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73 Cards in this Set
- Front
- Back
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7 causes of liver disease
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1. Hepatocellular damage
2. Biliary obstruction 3. Portal system/vascular congestion 4. Mass Abscess Trama Congenital |
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What is seen with hepatocellular damage?
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Elevated transaminases (ALT/AST, GGT) as hepatocytes die
Jaundice Hypoalbuminemia (edema, ascites) because hepatocytes make albumin Increased PTT/bleeding |
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What is seen with biliary obstruction/cholestasis?
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Jaundice
Elevated alk phos and bili Impaired secretion of bili from a functional obstruction intra or extra-hepatically |
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What is seen with portal system probs/vascular congestion?
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Intrahepatic
Pre and post extrahepatic Disease comes from portal htn and blood backflow (ascites, varices, enlarged spleen...) |
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What are common causes of masses in liver?
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Neoplasm
Parasite (e.g. hydatid) |
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What causes abscesses in liver?
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Bacteria
Parasites (e.g. amoeba) |
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What causes trauma to liver?
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Blunt trauma
Parasitic (e.g. liver flukes) |
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What causes congenital liver dz
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cysts
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4 causes of acute hepatic failure
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Virus (hep b, c, d e, sometimes A); hemorrhagic fevers; yellow fever; ebv, cmv; hsv; coxsacki
Parasitic (falciparum) Bacterial (lepto, enteric fever, plague, tularemia, relapsing fever, melioidosis, sepsis) Toxins (drugs, herbs, etoh) |
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What causes jaundice/hepatomegaly and FEVER
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Malaria
Yellow fever Viral hep VLM Rickettsial/q fever Katayama fever Liver flukes Bacterial sepsis Leptospirosis Drug reactions |
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What causes jaundice/HSM without fever
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Chronic schisto
Neoplasm Toxins |
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What causes tender HSM with eosinophilia
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Liver flukes
Katayama fever Serum sickness Eosinophilic malignancy |
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What causes tender hepatomegaly without eosinophilia
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Viral hep
amebic abscess (no eos with single celled parsites) pyogenic absess |
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What are the human schistosomes?
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S. mansoni
S. japonicum S. haematobium |
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Describe Katayama fever
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Rxn to maturing schistosome worms (adults). A big immune response
Serum sickness like illnes 2-16 weeks post exposure Prior to egg laying May be biphasic Varied sx (HSM, cough, fever, death) |
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Treatment for Katayama fever?
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Praziquantel (may need to retreat)
Steroids (as dz due to antigens, treatment may actually increase sx) |
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How to dx Katayama fever?
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Eosinophilia
Serology, ELISA or WBlot |
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How do amoebas get to liver?
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Flushed there from intestines via portal circulation
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How treat amoebic liver abscess?
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FAST response to flagyl
Not under pressure like normal abscess as not filled with WBCs (but amoeba poop) No need to drain Response is within days |
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When to drain an amoebic liver abscess?
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Pregnancy
Left lobe of liver Very large Thoracic |
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Causes of intraductal biliary disease?
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pigment stones from hemolysis (e.g. malaria areas, sickle cell, thallasemia)
parasites (liver flukes, ascaris) |
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Extraductal causes of biliary dz?
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Neoplasm
hydatid cyst |
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Which flukes injure the liver?
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Fasciola hepatica (tear thru)
Clonorchis sinensis (raw fish) Opisthorchis viverrini (raw fish); carciniogen |
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What is Febrile Fasciolitic Eosinophilic syndrome?
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Big worms migrating thru liver
Tender hepatomeg, fever, eos |
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Do fasciola hepatica cause chronic liver disease?
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Yes
Cholangitis, cholecystitis, cholelithiasis |
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What infection causes fulminating acute suppurative cholangitis?
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Clonorchis and opisthorchis if they clog the bile duct
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Dz caused by chlonorchis/opthisorchis?
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Fulminating acute suppurative cholangitis (blocking bile duct)
Pancreatitits Cholangiocarcinoma |
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What is the treatment of all liver flukes except F. hepatica??
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Praziquantel
F hepatica - triclabendazol or bithionol |
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What is Oriental cholangiohepatitis?
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A recurrent infection of the liver, likely caused by inflammation/scarring from prior fluke infection
Biliary ducts obstructed with stones/parasites Seen without flukes -- ?maybe caused by malnutrition too?? |
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Is oriental cholagiohepatitis easily treated?
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No, even with worm treatment sx persist for life
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Causes of prehepatic portal HTN?
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Hyperreactive malarious splenomegaly
Portal vein occlusion |
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Causes of intrahepatic portal HTN?
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Macronodular cirrhosis
Schistosomiasis Venooclusive dz from bush tea |
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Causes of post-hepatic portal HTN?
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Cardiac failure (rhematic heart dz)
endomyocardial fibrosis from hypereosinophilia Constrictive pericarditis (tb) Budd chiari syndrome |
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What causes hepatic schistosomiasis?
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Eggs of S. japonicum and mansoni float into liver vessels, wedge, cause pipestem fibrosis
Get portal HTN (HSM, ascities, varices) Liver failure may occur late |
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What is the leading cause of death from hepatic schisto?
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Bleeding to death from ruptured esoph varices
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What drugs used for schisto?
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Praziquantel
For S. mansoni - oxamnique For S. haematobium - metrifonate |
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What causes indian childhood cirrhosis?
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In indian upper class
High hepatic copper (from copper storage vessels/ingestion?) Inherited/familiar dz Seen in children 1/5-3y/o Can cause fulminant hepatitis/chronic cirrhosis Treatment: penicillamine |
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What herbal therapy causes veno-occlusive liver disease?
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Pyrrolizidine alkaloids (comfrey)
Heliotropum Senecio Crotalaria "bush teas" Can cause acute death Infants with greatest fatality |
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What causes "jamaican vomiting sickness"?
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Ackee poisoning
Fruit of the tree Blighia sapida Toxic when unripe Toxin: hypoglycins A and B Causes hypoglycemia, liver steatosis Vomiting, quiescent, more vomiting, seizures, death in 12 hours |
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Treatment of jamaican vomiting sickness?
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rehydrate and maintain glucose levels
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If you eat unripe ackee from the blighia tree, what might happen?
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You could die from hypoglycins A and B toxin
(Jamaican vomiting sickness) |
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What's the problem with sassafras oil, used in us to flavor root beer?
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highy carcinogenic and toxi safrole
1 tsp of oil can kill an adult sx: n/v/confusion/paralysis banned by fda, but in health food stores |
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If you drink homemade rootbeer, what could happen?
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Death from liver cancer or acutely N/V confusion/seizure
(sassafras poisoning) |
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What does squaw mint = pennyroyal tea do to you?
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hepatocellular necrosis
multisystem organ failure |
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What does germander do to you?
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Centrolobular necrosis, fatal
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What does chaparral from cresote bush do to you?
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Periportal injury, inflammation, cholangitis, cholestasis
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What does Jin Bu Huan do to you?
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Fatal hepatic injury
Severe bradycardia |
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What does syo saiko to do?
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Toxic hepatitis
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What does Dai saiko to do?
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Autoimmune hepatitis
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What does Kombucha tea (the big floating yeast blob tea) do to you?
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hepatotoxicity, pulmonary edema, dic
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What causes non-tender hepatomegaly with fever?
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Visceral leishmaniasis
Trypanosomiasis Toxoplasmosis Histoplasmosis VLM Neoplasm |
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What causes non-tender hepatomeg without fever?
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VLM
Neoplasm Hydatid cyst chronic schisto |
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What causes hydatid dz?
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Echinococcus (carnivore tapeworms)
Humans are accidental hosts |
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Rx for hydatid dz?
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PAIR technique (percutaineous aspiration, injection, reaspiration)
Surgery Albendazole |
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What causes hepatocellular carcinoma?
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Hep B, C
Aflatoxins Schisto (?) Fixable with transplant/chemo poor |
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What causes cholangiocarcinoma?
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Opisthorchis viverreni
(from nitrosamines from fermented fish and nitirc oxide/radicals from opthisorchis) |
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What happens to the spleen if the liver gets obstructed?
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Swells, because the vein of the spleen drains into the portal system
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Causes of spleen dz?
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Congestive (e.g. chf, pipestem fibrosis liver)
Infection Focal Sustemic (immune response) Neoplasm Trauma |
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What causes Hyperreactive Malarious Splenomegaly (big spleen dz)?
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Malaria
Even with small malarial load See anemia, lymphocytosis, elevated IgM Young/middle age adults Aberrant immune response to malaria -- suppressor t-lymph defect overproduction of polyclonal IgM |
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Clinical SE of Big Spleen Dz?
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Mild hepatomeg
Pain Early satiety Pancytopenia due to sequestration Infection due to impaired immunity |
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How to treat Big Spleen Disease
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Malaria therapy, then LIFELONG prophylaxis in endemic area
No splenectomy -- increased mortality Spleen will shrink with rx |
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Where do you see Leishmania donovani
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E. africa and india
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Where do you see Leishmania infantum
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Asia, mediterranian
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Where do you see Leishmania chagasi?
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S america
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Clnical appearance of visceral leishmaniasis?
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Parasites divide in macrophages of RES
insidious, wasting dz Massive HSM Pancytopenia Fever Skin pigmentation Intercurrent infections due to immunocompromise |
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Treatment of leishmaniasis (visceral)?
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Pentavalent antimonials
amphotericin B Miltefosine Paromomycin |
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How to control leishmaniasis?
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Control sandflies
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What is burkitt's lymphoma?
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Malignant b-cell lymphoma
In malaria endemic areas Assocated with EBV Genetic link Peak age 4-9 y/o Jaw primary site CNS 30% Fast |
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What is the fastest growing tumor of man?
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Burkitt's lymphoma
Doubling time of 2.8 days |
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What is the treatment of burkitt's lymphoma?
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Chemo, effective but dz is recurrent
Debulking NO radiation |
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What 4 diseases are localized to the spleen?
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Abscess (sterile, pyogenic or amoebic)
Cyst (hydatid or congenital) Trauma Neoplasm |
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What is Tropical Splenic Abscess?
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Sterile
Etiology unclear Africa and Asia Tender LUQ, Fever, fluctuant spleen Rx: splenectomy |
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What happens to the spleen in sickle cellers?
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splenomegaly in young children
autoinfarction by 5 y/o functional asplenia |
