restriction, diuretic therapy, LVP with albumin replacement |
| Signs and Sx of encephalopathy | Euphoria, confusion, asterixis, coma, ammonia. increased ICP |
| #1 indication for liver transplant in the US | Hepatitis C |
| NASH | non-alcoholic steatohepatitis |
| NASH tx | weight loss/exerice, control hyperglycemia, control hyperipidemia, stop any offending agents, |
| The key to the characterization of a liver mass is | imaging! Biopsy is not often used to diagnose b/c of the associated complications. Imaging should be able to diagnose nearly ALL of them |
| 3 major benign solid masses | hemangioma, adenoma, focal nodular hyperplasia |
| Most common benign liver mass | hemangioma, F:M 5:1 |
| Imaging required to diagnose malignant mass: HCC | must be multiphasic (triple or quad phase) |
Created by:
ltm12