Ch38 Liver

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Author:
wvuong
ID:
298213
Filename:
Ch38 Liver
Updated:
2015-03-14 22:09:12
Tags:
pathoweek6
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Description:
Week 6!
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  1. Gastroesophageal varices
    • -result from portal hypertension 
    • -increased vascular resistance in the liver 
    • -increase splanchnie blood flow 

    • -number of collateral venous pathways that dilate in response to elevated portal pressure 
    • ------> Compensation: shunting of the blood 

    -Dilation can load to rupture with critically high portal pressure: Upper GI blood
  2. Gastroesophageal varices 
    [Clinical features]
    main cause of death in patients with long-lasting cirrhosis (20-30%)

    -Mortality 50%
  3. Gastroesophageal varices 
    [signs and symptoms]
    • -Rapid intestinal transit and vigorous bleeding 
    • -Bright red rectal bleeding 
    • -Anemia
  4. Gastroesophageal varices 
    [Treatment]
    • -Normal saline - large bore IV linves 
    • -Correcting the coagulopathy and stopping further bleeding 
    • -Vasopressin, nitroglycerin, B-blockers 
    • -Emergency EDG
    • ------> Endoscopic sclerosis
    • -Balloon tamponade of varices 
    • -Esophageal transection and reanastomosis
    • -Surgery
    • ----->reduce portal pressure 
    • ----->Shunting of blood
    • -Transjugular intrahepatic portosystemic shunt (TIPS)
    • -Liver transplant
  5. Hepatic Encephalopathy
    [pathogenesis]
    • -complex neuropsychiatric syndrome 
    • -Associated with hepatic failure or severe chronic liver disease 
    • -symptoms: mild confusion -> lethary -> stupor and coma
  6. Hepatic encephalopthy
    [clinical manifestation]
    • -Delirious 
    • -Spastic myelopathy
    • -Asterixis 'Liver flap'

    -alkalosis, hypoxia, hypercarbia, GI hemorrhage 

    • ØGrade 1:
    • confusion, subtle behavioral changes, no flap

    • ØGrade 2:
    • drowsy, clear behavioral changes, flap present

    • ØGrade 3:
    • stuporous
    • but can follow commands, marked confusion, slurred speech, flap present

    • ØGrade 4:
    • coma, no flap
  7. Hepatic encephalopathy
    [treatment]
    • -restriction of proteins 
    • -oral antibiotics to suppress intestinal flora that break down dietary protein and release ammonia
    • -osmotic diuretics 
    • ---->enhances elimination nitrogenous wastes
  8. Ascites
    accumulation of fluid in peritoneal cavity
  9. Spontaneous bacterial peritonitis 
    [Etiology]
    [Risks]
    [Causes]
    Etiology: Bacterial infection in the peritoneal cavity

    Risks: Cirrhosis, ascites 

    Causes: Transmigration of gut bacteria across intestinal wall into the ascites
  10. Spontaneous bacterial peritonitis 
    [Diagnosis]
    [Treatment]
    • diagnosis: leukocyte count >250 cm3
    • ----->abdominal paracentesis 

    Treatment: Antimicrobial therapy
  11. Hepatorenal syndrome 
    [Etiology]
    Normal kidney with distribution intrarenal blood flow related to imbalance between vasoconstricting and vasodilation mechanisms
  12. Hepatorenal syndrome 
    [Causes]
    • -Vigorous diuretic therapy/paracentesis 
    • -Severe diarrhea 
    • -Variceal bleeding 
    • -Sepsis
  13. Hepatorenal syndrome 
    [treatment]
    • Hemodialysis 
    • -liver transplant
  14. Chronic Active Hepatitis
    [management]
    • corticosteroids 
    • immunosuppressive (azathioprine)
  15. Billiary Cirrhosis 
    [etiology]
    end result of continuous, ongoing inflammation of bile ducts caused by macroscopic/microscopic biliary obstruction
  16. Biliary Cirrhosis 
    [diagnosis]
    [treatment]
    • Diagnosis: 
    • appropriate serologic results 
    • livery biopsy

    • Treatment: 
    • ursodeoxycholic acid 
    • methotrexate 
    • colchicine 
    • supportive care: fat-soluble vitamins 
    • liver transplate
  17. Alcoholic fatty liver 
    [diagnosis]
    • hypertriglyceridemia 
    • liver enzymes mildly abnormal (serum transaminases)
  18. Alcoholic hepatitis 
    [treatment]
    • corticosteriods 
    • treat malnutrition and vitamin deficiencies 
    • ---thiamine 
    • ---multivitamin
    • ---vitamin B12
  19. Hereditary Hemochromatosis 
    [etiology]
    • common autosomal recessive disorders 
    • metal storage disease
  20. Hereditary Hemochromatosis 
    [pathogenesis]
    uncontrolled excessive Fe absorption
  21. Hereditary Hemochromatosis 
    [diagnosis]
    • elevated FE
    • liver biopsy
    • genetic analysis for HFE gene
  22. Hereditary hemochromatosis 
    [treatment]
    • Deferoxamine 
    • repeated phlebotomy 
    • liver transplant
  23. Wilson disease

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