GI_Final_Session 6

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GI_Final_Session 6
2011-03-06 17:20:46
GI gastrointestinal western

Westernu GI session 6 study cards for final
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  1. Describe the evalution of chronically abnL liver tests and some ddx's you may arrive at.
  2. what's the difference b/w acute and chronic abnL liver tests?
    • acute<6mo
    • chronic>6mo
  3. what lab results would indicate an Acute Cholestatic pattern? what diagnostic tests would you need to run?
    • Acute Cholestatic Pattern:
    • increased AlkP, GGT, and slight increase ALT

    • Dx Eval:
    • AMA
    • Drug Hx
    • US/MRI
    • **liver biopsy needed if dx remains unclear
  4. What lab results would indicate a Acute Hepatic pattern? What dxic test would you need to run?
    • Acute Hepatic Pattern:
    • increased ALT
    • (mixed hepatic/cholestatic pattern may show both increased ALT & AlkP)

    • Dx Eval:
    • IgM Anti-HAV
    • HBsAg
    • IgM Anti-HBc
    • Anti-HCV
    • ANA, SMA
    • Monospol, heterophile
    • Ceruloplasmin
    • EtOH Hx
    • Drug Hx
    • **if Dx remains unclear despite above testing --> Liver Biopsy
  5. what testing would need to be done for CHRONIC hepatic/mixed pattern of LFTs?
    • HBsAg
    • Anti-HCV
    • Fe sat, ferritin
    • ceruloplasmin
    • alpha,AT
    • ANA, SMA
    • US
    • EtOH Hx
    • **liver biopsy valuable for dx as well as staging&grading liver dz
  6. what testing would need to be done for CHRONIC cholestatic pattern of LFTs?
    • Drug Hx
    • AMA
    • P-ANCA
    • US
    • **liver biopsy valuable for dx as well as staging&grading liver dz
  7. what LFTs test "synthetic fn" of the liver?
    serum albumin [ ] & PTT
  8. what LFT's test the "excretory fn" of the liver?
    serum bili (measures liver's ability to detox metabolites & transport organic anions into bile).
  9. what is the definition of NAFLD? NASH?
    • NAFLD: hepatic fat accumulation in the absence of other identifiable causes
    • NASH: chronic necrosis, inflammation +/- fibrosis w/ progressive liver damage (occurs in ~40% of NAFLD pt's
  10. what are the risk factors for NASH?
    • type II DM or IGT
    • insulin resistance
    • metabolic syndrome (central obesity, dyslipidemia, HTN)
    • ethnicity: Hispanics>Af Am
  11. what are the clinical & lab findings in NASH?
    • RUQ discomfort
    • findings of cirrhosis in advanced dz
    • elevated plasma ALT>AST levels (*but in most they are nL!!!)
  12. list the d/o included in the NAFLD category.
    • hepatic statosis
    • steatosis w/minor non-specific inflammation
    • NASH
  13. describe the pathophys of NASH
  14. what is the Tx for NASH?
    • Wgt loss
    • diet adjustment
    • NO effective therapy; moderate efficacy in glucose lowering agents
    • Management of complications if pt develops cirrhosis
  15. what are the clinical manifestations of cirrhosis?
    • ascites
    • caput medusae
    • Spider angiomata
    • may have cholelithiasis and splenomegaly
    • gynecomastia
    • scleral icterus
    • jaundice
    • pitting edema
    • bilirubinuria
  16. what are the dxic tests for cirrhosis?
    • PE:
    • shifting air-fluid interface
    • examine for fluid wave (confirmatory test for ascites, however very subjective)

    • Imaging:
    • XR: may show hepatic angle (Hellmer's sign) and a centrally discplaced colon
    • US: increased echogenisity in the liver