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15 Cards in this Set
- Front
- Back
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 |
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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 |
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Key hepatitis serologic markers |
see table 2.6-7 on page 167 |
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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 |
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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, |
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Presentation of Cirrhosis, Portal Hypertension/SAAG gradient |
Look at figures on pages 168-169 |
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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), |
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Hepatic Encephalopathy |
precipitated by dehydration, infection, electrolyte abnormalities and GI bleeding Tx w/ protein restriction, lactulose, neomcyin, and metronidazole
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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 |
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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 |
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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 |
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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 |
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ABCD of Wilson's |
Asterixis Basal ganglia detioration Ceruloplasmin (dec.) cirrhosis, copper, carcinoma, coreiform Dementia |
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Pancreatitis |
Look at table on page 172 for differences between acute and chronic pancreatitis
Look at page 173 for Ranson's criteria for pancreatitis |
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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 |