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15 Cards in this Set

  • Front
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Abnormal Liver Tests

Hepatocellular injury: very inc. AST and ALT +/- inc. bili and alk phos


Cholestasis: very inc. alk phos and bili +/- inc. AST ALT


Isolated hyperbilirubinemia: very inc. bili, nl AST ALT and alk phos


Look at page 166 for approaches to cholestasis and hyperbili

Hepatitis

inflammation of the liver, acute: viruses, drug-induced (alc, tylenol, INH, methyldopa),


Chronic: viruses (B, C, D) alcohol, autoimmune, ischemic, hereditary (wilson's, hemochromatosis, alpha 1 antitrypsin)


HP: prodrome: malaise, fever, joint pain, fatigue, URI sx, N/V, changes in BM; followed by jaundice, and RUQ tenderness


Dx: dramatically inc. AST and ALT in acute, chronic ALT and AST elev for >6m inc. alk phos and hypoalbuminemia, PT prolonged w/ dec. clotting factors


*AST/ALT ratio >2 suggests alcoholic hepatitis


*80% w/ Hep C dev chronic hepatitis

Key hepatitis serologic markers

see table 2.6-7 on page 167

Hepatitis Tx:

steroids for severe alc hep, Immunosuppression for autoimmune


IFN-alpha, lamivudine (3TC), adefovir for chronic HBV, peg-IFN, ribavarin for HCV


Liver transplant for end-stage liver failure



Complications: cirrhosis, liver failure, hepatocellular carcinoma

Cirrhosis

Fibrosis and nodular regeneration from hepatocellular injury


Etiologies: chronic hepatitis, biliary tract disease, R-sided HF, constrictive pericarditis, Budd-Chiari sydnrome (hepatic vein thrombosis 2* to hypercoag)


HP: jaundice, ascites, spont bac peritonitis, hep encephalopathy (asterixis, AMS), gastroesophageal varices, coagulopathy, renal dysfxn


Dx: dec. albumin, inc. PT/PTT, inc. bili; anemia and thrombocytopenia, Ab US for ascites and liver size, Serum-ascites albumin gradient (SAAG)


Tx: ascites: Na restriction, diuretics, r/o inf. and neoplastic causes, paracentesis,

Presentation of Cirrhosis, Portal Hypertension/SAAG gradient

Look at figures on pages 168-169

Spontaneous Bacterial Peritonitis

Fever, ab pain, AMS


Peritoneal fluid: + if >250 PMNs/mL or >500WBCs


Tx w/ IV ABX (3rd gen ceph,) that covers G+ (entero) and G- (E. coli, Klebsiella),

Hepatic Encephalopathy

precipitated by dehydration, infection, electrolyte abnormalities and GI bleeding


Tx w/ protein restriction, lactulose, neomcyin, and metronidazole


1* Biliary Cirrhosis

autoimmune disorder: destruction of intrahepatic bile ducts. middle aged women


HP: jaundice, pruritis, fatigue, xanthomas, xanthelasma, and fat malabsorption


Dx; inc. alk phos, inc. bili, +antimitochondrial ab, inc. cholesterol


Tx: ursodeoxycholic acid, cholestyramine, liver transplantation


*jaundice and pruritis in middle-aged women

Hepatocellular Carcinoma

1* risk factors cirrhosis and chronic HCV, in dev countries aflatoxins (food sources) and HBV infection are major risk factors


HP: RUQ tenderness, ab distention, liver dis sx: jaundice, easy bruisability, coagulopathy. Cachexia and weakness may be present


Dx: US or CT shows mass, abnormal LFTs, elevated alpha fetoprotein (AFP)


Tx: orthotopic liver tx, chemo and radiation not helpful but may be used for neoadjuvant purposes


*comp: GI bleed, liver failure, mets

Hemochromatosis

hyperabsorption of iron, parenchymal hemosiderin accumulation in liver, pancreas, heart, adrenals, testes, pituitary, and kidneys. Auto recessive, male of N euro descent. 2* hemochromo from chronic transfusion therapy, alcoholics


HP: sx of DM, hypogonadism, arthropathy of MCP joints, heart failure, cirrhosis


Bronze skin pigmentation, CHF, hepatomegaly, testicular atrophy


Dx: inc. serum iron, dec. transferrin; fasting transferrin sat >45% is most sensitive test


Glucose intolerance


liver bx


Tx: weekly phlebotomy, deroxamine


Comp: cirrhosis, HCC, CHF, DM, impotence, arthropathy, hypopit

Wilson's Disease (Hepatocellular Degeneration)

dec. ceruloplasmin and excessive deposition of copper in liver and brain due to def copper transporting protein. Auto rec defect on chromosome 13. <30 yrs


HP: hemolytic anemia, liver abnormalities, trmor, psych (anxiety, mania, depression) Kayser-Fleischer rings in cornea, jaundice, hepatomegaly, asterixis, choreiform movements


Dx: dec. ceruloplasmin, inc. urinary copper,


Tx; dietary copper restrxn, penicillamine, zinc

ABCD of Wilson's

Asterixis


Basal ganglia detioration


Ceruloplasmin (dec.) cirrhosis, copper, carcinoma, coreiform


Dementia

Pancreatitis

Look at table on page 172 for differences between acute and chronic pancreatitis



Look at page 173 for Ranson's criteria for pancreatitis

Pancreatic Cancer

75% of adenocarcinomas in the head of the pancreas. risks: smoking, chronic pancreatitis, first-degree relative w/ panc cancer, high fat diet, men in 60s



HP: ab pain radiating to back, jaundice, n/v, weight loss, weakness, fatigue, and indigestion


Palpable nontender gallbladder (Courvoisier's sign) or migratory thrombophlebitis (Trousseau's sign)


Dx: CT, ERCP and bx


Tx: 10-20% have no evidence of mets and may be resected using Whipple's procedure (pancreaticoduodenectomy)


Chemo: 5-FU, gemcitabine


5% 5yr survival


*classic presentation is painless progressive jaundice