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GI VI: Liver Cheat Sheet by

Gastroenterology
cancer     liver     hepatitis     cirrhosis

Hepatitis: General

Defined as acute or chronic hepato­cel­lular.
- Most common cause of acute hepatitis is viral followed by toxins (*EtOH).
- Most common cause of chronic hepatitis is viral (can also be inherited disorders, autoim­mune)

Viral Hepatitis

Transm­ission (A + E)
Fecal-oral contam­ina­tion. Prevent by having a sanitary water supply and hand washing)
Transm­ission (B + C + D)
Parent­erally or by mucous membrane contact
Progre­ssion to serious liver disease in pts. with chronic Hepatitis C
20-30% progress to serious liver disease, usually if EtOH is involved or pt. also has Hep B or HIV
Clinical Features: general
Fatigue, malaise, anorexia, nausea, tea-co­lored urine, vague abdominal discomfort
When is Hep D found?
In conjun­ction with Hep B, assoc. w/ more severe course
Which infectious are frequently found as co-inf­ect­ions?
Hep C + HIV, Hep B + HIV
Lab Findings
Elevated aminot­ran­sferase levels, bilirubin > 3.0 (=scleral icterus or jaundice), antibodies and antigens present in serology
Treatment: Acute viral hepatitis
Supportive (Hep A pts be careful to wash hands/­dishes and not share food), avoid EtOG/t­oxins
All HIV-po­sitive pts. with chronic Hep B should be...
Treated for HIV (no matter what the CD4 count is) w/ therapies that cover both infx.
Hep C. patients should also be evaluated for...
The level of fibrosis
 

Toxic Hepatitis

Etiology
EtOH, acetam­ino­phen, isoniazid, halothane, phenytoin, carbon tetrac­hloride
How to diagnose and treat?
Eliminate the suspected agent
What is used for acetam­inophen toxicity?
Acetyl­cys­teine
Prognosis?
Good if the patient survives the acute episode

Cirrhosis

Definition
Irreve­rsible fibrosis and nodular regene­ration throughout the liver
Etiology
EtOH (causes >45% of cases in US), or Hep B/C or congenital disorders
Clinical Presen­tation
Weakness, fatigue, weight loss, N/V, anorexia, amenor­rhea, impotence, loss of libido, abdominal pain, hepato­megaly.
Signs/­sym­ptoms of late stage cirrhosis
Ascites, pleural effusions, peripheral edema, ecchym­osis, esophageal varices, and signs of hepatic enceph­alo­pathy
Signs of Hepatic Enceph­alo­pathy
Asterixis, tremor, dysart­hria, delirium, coma
Lab Findings
Can be normal until late-stage disease. Anemia, mild AST elevation.
Treatment
Abstain from EtOH use, salt restri­ction + bed rest for ascites, can do Spiron­ola­ctone 100mg qd to diurese. Liver transplant for select patients
 

Liver Abscess

- Caused by Entamoeba histol­ytica or the coliform bacteria
- Happens after travel or secondary to an intra-­abd­ominal infection.
- Presents with fever and abdominal pain
- Treat with abx, percut­aneous drainage, surgical excision

Liver Neoplasm

General
Can be malignant (primary or metast­atic) or benign
Types of benign neoplasm
Cavernous hemang­ioma, hepato­cel­lular adenoma, infantile hemang­ioe­ndo­the­lioma
Liver is a common site for...
Metastases from other cancers (esp. lung and breast). But if the primary tumor is silent, manife­sta­tions may occur in liver first.
What is associated with primary hepato­cel­lular carcinoma
Hep B, Hep C, cirrhosis, aflatoxin B1 exposure (from Asper­gillus in foods)
Clinical Charac­ter­istics
Malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain. Signs include hepato­megaly, spleno­megaly, hepatic bruit, ascites, jaundice, wasting, fever
Lab Findings
Elevated a-feto­protein
Treatment: Benign neoplasms
Treat if the tumor size might be in danger of rupturing hepatic capsule
Treatment: Metastatic disease
Treat the primary lesion
When may surgical resection be attempted?
If the cancer is confined to one lobe and there is no concurrent cirrhosis. Liver transplant might be an option. Poor prognosis overall.

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