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47 Cards in this Set

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What lab values in a patient are Very High w/ Obstructive liver disease?

Parenchymal liver disease?
(2)
Obstructive:
Alk Phos

Parenchymal:
1. PT
2. ALT/AST
Definition:
Chronic hepatic injury assoc w/ hepatic necrosis, fibrosis and nodular regeneration
Cirrhosis
A patient w/ alcoholic cirrhosis comes in vomiting blood. He is stabilized w/ fluid. What is the next step?
Octreotide
MCC of cirrhosis in USA?

worldwide?
USA: Alcohol abuse

world: Hepatitis
Dx:
spider nevi, gynecomastia, loss of sexual hair, asterixis, bleeding tendency, Dupuytren's contracture, encephalopathy, portal HTN, jaundice
Cirrhosis of the Liver
What are the causes in the following symptoms that are diagnostic of liver cirrhosis:
1. Bleeding
2. Encephalopathy
3. Ascites, melena, edema
1. Decreased clotting factors made in the liver

2. Increased ammonia

3. Portal HTN
Order of the (4) liver problems (Dx names) caused by increasing alcohol consumption
Alcoholic Fatty Liver ->

Alcoholic Cirrhosis ->

Alcoholic Hepatitis ->

Necrosis
Most sensitive serum marker for recent alcohol bingeing
GGT
Rx for the following Sx in Alcoholic liver cirrhosis:
1. Decrease inflammation (2)
2. Ascites
3. Hepatic encephalopathy (2)
4. Esophageal varices (2)
1. Glucocorticoids and Colchicine

2. Spironolactone

3. Lactulose and Neomycin

4. Beta-blocker or IV somatostatin
(or banding or balloon tamponade)
(3)* metabolic diseases that cause Liver Cirrhosis.

Name the test markers that would indicate the Dz as the cause
Will Agitate Hepatocytes:

1. Wilson's Dz
(high serum Ceruloplasmin)

2. Alpha-1-antitrypsin deficiency
(serum electrophoresis w/ absence of alpha-globulin)

3. Hereditary Hemachromotosis
(Fasting Transferrin Saturation = high Ferritin and TIBC)
Will Agitate Hepatocytes
Why would the BUN be lower in liver cirrhosis?
Decreased protein production
Test marker that indicates cirrhosis w/ hepatocellular CA
Increased Alpha-fetoprotein
Definition:
Autoimmune dz causing destruction of the intrahepatic ducts
Primary Biliary Cirrhosis
Dx:
40-yo woman w/ scleroderma is admitted w/ jaundice, pruritis and xanthomas

What is the serologic hallmark?
Primary Biliary Cirrhosis

(Anti-mitochondrial Ab)
(2) autoimmune disorders assoc w/ Primary Biliary Cirrhosis
Scleroderma

Sjogren's syndrome
What drug Tx will slow the progression of Primary Biliary Cirrhosis?

What is only cure?
Ursodiol
(synthetic bile acid)

Cure:
Liver Transplant
MCC of Portal HTN worldwide
Schistosomiasis
Signs of Portal HTN
(5)*
CHASE:

Caput medusa;
Hemorrhoids;
Ascites;
Splenomegaly;
Esophageal Varices
CHASE
Tx for Portal HTN
(4)
Propranolol to reduce pressure;

Portosystemic shunt surgery;

TIPS - shunt b/t hepatic and portal veins;

Liver transplant
Dx:
Liver disease, joint pain, Diabetes, cardiomyopathy, skin hyperpigmentation and infertility.

First test?

what is the confirmatory test?
Hereditary Hemochromatosis


first test:
Fasting Transferrin saturation

Confirmatory:
HFE Gene and C282Y mutation
(eliminates the need for liver Bx in HH)
GI functions of Somatostatin
(6)
Inhibits:
- Visceral blood flow
- Gastric acid secretion
- Gastric motility
- Gallbladder emptying
- Pancreatic enzyme and bicarbonate secretion
- Intestinal absorption of glucose, water, AA, and triglycerides
Hepatic encephalopathy is precipitated by what?
(3)*
PIG:

Protein (dietary) increase;

Infection;

GI bleed
PIG
Signs/Sx of Hepatic Encephalopathy
(3)
Fetor Hepaticus (Corpse breath);

Asterixis;

Mental status change or coma
In a patient w/ bleeding esophageal varices, after stabilizing IV fluids, what is the next step?
Octreotide
Tx for Hepatic encephalopathy
(3)
Protein restriction;

Lactulose
(to change NH3 to NH4 so it cant cross BBB)

Neomycin
(for gut bacteria that make NH3)
MCC of Spontaneous Bacterial Peritonitis (bug)
E. coli
Dx:
Patient w/ ascites, fever, chills, abdominal pain w/ rebound, may progress to sepsis
Spontaneous Bacterial Peritonitis
Dx test for Spontaneous Bacterial Peritonitis

Tx?
Test: Paracentesis
(abdominal tap)

Tx: Gram-negative coverage
(Cefuroxime)
Definition:
Systemic infection of the liver due to viral agents, toxins, or alcohol
Hepatitis
Mode of transmission of Hepatitis:
A, B, C, D, E, G
Vowels from the Bowels:
A and E - fecal-oral route

Consonants from "Consumance":
B, C, D, G - sex and blood
Which forms of hepatitis are associated w/:
1. IV drug use (2)
2. Unprotected sex
3. Overseas travel (2)
1. HBV and HCV

2. HBV

3. HAV and HEV
What (2) toxins cause hepatitis?
Acetaminophen

Aflatoxin
*Viral class for:
1. HAV
2. HBV
3. HCV
4. HDV
5. HEV

Which is the only DNA virus?
Please Help Find Danielle's Cat:
1. Picorna
2. Hepadna
3. Flavi
4. Delta
5. Calici

HBV is DNA
(the rest are RNA)
Please Help Find Danielle's Cat
Meaning of HAV antibodies
(2)
HAV IgM = Acute infection

HAV IgG = Immunity from prior infection
Prevention of HAV?

Tx of HAV?
Prevention:
Anti-HAV Ig is 90% effective if given w/i (2) weeks of exposure

Tx:
symptomatic
How is hepatotoxicity from Acetaminophen prevented if detected early?
N-acetylcysteine
Meaning of HBV antibodies in order of detection
(4)*

Which signifies the "window period"?
Which indicates immunity?
SAGing BAG-E / Camels May / Spit and Gag:

HBsAg positive = infection is present

HBeAg = Chronic hepatitis

Anti-HBc IgM = infection is acute (window period)

Anti-HBs IgG = past infection or vaccine (indicates immunity)
SAGing BAG-E Camels May Spit and Gag
Exposure scenarios:
What is Tx to a newborn exposed w/ Hepatitis B?

Adult infected blood exposure?
Newborn: Give HBIG and vaccine

Other: Test for HBV, if negative give HBIG only
Tx for HBV

What does HBV give patient a risk of developing?
Lamivudine


Risk: Hepatocellular cancer
Meaning of "HCV antibody"
Anti-HCV IgG = indicates chronic or past infection
Tx for HCV
(2)
Interferon

Ribavirin
What do 25% of the chronic HCV patients develop?
(2)
Cirrhosis

and/or

Hepatocellular CA
Dx:
Medical student develops fever, jaundice and fatigue 2 weeks after returning from a trip to India
Hepatitis E
A young female is diagnosed with liver disease, but does not drink, have inflammatory bowel disease or infectious hepatitis.

Next test?
if positive, what is the Dx?
What additional immune marker is assoc w/ it?
Next test:
Anti-Smooth Muscle Ab (ASMA)

Dx:
Autoimmune Hepatitis

Additional immune marker:
Anti-Liver/Kidney Microsome type 1 Ab
(anti-LKM1 Ab)
Indications for Liver transplantation
(5)
Cirrhosis;

Primary Sclerosing Cholangitis;

Chronic Hepatitis;

Hepatocellular CA;

Hepatic Vein Thrombosis
What must match w/ donor liver?
(2)
Size and ABO

(not Rh or HLA)
(3) medications for Immunosuppression of Liver recipients
Cyclophosphamide;

OKT3;

Tacrolimus