Treatment for hepatic encephalopathy
Lactulose: prevents ammonia absorption by stimulating NH4+ formation
Neomycin: kills bacteria that produce ammonia in GI tract
Medicine given to treat bleeding esophageal varices.
Octreotide: vasoconstrictor to prevent bleeding
Way to classify liver cirrhosis.
Childs Classification
-based on ascites, nutrition, albumin, bilirubin, and encephalopathy
Dx mode of choice for cirrhosis
Liver biopsy
Most sensitive and specific test for colon cancer
Colonoscopy
Riskiest type of colonic polyp
Villous type (tubular lesions don't turn into cancer as often)
What is FAP?
Familial Adenomatous Polyposis: autosomal dominant condition with lots of polyps in the colon and sometimes duodenum.
Colon cancer is 100% in 4th decade, colectomy recommended
What is Peutz-Jeghers Syndrome?
Hamartomas scattered throughout the GI tract, pigmented spots seen on the lips.
What are the Lynch Syndromes?
Hereditary Nonpolyposis CRC
Lynch 1: only one site
Lynch 2: multiple sites with other types of cancers
Test of choice for diverticulosis
Barium Enema
Test of choice for diverticulitis
CT scan
a barium enema would increase pressure too much and risk perforation
What is Ogilvie Syndrome
Symptoms of a bowel obstruction without actual mechanical obstruction. Usually post trauma, surgery or some drug use.
Treatment for pseudomembranous colitis.
Also called C. diff colitis, stop antibiotic and give metronidazole
Treatment for hepatorenal failure and cirrhosis
Liver Transplant
Treatment for Wilsons Disease
D-penicillamine
Primary organ affected by hemochromatosis.
Liver
-cirrhosis is a common complication
(autosomal recessive disease)
Requirement for diagnosis of hemochromatosis
Liver Biopsy to determine hepatic cellular iron concentration
Board buzz word for hemochromatosis
Bronze Diabetic
- iron deposits in the pancreas inhibiting insulin release causing diabetes
- iron deposits in the skin causing a hyper-pigmentation appearance
Treatment for hemochromatosis
Repeated phlebotomies
Most common population to get hepatocellular adenomas and why?
Women age 15-40 because of oral contraceptive use
Most common benign tumor of the liver and which population most commonly gets them?
Cavernous Hemangioma
- vascular tumor in the liver vessels
- oral contraceptive use causes them in menstruating women
Two types of hepatocellular carcinoma and which is associated with Hep B and Hep C and cirrhosis?
Nonfibrolamellar: associated with cirrhosis and viruses
Fibrolamellar: not associated (better outcome because usually resectable)
Biggest risk factor for hepatocellular carcinoma
Cirrhosis: especially due to Hep B, Hep C, or alcohol
What is required for diagnosis of hepatocellular carcinoma?
Liver Biopsy
Defect in Gilbert Syndrome
Autosomal dominant deficiency of diphosphate glucoronyl transferase. Elevation of unconjugated bilirubin
Cause of hydatid cyst liver disease
Echinococcus granulosus
Most common cause of pyogenic liver abscesses
Biliary duct obstruction, causes backup of bile flow allowing bacterial proliferation
Main cause and prominent population to get amebic liver abscesses
Homosexual men, due to fecal oral route
Caused by Entamoeba histolytica
What is Budd Chiari Syndrome?
Liver disease occludes hepatic venous flow causing portal congestion leading to ascites, RUQ pain, vatical bleeding, jaundice.
When does jaundice clinically present?
When bilirubin levels are above 2mg/dl.
Which bilirubin makes urine darker?
Conjugated (direct) because it is loosely bound to albumin and therefore more water soluble. Can be excreted easily by kidneys
Name the two major inherited disorders that can cause direct hyperbilirubinemia
Dubin Johnson and Rotors
What clinical signs on PE differentiate direct from indirect hyperbilirubinemia?
Direct: dark urine and pale stool
Indirect: neither of these
Which aminotransferase is more specific for the liver?
ALT
ALT (a liver test)
AST (a systemic test)
What change in LFT is expected with alcoholic liver disease
AST>ALT by about 2:1
What is suspected with LFT where the AST and ALT are:
- Mildly elevated (low hundreds)
- Moderately elevated (high hundreds to thousands)
- Severely elevated (>10,000)
Mild: chronic viral hepatitis, acute alcoholic hepatitis
Moderate: acute viral hepatitis
Severe: ischemia, shock, bad viral hepatitis, acetaminophen toxicity
(Normal ALT: 10-35)
(Normal AST: less than 35)
What does an elected alkaline phosphatase mean in regard to liver disease?
Cholestasis, if its very high (10x increase) think extra hepatic biliary tract obstruction.
What can be measured to determine if an elevated alk phos is related to a hepatic disease?
Gamma-glutamyl-transferase activity. If it is also elevated it is probably a liver disease
What is suspected if Alk phos is elevated but GGT is not?
Biliary obstruction, pregnancy, or bone disease