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17 Cards in this Set
- Front
- Back
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Cholestatic Liver Injury Labs
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AP elevated 3-5 fold
Conjugated bilirubin increased Aminotransferases elevated 2-3 fold only |
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Hepatocellular injury labs
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Mild (2-5) fold elevation in AST and ALT in chronic viral hepatitis, steatohepatitis, metabolic disease
>10 fold elevation in viral hep, ischemia, drug induced hep |
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Primary Sclerosing Cholangitis Pathogenesis
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Associated with Ulcerative Colitis more than Crohn;s disease
chronic cholestatic liver disease - inflammation and fibrosis of biliary tree -> biliary cirrhosis, portal htn |
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Primary Sclerosing Cholangitis Labs
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AST,ALT < 5 times normal
AP increased p-ANCA in 80%, ANA in 50-60%, SMA 35% |
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ERCP, MRCP
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cholangiography used to diagnose primary sclerosing cholangitis
see multifocal stricturing |
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Primary Sclerosing Cholangitis histology
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periductal fibrosis - concentric rings around bile duct "onion skin"
reduced number of bile ducts ductular retraction copper deposition (copper usually secreted into bile) |
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PSC vs PBC
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PSC:
Cholestasis intra OR extrahepatic History of Colitis AMA- onion skin fibrosis abnormal cholangiogram PBC: cholestasis ONLY intrahepatic NO history of colitis AMA+ florid duct lesions normal cholanngiogram |
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Primary Sclerosing Cholangitis complications
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malabsorption of fat soluble vitamins
cholangiocarcinoma |
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primary biliary cirrhosis
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chronic cholestatic disease
AMA+ destruction of bile ducts |
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Primary biliary cirrhosis labs
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AP 3-4x normal
AST, ALT <200 elevated cholesterol high IgM Antimitochondrial antibody + |
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Primary biliary cirrhosis symptoms
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pruritius
sicca syndrome (secondary Sjögren's syndrome) - keratoconjunctivitis, xerostomia) xanthomata due to increased cholesterol level thyroid disease, arthritis, scleroderma, raynauds, CREST possible |
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Usodiol (UDCA)
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management of primary biliary cirrhosis
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autoimmune hepatitis pathogeneisis
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intermittent progressive inflammatory liver disease
high IgG autoantibodies periportal hepatitis type1 (50yo females): ANA+, SMA+ type 2 (young girls, does not respond to corticosteroids): liver kidney microsome 1 (LKM1) + type 3: SLA/LP |
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autoimmune hepatitis treatment
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corticosteroids - prednisone
azathrioprine - steroid sparing agent, takes along time to take effect |
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autoimmune hepatitis histology
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lots of plasma cells
interface hepatitis no biliary lesions, granulomas, steatosis |
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liver ultrasound showing diffuse bright hyperechoic pattern is indicative of
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nonalchoholic fatty liver disease
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nonalchoholic fatty liver disease pathogenesis
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insulin resistance and incresaed oxidative stress impairs mitochondiral beta oxidation of fatty acids -> accumulation
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