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Term Definition
Spontaneous bacterial peritonitis SBP def Infection without a perforation of bowel
SAAG <1.1 Infection, cancer, nephrotic syndrome, tb
SAAG >1.1 Protal HTN, CHF, hepatic vien thrombosis, constrictive pericarditis, crhosis
Spontaneous bacterial peritonitis dx Paracentisis WBC > 500, cell count >250 neutrophil
Spontaneous bacterial peritonitis tx Cefotaxime or ceftriaxone + albumin
Spontaneous bacterial peritonitis recurrence Prophylactic norflocacin or trimethoprim/sulfamethoxazole
Chronic hepatitis B Presence HBsAgTx: adefovir, lamivudine, telbivudine, entecaver,tenofovir,interferon
Chronic hepatitis c Anti HCV Abs and postive viral load.Tx: interferon, ribavirin
Primary sclerosing cholangitis def Association w/ inflammatory bowel disease
Primary sclerosing cholangitis lab Elvated alkaline phosphate, and GGTP and bilirubin.normal ast and alt
Primary sclerosing cholangitis sx Pruritus, jundice, fatigue
Primary sclerosing cholangitis dx MRCP & ERCP
Primary sclerosing cholangitis tx Bile acid-binding resins ( cholestyramine) , liver transplant
Primary biliary cirrhosis px Middle age woman who have other autoimmune disorders, fatigue, pruritus, jaundice
Primary biliary cirrhosis lab Normal ast, alt, elevated alkaline phosphate, elevated GGTP
Primary biliary cirrhosis dx AMA antimitochondria antibody titer+,
Primary biliary cirrhosis tx Bile acid-binding resins ( cholestyramine) , liver transplant
Hemochromatosis def Gentic disorder leading to overabsorption of iron in the duodenum. C282Y gene.
Hemochromatosis sx Cardiomyopathy, arthragia, hyperpigamentaion, DM, hypogonadism
Hemochromatosis hx Cirrhosis, liver cancer, liver problems
Hemochromatosis dx Iron studies ( high iron level, high ferritin, low TIBC) .Liver biopsy
Hemochromatosis tx Phlebotomy, deferoxamine
Wilson disease def Decreased copper excertion from the body
Wilson disease px Neurological symptoms: psychosis, tremor, dysarthria, ataxia, seizures.Renal tubular acidosis or nephrolithiasis
Wilson disease dx Slit-lamp for kayser-fleischer rings .Low serum ceruloplasmin, high serum copper, liver biopsy
Wilson disease tx Penicillamine
Alpha 1-antitrypsin deficiency def Look for combination of liver disease and emphysema (COPD)in young pt <40 who non smoker, may fhx of COPD
Alpha 1-antitrypsin deficiency tx Replacment enzyme
Causes of unconjugated hyperbilirubinemia hemolysis, ineffective erythropoiesis, or enzyme deficiencies
Causes of conjugated hyperbilirubinemia liver dysfunction, hepatocellular or cholestatic (obstructive)
wilson disease ATP7B gene
Hepatitis A traveler, food , water
Specific vaccines are available for hepatitis A and B
fecal-oral route Hepatitis A and E
spread by sexual transmission Hepatitis B and D
respond to specific antiviral therapy B and C
Immunoglobulin injection can provide prophylaxis against hepatitis A and B
Hepatitis equire help for replication D
MC benign tumor affecting the liver Hepatic hemangioma
Benign liver tumor strongly associated w OCPs, anabolic steroids, pregnancy, and fertility drugs Hepatocellular adenoma
Most pt w/ malignancy liver will have RUQ pain, high liver enzymes and anemia
RUQ pain followed by Ultrasound, but in suspicion of malignancy CT w/ contrast should always be performed
Hepatocellular carcinoma def MC primary hepatic malignancy, M>W, average age 50
Hepatocellular carcinoma risk factor Cirrhosis, chronic HBV/HCV,hemochromatosis, schistosomiasis
Hepatocellular carcinoma sx Dull, achy RUQ pain, malise,jundice,hepatomegaly,tender abd mass, fever, W/L, acute hemorrhage /shock
Hepatocellular carcinoma dx Suspected sonography, 1st CT w/ contrast, liver anzyme and a-fp elevatd, most accurate test biopsy
Hepatocellular carcinoma tx Ideally resection, if not respectable trasplanation is only hope. No effect of chemotherapy
Hepatoplastoma def The most common primary hepatic malignant in pediatric, usually present first 3 years of life
Hepatoplastoma correlation w/ Beckwith Wiseman syndrome, thx of FAP, early onset of colon CA
Hepatoplastoma sx Abdominal dissension, FTT, JUNDICE
Hepatoplastoma dx Suspected by ultrasound, 1st CT w contrast, liver anzyme A-fp elevated, biopsy most accurate test
Hepatoplastoma tx Resection and adjuvant chemotherapy (cisplatin and doxorubicin)
Cholngiocarcinoma def Malignancy of bile duct epithelium, usually in older pts
Cholngiocarcinoma risk factor Ulcerative colitis, choledochal cysts, caroli syndrome, infection w/ clonorchis sinensis
Cholngiocarcinoma sx Dull, achy RUQ PAIN, hepatomegaly, palpable abd mass, sings of obstruction jundice (pruritus, dark urine,clay coler stool) sings of cancer (malise,W/L)
Cholngiocarcinoma dx Suspected on ultrasound, labs,CT and ERCP, tumor marker is CA 19-9
Cholngiocarcinoma tx Resection, palliation, poor prognosis
Hepatic angiosarcoma def Highly malignant tumor of the hepatic vessels
Hepatic angiosarcoma risk factors Exposure to vinyl chloride, arsenic,thorotrast and organochloride pesticides,hx of IHH NF-1,hemochromatosis
Hepatic angiosarcoma sx RUQ pain, ascites, jundice, high output cardiac faulire , hepatic bruit, HSM
Hepatic angiosarcoma dx CT with contrast, Hepatic arterography is the gold standard, biopsy should avoid
Hepatic angiosarcoma tx Resection is the only chance
Liver metastasis (secondary ) Dec MC hepatic malignancy,
Liver metastasis (secondary )etiology GI(MC) ,lung,breast,pancreas,ovary,uterus,kidney,gallbladder,prostate
Pyogenic abscess def Localized bacterial infection of the liver parenchyma
Pyogenic abscess sx RUQ/epigastric pain, fever chills, jaundice, sepsis, hepatomegaly,
Pyogenic abscess risk fact Cirrhosis, liver tumors,IBD, immunodeficiency, recent abd infection, older male sex
Pyogenic abscess dx Ultrasound, best 1st CT
Pyogenic abscess tx CT guided percutaneous drainage .Blood cultures, ABX
Aomebic abscess hx Recent travel, diarrhea, dysentery
Aomebic abscess sx Fever, RUQ pain, hepatomegaly, jaundice
Aomebic abscess dx CT
Aomebic abscess tx 1. < 12cm. 2. > 12cm or faulire respond to medical 1.po metronidazole 2.CT percutaneous drinage
Hydatid cyst (echinococcosis) def Seen in endemic area, tapeworm echinococcus granulosis, associated with exposure to dogs,sheep and cattle
Hydatid cyst (echinococcosis) sx Hepatomegaly, RUQ pain, biliary obstruction, urticaria,anaphylaxis may present
Hydatid cyst (echinococcosis) dx Suspected ultrasound, 1st best CT, most accurate serology for hydatic antigen
Hydatid cyst (echinococcosis) tx Surgical remove of cyst and sterilization. Albendazole and mebendazole acceptable in most pt
Portal HTN pre-hepatic causes Increase incidence in pediatric,congenital atresia of portal vein, external compression(Wilma tumor), thrombosis (portal,spleniv)
Portal HTN intra-hepatic causes MC, cirrhosis, schistosomiasis, inherted causes:CF,congenital hepatic fibrosis
Portal HTN post-hepatic causes Bud chairs syndrome (thrombosis or compression of hepatic pain)
Portal HTN complication Hepatic encephalopathy, splenomegaly,ascites, malnutrition,hemorrhoid, esophageal varices
What are the parameters for the Child-Pugh classification? Ascites, Total bilirubin, Albumin, PT Encephalopathy
esophageal vaices tx beta blocker to prevent primary variceal bleeding
ruptured esophageal vaices tx octreotide and endoscopic correction of varices (sclerotherpay,banding) . ballon tamponade, TIPS,protocaval shoung 2nd line therapy
pt present w/ esophageal bleeding tx EGD fot banding, meds octreotide and ABX, if banding fail ballon tamponade (sengstaken-blackmore) if not TIPS

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