Term
| Patterns of hepatobiliary injury |
|
Definition
Hepatocellular - AST/ALT elevation, GGT elevation, +/- hyperbilirubinemia
Cholestatic - alk phos elevated, hyperbilirubinemia
Isolated hyperbilirubinemia
Mixed hepatocellular/cholestatic
Synthetic dysfunction - low albumin, elevated INR
Thrombocytopenia leading to portal HTN leading to splenomegaly leading to sequesteration |
|
|
Term
|
Definition
| Impaired movement of bile |
|
|
Term
|
Definition
RUQ pain
Jaundice
Pruritis
N/V
Acholic stools
dark urine |
|
|
Term
|
Definition
Tenderness to palpation in RUQ
Jaundice/icterus |
|
|
Term
| Cholestasis - causes (other than stones) |
|
Definition
Strictures
mass
Surgical anastamoses
MEDICATIONS
Pregnancy
acute illness/sepsis |
|
|
Term
|
Definition
Cholestasis + infection/inflammation
MEDICAL EMERGENCY |
|
|
Term
|
Definition
Sign of Cholangitis
Fever, RUQ pain and jaundice |
|
|
Term
|
Definition
Sign of Cholangitis
Fever, RUQ pain, jaundice, confusion and shock |
|
|
Term
|
Definition
IVF resuscitation and supportive care
Antibiotics to target gram negative and enteric organisms |
|
|
Term
|
Definition
| Most common gallstone complication |
|
|
Term
|
Definition
MEDICAL EMERGENCY
Initially may be cholestatic
progresses to hepatocellular injury |
|
|
Term
|
Definition
Screen for HCC (hepatocellular carcinoma)
Pts with Hep B are at increased risk for HCC
Asians and Africans can go on to develop HCC even in the absence of cirrhosis
Ultrasound + AFP measurement every 6-12 months |
|
|
Term
|
Definition
| Only occurs in patients with Hepatitis B |
|
|
Term
|
Definition
Most prevalent blood borne infection in the US
Route of transmission - IV drugs! |
|
|
Term
|
Definition
Anti-HCV (variable presence)
HCV RNA - viral load
Genotype is useful in guiding therapy |
|
|
Term
|
Definition
Most common cause of acute liver failure in the US
May cause AST/ALT elevations > 1000 |
|
|
Term
|
Definition
Impaired blood flow leading to ischemia/infarction
May cause AST/ALT elevations > 1000 |
|
|
Term
|
Definition
| Kayser-Fleischer ring around the iris |
|
|
Term
|
Definition
Bronze diabetes
Biopsy by Prussian blue staining
Tx is phlebotomy |
|
|
Term
|
Definition
Hepatic vein occlusion
triad of abdominal pain, ascites and hepatomegaly |
|
|
Term
|
Definition
Causes portal HTN and ascites without liver dysfunction
Usually occurs in cirrhosis or hypercoaguable states |
|
|
Term
|
Definition
Natural progression of chronic liver disease
Once you develop fibrosis the damage is irreversible |
|
|
Term
| Cirrhosis - complications |
|
Definition
Portal HTN - impaired blood flow leads to diversion of blood through systemic circulation via collateral pathways
Ascites - compounded by low albumin |
|
|
Term
|
Definition
Complications of cirrhosis
Primary prophylaxis is essential for all cirrhosis pts
primary prophylaxis reduces risk of variceal bleeding by 30-40% |
|
|
Term
| Ascites and SBP - Diagnosis |
|
Definition
| Most common complication of portal HTN Made by WBC > 250 on paracentesis + positive culture |
|
|
Term
| Ascites and SBP - Prophylaxis |
|
Definition
Long term for any pt with Hx
Pts with GI bleeds should be treated empirically |
|
|
Term
|
Definition
Altered mental status, somnolence, coma
Amonia levels correlate POORLY with clinical disease
A common complication of TIPS procedure
Tx is elimination through loose stool |
|
|
Term
|
Definition
| Highly suspicious in any pt with risk factors and a liver mass |
|
|
Term
|
Definition
Incidence is at least 20X greater than primary tumors
Most common site aside from the lymph nodes |
|
|
Term
| Etiology of acute pancreatitis |
|
Definition
| Gallstones (45%) and Alcohol (35%) are the major causes |
|
|
Term
|
Definition
| is an indication for both antibiotics and surgical consultation (for debridement) |
|
|
Term
| Etiology of chronic pancreatitis |
|
Definition
Alcohol (45%)
Cystic fibrosis - chronic obstruction, hyperlipidemia, hypercalcemia, hereditary, trypsin inhibitor mutations |
|
|
Term
| Dx of chronic pancreatitis |
|
Definition
| Calcifications - only show up if there is chronic inflammation |
|
|
Term
|
Definition
most common life shortening genetic disorder in caucasians
previously a disease of childhood but today about 45% of pts are over 18 |
|
|
Term
| Cystic fibrosis pathophysiology |
|
Definition
| Intestine - inability to flush secretions from tract leading to obstruction |
|
|
Term
| Pancreatic adenocarcinoma |
|
Definition
| Presents with painless jaundice, cachexia, weight loss |
|
|
Term
| Pancreatic adenocarcinoma prognosis |
|
Definition
surgically resectable disease 5 yr survival rate - 20-25%
Locally advanced disease - 10 month
metastatic disease - <6 months |
|
|
Term
|
Definition
Complication of pancreatitis
Usually takes 4 weeks to form
Treatment is drainage |
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