Duke PA Liver Disease
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| product of heme metabolism | bilirubin
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| __ bilirubin is water insoluble | unconjugated
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| __ bilirubin is bound to glucuronic acid and is therefore water soluble for elimination by the liver and kidney | conjugated
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| increase in conjugated bilirubin is caused by | obstruction of the outflow tract or in the liver
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| increase in uncomjuagated bilirubin is caused by | hemolysis
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| 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
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| 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
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| flapping tremor of the hand, can be a sign of hepatic encephalopathy, thought to be related to abnormal ammonia metabolism | asterixis
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| AST/ALT can be normal in __ | cirrhosis
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| __ can be released by the liver, bone, intestinal tract, placenta, kidney | alkaline phosphatase
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| what does the liver actualy make | albumin, clotting factors
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| what are true liver function tests (this is not what everybody means when they say liver function tests) | albumin, prothrombin time/INR
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| __ tests for hepatocellular carcinoma and inflammation- not 100% specific | alpha fetoprotein (AFP)
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| you have to be infected with __ for hepatitis D to matter | hepatitis B
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| no vaccine available for __ | hepatitis C
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| __ is due to infected drinking water | hepatitis E
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| source of __ is feces | hepatitis A and E
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| source of __ is blood/body fluids | hepatitis B, C, and D
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| non-chronic hepatitis | A and E
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| chronic hepatitis | B, C, and D
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| incubation period of hepatitis A is average | 30 days
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| complications of hepatitis A | fulminant hepatitis, cholestatic hepatitis
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| chronic sequelae of hepatitis A | none
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| hepatitis A post exposure immunoglobulin should be given withing __ after exposure | 14 days
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| hepatitis B incubation period average | 60-90 days
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| major cause of hepatitis worldwide | HBV
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| 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
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| incubatino period of hepatitis C average | 6-7 weeks
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| #1 indication for liver transplant | hepatitis C
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| responsible for the cirrhosis epidemic | hepatitis C
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| excellent screening test for chronic infection with hepatitis C | antibody test
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| good test for acute hepatitis C infection | HCV RNA test
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| liver biopsy is generally advisable for patients with __, although it should not be mandatory. | hepatitis C
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| treatment for hepatitis C | peginterferon alfa, ribavirin
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| peginterferon AE | flu-like symptoms, depression/anxiety, thyroid dysfunction, bone marrow suppression
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| ribavirin AE | hemolytic anemia
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| symptoms of acute alcoholic hepatitis | jaundice, fever, anorexia, nausea
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| treatment for sever alcoholic hepatitis | supportive care, steroids for 30 days, pentoxifylline for 30 days
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| how much alcohol does it take to induce alcoholic hepatitis | 80gm/day for 20 years (eight beers, 1 liter wine, 1/2 pint spirits)
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| pathologic diagnosis of cirrhosis | fibrosis, regerated nodules, vascular distortion
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| complications of cirrhosis | hepatorenal syndrome, hepatoma, portal hypertension
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| signs of portal hypertension | varices, ascites, encephalopathy, GI bleeding
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| varices-prevention | beta blockers, edoscopic ligation, nitrates
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| ascites management | salt restriction, fluid restriction, diuretic therapy (aldactone, lasix), Large Volume Paracentsis (LVP) with albumin replacement, TIPS for refractory ascites
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| signs of encephalopathy | euphoria, confusion, asterixis, coma, ammonia
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| encephalopathy treatment | R/O infection, correct electrolytes, lactulose, Neomycin, Rifaximin
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| #1 indication for liver transplant in US | hepatitis C
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| NASH | non-alcoholic steatohepatitis
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| histologic evidence of chronic ETOH liver disease without significant ETOH consumption | NASH
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| treatment of NASH | wt loss, control hyperglycemia, control hyperlipidemia, stop offending meds
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| key to characterization of liver mass | imaging
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| 3 major benign solid liver masses | hemangioma, adenoma, focal nodular hyperplasia
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| most common benign tumor of the liver, increased growth associated with high estrogen states, most are small, asymptomatic and found incidentally | hemangioma
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| rare benign tumor of the liver, associated with long term estrogen use, can rupture and bleed | hepatic adenoma
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| second most common benign liver lesion | focal nodular hyperplasia (FNH)
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