CM Liver Disease
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| 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
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| At what bilirubin level is jaundice apparent? | total bili>2mg/dL
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| In dark skinned people, where should you look for jaundice? | under the tongue
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| water insoluble bilirubin | unconjugated (INDIRECT)
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| bilirubin bound to glucuronic acid | conjugated (DIRECT)
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| breakdown product of normal heme catabolism | bilirubin
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| Conjugated Bilirubin can be caused by | biliary obstruction, PBCs, Drugs and Toxins, NASH, Alcoholic hepatitis, Autoimmune and Viral Hepatitis, Dubin-Johnson, Cirrhosis
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| Unconjugated Bilirubin can be caused by | Hemolysis, CHF, Crigler-Najjar I and II, Gilbert's, Cirrhosis
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| What can cause both unconjugated and conjugated bilirubin increase? | Cirrhosis
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| If liver enzymes (AST, ALT) are greater than alkaline phosphatase, this suggests: | damage to hepatocyte damage rather than duct damage
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| 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
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| Acute Liver disease | no prior hx of liver disease.
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| 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
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| 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
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| HEENT: Physical exam findings in Liver Dz | Icteric sclerae, Kayser-Fleischer rings (from wilson's)
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| Chest: Physical exam findings in Liver Dz | gynecomastia
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| Abdomen: Physical Exam findings in Liver Dz | ascites, small liver, splenomegaly, caput medusae
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| GU: physical exam findings in Liver Dz | Testicular atrophy
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| Extremities: Physical Exam findings in Liver Dz | Edema, Palmar erythema
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| Skin: Physical Exam Findings in Liver Dz | Spider angiomata
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| Neurological: Phsyical Exam Findings in Liver Dz | Encephalopathy, asterixis (flapping of outsretched hands), coma
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| When hepatocytes die, they release | AST and ALT
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| If AST and ALT >1000, think | viral hepatitis, shock, toxins
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| AST and ALT in ETOH abuse | <500. AST/ALT ratio 3:1 or 2:1. (aLt: Liquor is Lower!)
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| What is the next test after an alkaline phosphatase? | GGT
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| The liver makes | clotting factors (1,2,5, 7 & 9) which affects INR, and albumin
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| Child-Pugh Classification can give you an idea of | patient's mortality over the next year.
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| Low ceruloplasmin is seen in | Wilson's dz
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| Most common type of Acute Viral Hepatitis in the US | hepatitis A: 48%, Hepatitis B: 34%
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| There is no vaccination or tx for which type of heptatitis? | Hepatitis C
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| This type of hepatitis is caused by infected drinking water | Hep E
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| Hepatitis ___ is a superinfection on top of Hepatitis B | Hepatitis D
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| Which hepatitis types have fecal-oral transmission? | A and E
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| Which Hepatitis Types have percutaneous/permucosal transmission? | B, C and D
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| Who should be vaccinated for Hep. A | Travelers, homosexual and bisexual men, drug users, persons with chronic liver disease
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| Major cause of hepatitis worldwide | HBV
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| Which population has the highest prevalence of Hepatitis B | Asians
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| Peginterferon alfa and ribavirin are treatments for | Hepatitis C
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| Tx for alcoholic hepatitis | Supportive Care, if severe, then steroids for 30 days and possibly pentoxifylline for 30 days
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| Laennec cirrhosis is | alcohol induced cirrhosis. Histology makes the diagnosis
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| Causes of cirrhosis | alcohol, viral, toxin, fatty liver, portal htn, etc
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| evidence of portal htn | varices, ascites, encephalopathy, GI bleeding
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| 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
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| Emergent endoscopy, Octreotide and minnesota tubes are used for | varices tx
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| Tool used to evaluate ascites in cirrhosis patients | US
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| What cell count confirms the presence of spontaneous bacterial peritonitis? | >500 PMNs confirms to 97% specific
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| Ascites Treatment | Salt and fluid restriction, diuretic therapy, LVP with albumin replacement
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| Signs and Sx of encephalopathy | Euphoria, confusion, asterixis, coma, ammonia. increased ICP
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| #1 indication for liver transplant in the US | Hepatitis C
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| NASH | non-alcoholic steatohepatitis
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| NASH tx | weight loss/exerice, control hyperglycemia, control hyperipidemia, stop any offending agents,
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| 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
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| 3 major benign solid masses | hemangioma, adenoma, focal nodular hyperplasia
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| Most common benign liver mass | hemangioma, F:M 5:1
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| Imaging required to diagnose malignant mass: HCC | must be multiphasic (triple or quad phase)
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Created by:
ltm12