Term
| what is the most common symptom of people with liver disease? |
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Definition
| fatigue, malaise, insomnia, and nausea |
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Term
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Definition
| a non-alcoholic fatty liver - detectable via ultrasound |
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Term
| what are important parts of the history to ask possible liver disease pts about? |
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Definition
| family hx (anemia/congenital hyperbilirubinemia), occupation (printer/plumber), environment, medications (HMG CoA reductase inhibitors), toxic substances, travel, and alcohol intake |
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Term
| what is aspartate aminotransferase (AST)? |
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Definition
| an enzyme ubiquitous in the liver, cardiac muscle, skeletal muscle, kidney, brain, pancrease, and lung |
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Term
| what is alanine transaminase (ALT)? |
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Definition
| an enzyme specific to the liver |
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Term
| what serum level of ALT is usually indicative of severe liver damage? what might cause this level of damage? |
|
Definition
| >15,000. rare cases of viral hepatitis can raise serum levels this high or exposure to some chemicals such as CCl4 |
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Term
| what kind of condition might raise serum ALT levels to 800-1200? |
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Definition
| viral hepatitis such as HAV |
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Term
| what kind of condition might raise serum ALT levels to 500-1000? |
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Definition
| acute bile duct obstruction (can be due to a stone or medication). if pt has RUQ pain and eating a lot of fatty foods, think gall bladder. there is not a lot of severe pain associated with the liver, but there can be if the stones are touching glisson's capsule. |
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Term
| what kind of condition might raise serum ALT levels to <500? |
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Definition
| you might see this with an immunosuppressed AIDs pt w/cirrhosis, mild inflammation, obstructive jaundice and on meds |
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|
Term
| what kind of condition might raise serum ALT levels to 250-300? |
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Definition
| alcoholic liver disease - get a good hx |
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Term
| how can LFTs help you determine between intrahepatic, extrahepatic, and cholestasis in terms of what is going wrong with the liver? |
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Definition
| intrahepatic: AST and ALT levels will be raised to the same multiple, Alk Phos levels will also be raised to a slightly lower multiple and bilirubin will be normal or slightly increased. extrahepatic: AST and ALT will be high, but Alk Phos will be raised higher than in any other circumstance and bilirubin will usually be elevated. cholestatis: AST and ALT will be slightly increased, Alk Phos will be slightly more increased and bilirubin will not. |
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Term
| what are common causes of intrahepatic, extrahepatic and cholestatis in terms of liver damage? |
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Definition
| intrahepatic: alcohol/meds/toxins. extrahepatic: bile backup through liver and into vascular tree, can deposit in and irritate skin. painless jaundice - think of carcinoma w/ pancreatic head neoplasm. painful jaundice - stone in the common bile duct/cholangiocarcinoma. cholestasis: pregnant, medications (if you can eliminate these, its prob not cholestasis). |
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Term
| what do you need to confirm 100% before doing a liver bx? |
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Definition
| the problem is not extrahepatic, b/c if it is: pt risks bile peritonitis |
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Term
| if a pt's albumin is low, their prothrombin time is prolonged, but they aren't jaundiced - what does this probably mean? |
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Definition
| they are going into liver disease |
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Term
| why is gamma glutamyl transpeptidase (GGTP) a better test for alcoholic liver disease than Alk Phos? |
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Definition
| b/c Alk Phos could be from the bone, where GGTP is specific to the liver |
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Term
| what might LFTs look like for a pt with obstructive jaundice? |
|
Definition
| AST and ALT: slightly elevated b/c of regurgitation of bili out into vascular tree. albumin: normal. prothrombin time: normal. bili: normal to elevated. GGTP: elevated b/c involving common bile duct (where GGTP is produced) |
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Term
| what are etiologies for hepatitis? |
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Definition
| hep A,B,C, autoimmune hep, wilson's disease, medicaions, primary biliary cirrhosis, alcohol, primary sclerosing cholangitis, alpha 1 anti-trypsin deficiency, and and HFE abnormality of hemochromatosis |
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Term
| what are some serologic tests to dx hepatitis? |
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Definition
| HBV-HBs Ag, HBe Ag, HBV-DNA (PCR): if the pt has the surface antigen and e antigen - they are actively infective. HCV-RIBA and PCR-HCV-RNA: the latter will give you viral load, to determine severity. HDV-Anti-HDV in HBSAG, HDV-RNA (ELISA). |
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Term
| what are the autoimmune markers for type 1 and 2 hepatitis? |
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Definition
| type 1: ANA, anti-smooth muscle AB, antiactin. type 2: anti-LKM-1, anti-liver cytosol-1. |
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Term
| what is a positive wilson's disease test? |
|
Definition
| serum ceruloplasmin levels <20 mg/dl |
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|
Term
| what are positive tests for primary biliary cirrhosis? |
|
Definition
| normal labwork except for a big elevation in Alk Phos |
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|
Term
| what kind of hepatic drug reaction will acetaminophen, CCl4 and mushrooms cause? |
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Definition
|
|
Term
| what kind of hepatic drug reaction will INH, propylthiouracil cause? |
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Definition
|
|
Term
| what kind of hepatic drug reaction will halothane and isoflurane cause? |
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Definition
|
|
Term
| what kind of hepatic drug reaction can phenytoin, amoxicillin, and sulfa cause? |
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Definition
|
|
Term
| what kind of hepatic drug reaction will chlorpromazine, erythromycin-estolate, captopril, and sulfas cause? |
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Definition
|
|
Term
| what kind of hepatic drug reaction will dilatiazem, quinidine, and phenytoin cause? |
|
Definition
|
|
Term
| what kind of hepatic drug reaction will amidarone and ASA cause? |
|
Definition
|
|
Term
| what kind of hepatic drug reaction will cyclophosphamide and herbal teas cause? |
|
Definition
|
|
Term
| what kind of hepatic drug reaction will cocaine and nicotinic acid cause? |
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Definition
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|
Term
| in pts with hepatitis A (HAV), how do you know if they are infected(ive?)? |
|
Definition
| as long as the ALT is rising, they are considered infected(ive?) |
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|
Term
| when foes the ALT peak occur in HAV pts? |
|
Definition
| the ALT peak occurs during the mid-point of the icteric phase |
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Term
| what is the tx for HAV pts? |
|
Definition
| immune serum globulin, which is also recommended for those in close personal contact with the pt |
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Term
| what will be seen on EM when viewing hepatitis B virus (HBV)? |
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Definition
| the virus with an outer grey area (surface antigen) and an inner dark part (core antigen). tubular and spherule surface antigens are also seen. |
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Term
| when do you see ALT levels start to rise with HBV? when do they peak? what is the "window" when ALTs are elevated, but the dr if just starting to work up the pt may not know the cause? |
|
Definition
| ALT levels rise at a lag of 3-4 weeks, while the pt is still infective b/c the virus is producing both HBe Ag and HBs Ag. ALT levels peak and descend during the icteric phase, at which point the body starts to produce antibodies. there is a "window" on the start of the ALT descent where HBs antibodies are not being produced - so need to order a HBc antibody test. |
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Term
| what does it mean if you find antibodies to HBsAg in a pt, but nothing else abnormal? |
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Definition
| this means that pt was exposed to HBV, got over it, and had a normal response |
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Term
| what is the post-exposure prophylaxis for infants being born to a Hep B mother (vertical exposure vaginally/breast milk)? |
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Definition
| Hep B Ig immediately upon deliver to pt and infant |
|
|
Term
| what does it mean to be a Hep B carrier? |
|
Definition
| generally asymptomatic, can transmit Hep B through blood/sexual contact, and HBsAg carriers can revert (rare) |
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|
Term
| how do the incubation period, onset and seasonal incidence of Hep A and Hep B compare? |
|
Definition
| incubation- A: 2-6 wks, B: 6 wks-5 mos. onset- A: acute (acute onset jaundice, enzymes 800-1000), B: insidious. seasonal incidence- A: fall/winter, B: year-round. |
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Term
| how do the age preference, transmission, and severity of Hep A and Hep B compare? |
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Definition
| age- A: children/young adults, B: any. transmission- A: fecal-oral, B: needles. severity- A: mild, B: often severe. |
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Term
| how do the prognosis, carrier state, and Ig of Hep A and Hep B compare? |
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Definition
| prognosis- A: good, B: worse w/age. carrier state- A: rare, B: 0.1-1.0%. Ig- B: very good |
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Term
| what are other diagnostic modalities for evaluating a pt with hepatitis or jaundice? |
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Definition
| flat plate of the abdomen, ultrasound, peritoneoscopy, transjugular cholangiography, liver bx, ERCP (endoscopic retrograde cholangiopancreatography), PTC (percutaneous transhepatic cholangiography), computerized tomography (CT) |
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|
Term
| what would you look for on any pt with jaundice via ultrasound? |
|
Definition
| dilated ducts, cysts, masses, solid lesions, or structures pushed to one side |
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Term
| what is a peritoneoscopy? |
|
Definition
| putting air in the abdomen (careful not to perforate the intestine) and observe the top parts of the intestine, the liver, the spleen, and the anterior aspect of the stomach |
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|
Term
| what is a transjugular cholangiography good for? |
|
Definition
| evaluating the gall bladder |
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|
Term
| what are indications for percutaneous transhepatic cholangiography (PTC)? |
|
Definition
| if a pt has idiopathic jaundice or to determine the exact site of extrahepatic obstruction before sx |
|
|
Term
| what are contraindications to PTC? |
|
Definition
| abnormal bleeding studies (pt on anticoagulants), fever/cholangitis, ascites (possible bowel puncture risk, advanced lung disease (possible pneumothorax, hx of contrast allergy or uncooperative pt |
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|
Term
| how will a biliary system affected by a neoplasm appear? |
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Definition
|
|
Term
| what is the usual appearance of a gallstone on a PTC? |
|
Definition
|
|
Term
| what are indications for ERCP (endoscopic retrograde cholangiopancreatography) |
|
Definition
| cholestasis, pancreatic disease, gallbladder disease, postcholcystectomy syndromes, unknown abdominal pain and therapeutic. |
|
|
Term
| can PTC evaluate the pancreas? |
|
Definition
|
|
Term
| what is one of the first studies you do for someone with abnormal LFTs? |
|
Definition
| ultrasound (look for a stone, mass, dilatation, cyst, abscess, etc) |
|
|
Term
| what diagnostic modality is better for extrahepatic issues? |
|
Definition
|
|
Term
| what diagnostic modality is better for pancreas-related issues? |
|
Definition
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