Clin II: Hepatobiliary
What is the treatment for alcoholic hepatitis?
- IVF, CIWA, nutritional supplement - Pentoxifylline (Trental) - Prednisolone for severe inflamm
What medications are associated with hepatic steatosis?
- Isoniazid - MTX
What are the MCC of cirrhosis?
- NAFLD - Hepatitis B/C - ETOH
What is the tx for acute pancreatitis?
- NPO - LR [dec SIRS after 24 hrs] - pain control [dilaudid] - monitor glucose b/c NPO - monitor electrolytes [Pi, Mg]
How does acute pancreatitis present?
- Severe midepigastric abd pain, radiates to back - Inc amylase, inc lipase - poor prognosis - inc lactate * Amylase is better progression indicator but lipase is more sensitive
How does pancreatic cancer present?
- fatigue, wt loss, anorexia - early satiety - N/V - painless jaundice - later stage: dark urine/acholic stools [b/c pressing on pancreatic duct], ascites [poor prognosis]
What are the five signs of metabolic syndrome?
- hyperTG - high fasting glucose - low LDL - truncal obesity
How does decompensated cirrhosis present?
- jaundice, pruritis - ascites, caput medusae [swollen veins in abd] - ASTERIXIS [encephalopathy] - lower extremity swelling [dec albumin] - diarrhea [too much bacteria in gut] - Inc INR, dec platelets, dec albumin
How does alcoholic hepatitis present [labs]?
- markedly inc GGT - AST/ALT [ratio 2:1] - SPECIFIC ALCOHOLISM - spider angioma
What are the complications of cirrhosis?
- portal hypertension [shunting of blood] - variceal bleeding/hemorrhage - ascites - hepatic encephalopathy - spontaneous bacterial peritonitis - hepatocellular carcinoma
What are the 5 F's of cholelithiasis?
-fat -fair -female -forty -fertile
What size gallstones are high risk for gallbladder cancer?
3+ cm
What is IPMN?
Intraductal papillary mucinous neoplasm - "the colon polyps of the pancreas"]
What is hepatic steatosis, what dz does it occur in and what other dz is it associated with?
Intraheptic fat - Non-Alcoholic Fatty Liver Dz [NAFLD] Assoc with metabolic syndrome
What is the worst prognosis for cholangiocarcinoma?
Klatskin tumor
What is the tx for hepatic encephalopathy?
Lactulose, Rifaximin
How do you Dx alcoholic hepatitis?
Liver Biopsy
How do you Dx cirrhosis?
Liver biopsy - GOLD STANDARD
What is the MCC of: liver cancer? liver transplant?
Liver cancer - HBV [no cure - chronic] Liver transplant - HCV [cure]
Best treatment for cirrhosis?
Liver transplant
What liver classification measures liver dz severity? And what lab score does it take into account?
MELD score - INR
What liver classification estimates the prognosis of alcoholic hepatitis?
Maddrey Discriminant Function
How does liver dz cause ascites? What is the tx?
Portal hypertension - fluids leaks from liver and collects in abdomen Tx: Aldactone
What is the tx for pancreatic cancer?
Surgery - the only curative option
What are the causes of acute pancreatitis?
(I GET SMASHED) idiopathic, gallstones, ETOH, trauma, steroids, mumps, autoimmune, scorpion sting, hyperca++/hyperTG, ERCP, drugs(sulfa,DM)
How can you dx choledocholithiasis?
- Abd US - MRCP/ERCP [tx + therapeutic]
How does choledocolithiasis present?
- Charcot's triad: Jaundice, fever, RUQ - Reynold's Pentad: + hypotension, AMS
What are the causes of chronic pancreatitis?
TIGARO - toxic/metabolic [ETOH, smoking, hyperTG, DM], idiopathic, genetic, autoimmune, recurrent/severe, obstructive
What lab is markedly elevated in Hepatitis?
AST/ALT - in the thousands
Hep A and E often present with _______
Abd pain [unlike the others]
In antibody testing, how can you differentiate between an acute and chronic HBV infection?
Acute = + HbsAG, + anti-Hbc, + IgM anti-HBc Chronic = + HbsAG, + anti-Hbc, - IgM anti-HBc
How does early cirrhosis present?
Anorexia, wt loss, fatigue, weakness
What results in an antibody test would indicate a current HCV infx?
Antibody reactive = + infx
What liver classification estimates cirrhosis mortality? What conditions does it take into account?
Child's Class - ascites, encephalopathy
Why is INR high, platelets low and albumin low in cirrhosis?
Coag factors and albumin are made in the liver
What is exocrine pancreatic insufficiency? What is the Tx?
Deficient digestive enzymes [results in inc fecal fat, loose stools] Pancreatic enzymes (Creon)
What is the MC type of pancreatic cancer?
Ductal adenocarcinoma
What is the first-line tx for Hep B?
Entecavir (Baraclude) - Management of Hep B [MOA: dec viral replication]
In acute pancreatitis, the hematocrit ___________
Fall by 10% within 48 hrs
What antibody test would confirm a + HBV?
HbsAg - surface antigen
How does Hep A differ from other viral hepatitis?
Hep A is transmitted fecal-oral and results in complete resolution
Hep D cannot infect without _______
Hep B
Hepatocellular carcinoma is MCC by?
Hep B/C
For which Hepatitis is there no vaccine?
Hep C [main one] [there are vaccines for Hep A/B... none for Hep D/E]
MC liver dz in the developed world?
NAFLD - non-alcoholic fatty liver dz
Cirrohosis is a _________cytic anemia
Normocytic anemia
What is the tx for varices?
Octreotide, PPIs
What is the prognostic for acute pancreatitis? What lab value is taken into account?
RANSON criteria - Hematocrit
Ascending cholangitis
True emergency Reynold's pentad = fever, jaundice, ruq pain, MS changes, hypotension
ANY cirrhotic pts must be screened for _________
Varices
