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DU PA Liver Disease
Duke PA Liver Disease
| Question | Answer |
|---|---|
| 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
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