Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Liver Disease
Gastroenterology
| Question | Answer |
|---|---|
| Viral hep that can cause cirrhosis | Hep B & C |
| Conjugated bili: | direct; bound to gluc acid; water soluble; caused by obstruction of outflow tract or in the liver |
| Unconjugated bili: | indirect; water insoluble; caused by hemolysis |
| Fulminant acute liver dz: | progress to liver fail in 14 days; no h/o liver dz; develop coagulopathy (INR >2), encephalopathy |
| ALT/AST | hepatocell injury: correlates w/degree of cell death; >1000: hepatitis, shock, toxins (Tylenol) |
| Abnormal AST/ALT | AST:ALT >2:1 = alcoholic hep; <500: EtOH; poss normal in cirrhosis |
| Alk phos | liver, bone, intestinal tract, placenta, kidney; elevated in liver damage/obstruction; if elevated more than AST/ALT, more likely biliary disorder |
| Child-Pugh score assesses: | prognosis of chronic liver dz |
| Alfa fetoprotein (AFP) is used to detect: | hepatocellular ca; inflammation |
| Liver dz lab w/u | Hep A, B, C; ANA; ASMA; IgG; Anti-mito Ab (primary biliary cirrhosis) |
| Labs for hemochromatosis | ferritin, iron sat, HFE gene |
| Hep A clinical features | Incubation 4-6 wks (average 30d); 80% jaundice pts >14 yo; fulminant course uncommon; no chronic/carrier state |
| Hep B clinical features | Incubation 6 wks- 6 mos (average 60-90d); 60% fulminant dz; 15-25% premature mortality; cirrhosis (3-5%); HCC; Asians |
| Hep C clinical features | Incubation 6-7 weeks; 40% jaundice; 50-70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant |
| Hep C dx labs | ELISA (pos in 8-10 wks; good screen for chronic); HCV RNA; HCV genotype |
| Alcoholic hepatitis | 40-60 g EtOH/day (less for women); jaundice, fever, anorexia, nausea; TBil, alb, INR; histo makes the dx; hepatomegaly, steatohepatitis; Tx supportive (severe: prednisone/pentoxifylline) |
| Cirrhosis: dx | pathologic; Fibrosis, Regenerated nodules, Vascular distortion |
| Cirrhosis: complications | Hepatorenal syndrome; hepatoma (hepatocellular ca); Portal HTN (pressure > 12mmHg; varices, ascites, encephalopathy, GI bleeding) |
| Varices Tx | Active bleed (Hematemesis, melena, hematochezia; Hypotension, tachy): Emergent endoscopy; Octreotide (splanchnic VC to reduce portal pressure; dec collateral flow & variceal pressure); Minnesota tube: Last chance (bridge to TIPS) |
| Varices prevention | screening endoscopy; endo banding (if large varices & prior bleed); beta blockers to HR<60; nitrates |
| Ascites | 60% develop within 10 yrs of cirrhosis dx; US (check for fluid & portal v. thrombosis) |
| Serum ascites albumin gradient | paracentesis; if gradient >1.1: portal HTN |
| Spont bac peritonitis | peritoneal cell count: >500 PMN confirms dx |
| Ascites mgmt | Na & fluid restriction; diuretic tx (Aldactone/Lasix); LVP & albumin replacement; TIPS for refractory ascites |
| Encephalopathy tx | r/o infxn, correct lytes; lactulose; neomycin; rifaximin |
| Cirrhosis & Hepatoma (HCC) | screen (US & AFP 6-12 mos); common/increasing worldwide ca; tx Partial hepatectomy, Chemoembolization, RF ablation; poss TP |
| Liver TP indications | Hep C (No. 1 in US); EtOH (abstinent >6 mos); Cryptogenic/NASH; PBC, PSC; Autoimmune hep; Hep B; risk of relapse in new liver |
| NASH | chronic hep or metab syn; usu Asx; liver bx; hepatocytes replaced; tx: stop offending meds; wt/glycemic ctrl |
| Benign masses: dx | imaging > bx; 20% of popn |
| Most common benign liver tumor | hemangioma; W>M, 20-40 (2nd most common: FNH) |
| Hepatic adenoma | W>M, young, LT estrogen use; anabolic steroids |
| HCC/malignant mass | usu in setting of chronic liver injury or cirrhosis; need multi-phasic imaging to dx (arterial phase hypervascularity; delayed phase wash-out) |
| Hep A mgmt | IVIG within 14d post exposure |
| Hepatitis virus types (RNA / DNA): | HAV: RNA virus; HAV: double-stranded DNA; HCV: single-stranded RNA; HDV: defective RNA virus (requiring assistance by HBV) |
| Hepatitis: modes of transmission | HAV: fecal-oral route; HBV: blood or body fluids (sex, transfusion, IVDU / needles); HCV: blood or body fluids (50% IVDU); HEV: fecal-oral route |
| Defn Chronic HBV: | Positive HBSAg >6 months |
| Hep E clinical features | Incubation 35-40 days; 0.5% mortality (20% in PG); no carrier state |
| Viral hepatitis causing spiking fevers: | HAV |
| Acute Hep C mgmt | Acute HCV may benefit from interferon alpha or peginterferon (reduces risk of chronic hep) |
| How many patients with acute HCV clear the virus spontaneously? | 20% |
| Chronic Hep C mgmt | slow-release peginterferon; daily ribavirin in divided doses; protease inhibitors (boceprivir or teleprivir) |
| Chronic Hep B mgmt | interferon alpha or peginterferon; possibly entecavir or tenofovir (short-term: lamivudine & telbivudine) |
| Use of immune globulin: | Give to all household persons / close contacts of patient with HAV. Give HBIG within 7 days of exposure to HBV |
| Cirrhosis etiology | EtOH (leading cause in US); viral hep; chronic biliary obstruction, metabolic disorders; CHF |
| Cirrhosis workup | Labs: CBC (low WBC, anemia, low Plt), elevated PT/PTT & LFTs; US (HSM, liver nodules/atrophy); endoscopy (varices); CT & bx (dx HCC) |
| Most common primary for liver mets | Colon (no. 1), GI tract (adenocarcinoma), breast, lung. Primary liver cancer is uncommon. |
| Risk factors for liver cancer | Aflatoxins (in food with Aspergillus flavus). Cirrhosis. Parasitosis (liver fluke: Clonorchis sinensis). Alpha-antitrypsin deficiency |
| Types of liver cancer (4) | HCC (nodules with prominent vascularity). Cholangiocarcinoma (adenocarcinoma from bile ducts). Hepatoblastoma (HCC fetal variant w/familial adenomatous polyposis). Metastatic |
| Portal HTN etiologies | Cirrhosis (EtOH, hepatitis, hemochromatosis). Budd-Chiari (phlebitis). Extrinsic compression (trauma, inflammation, tumor). Schistosomiasis |
| In varices, collateral circulation develops thru: | coronary vein (stomach/esophagus), superior hemorrhoidal veins, anterior abd wall veins , plexus of Retzius |
| Portal HTN tx | Vasopressin with nitrates, octreotide, propranolol |
| Portal HTN surgical mgmt | Paracentesis and peritoneovenous conduits (for ascites). Portal decompression: TIPS, portosystemic shunt, splenectomy, GE devascularization (Sugiura). Liver transplant |
| Elevated AST, ALT, indirect bilirubin = | Hepatitis |
| Isolated elevated indirect bilirubin = | Gilbert syndrome |
| Elevated indirect bilirubin w/defective glucuronyl transferase | Crigler-Najjar |
| Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility | Porphyria |
| Spontaneous bacterial peritonitis (SBP) = | infected ascites |
| Hep B transmission | Sex; bloodborne (1 in 63K risk); perinatal (c-section does not lower risk): vax+HBIG |
| histological pattern of advanced fibrosis in liver = | cirrhosis |
| Most common cause of abnormal liver tests | fatty liver dz |
| Hep A incubation | average 30d |
| Hep B incubation | average 60-90d |
| Hep C incubation | average 6-7 wk |
| Hep A clinical sxs | 80% jaundice pts >14 yo; fulminant or cholestatic hep |
| Hep B clinical stuff | 15-25% premature mortality; cirrhosis/hepatocell ca; Asians |
| Hep C clinical stuff | 40% jaundice; 70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant |
| Most common benign liver tumor | hemangioma; W>M, 20-40 (2nd most common: FNH: focal nodular hyperplasia) |
| No. 1 indication for liver transplant | Hep C |
| Hep B: more likely to become chronic if: | young at age of infxn (or immunocompromised); 95% of pts clear the virus & develop Abs; chronic Hep B increases risk of cirrhosis & HCC |
Created by:
Abarnard
Popular Medical sets