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Gastroenterology | Medical (MD/DO) School Study Aid


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Hepatic Disorders
26 Picmonics to Learn | 1 hr 2 mins

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Hepatocellular Carcinoma Characteristics and Presentation
Characteristics
Malignant Liver Cancer
Risk Factors
Cirrhosis
Chronic Hepatitis B or C
Aflatoxin
Alcoholic and Nonalcoholic Liver Disease
Presentation
Clinical Findings of Cirrhosis
Often Asymptomatic
Jaundice
Ascites
2 mins
Hepatocellular Carcinoma Diagnosis and Management
DIAGNOSIS
Increased AFP
Ultrasound
Abdominal CT or MRI
MANAGEMENT
Surgical Resection
Transplantation
Image-guided Procedures
Surveillance
CONSIDERATIONS
Poor Prognosis
3 mins
Hepatitis A
Characteristics
Picornavirus
4 Week Incubation Period
Fecal-oral
Day Care Centers
Travel to Developing Countries
Signs and Symptoms
Usually Asymptomatic
Acute Disease
Jaundice
Fever
Vomiting
2 mins
Hepatitis A (HAV) Assessment
Transmission
Fecal-Oral
Ingestion of Contaminated Food or Water
Incubation
4 Weeks
Assessment
Fever
General Malaise
Hepatomegaly
Considerations
Self-Limiting
Proper Hand Washing
2 mins
Hepatitis B (HBV) Assessment
Transmission
Bodily Fluids
Blood Transmission
IV Drug Abusers
Incubation
Variable 1-6 Months
Assessment
Fever
Nausea and Vomiting
Hepatomegaly
Chronic Disease
Cirrhosis
Hepatocellular Carcinoma
Considerations
Vaccination
2 mins
Hepatitis B Virus Disease
Can turn chronic
< 10% of adults become chronic carriers
90% of newborns become chronic carriers
Cirrhosis
Hepatocellular carcinoma
Membranous Glomerulonephritis
Polyarteritis nodosa
Serum sickness like syndrome
2 mins
Hepatitis B Virus Characteristics
Hepadnavirus
Enveloped
Circular
Partially Double-stranded DNA
Has Reverse Transcriptase
IV Drug Use
Sex
Maternal fetal routes
3 month incubation period
2 mins
Hepatitis C
Characteristics
Enveloped
RNA Virus
Flavivirus
Icosahedral
SS positive linear
Signs and Symptoms
Most cases due to IV drug use
Turns to chronic hepatitis in over 70% of cases
Cirrhosis
Hepatocellular Carcinoma
Most common indication for liver transplantation
Associated to type I MPGN
Porphyria Cutanea Tarda
2 mins
Hepatitis C (HCV) Assessment
Transmission
Blood Transmission
High Risk Sex (rare)
IV Drug Abusers
Incubation
7 Weeks
Chronic Disease
Cirrhosis
Considerations
Barrier Protection
2 mins
Cirrhosis Assessment
Mechanism
Degeneration and Destruction of Liver Cells
Signs and Symptoms
Jaundice
Fatigue
Palmar Erythema
Spider Angiomas
Hepatosplenomegaly
Edema
Gynecomastia
Change in LOC
2 mins
Cirrhosis Interventions
Interventions
Maintain Nutrition
Paracentesis
Esophageal and Gastric Varices
Drug Therapy
Endoscopic Band Ligation or Sclerotherapy
Balloon Tamponade
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Hepatic Encephalopathy
Lactulose
Antibiotics
2 mins
Complications of Cirrhosis
Portal Hypertension
Ascites
Esophageal Varices
Coagulation Defects
Portal-Systemic Encephalopathy
Hepatorenal Syndrome
1 min
Gilbert's Syndrome
Pathophysiology
Decreased UDP-Glucuronosyltransferase Activity
Decreased Bilirubin Conjugation
Signs and Symptoms
Often Asymptomatic
Jaundice (Mild)
Fasting
Stress
Alcohol Intake
Labs
Increased Unconjugated Bilirubin
2 mins
Crigler-Najjar Syndrome Type 1
Pathophysiology
Autosomal Recessive
Absent UDP-glucuronosyltransferase
Symptoms
Neonatal Jaundice
Kernicterus
Diagnosis
Normal Liver Function Tests
Elevated Unconjugated Bilirubin
Treatment
Phototherapy
Plasmapheresis
Calcium Phosphate and Orlistat
Death often by Age 2
Considerations
No Response to Phenobarbital
3 mins
Budd-Chiari Syndrome
Causes
Pregnancy and Postpartum
Hematologic Disorders
Tumors
Chronic Infections
Mechanism
Thrombosis of Major Hepatic Veins
Centrilobular Congestion and Necrosis
Symptoms
Abdominal Pain
Ascites
Hepatomegaly
Nutmeg Liver
3 mins
Reye's Syndrome
Cause
Aspirin (Salicylates) to Treat Viral Illness (In Children)
Assessment
Cerebral Edema
Lethargy (Decreased LOC)
Vomiting
Liver Failure
Interventions
Monitor for Increased ICP
Mannitol (Osmitrol)
Considerations
No Aspirin for Children
2 mins
Hemochromatosis Pathophysiology
Pathophysiology
Hemosiderin Deposition
Autosomal Recessive
HLA-A3
Secondary to Transfusion Therapy
Increase Iron
Increase Ferritin
Increased Transferrin Saturation
2 mins
Hemochromatosis Signs and Symptoms
Signs and Symptoms
Micronodular Cirrhosis
Hepatocellular Carcinoma
Diabetes
Bronze Skin Coloring
CHF
Arthropathy
Testicular Atrophy
Impotence
2 mins
Wilson's Disease Pathophysiology
Autosomal Recessive
Mutation in ATP7B gene
Chromosome 13
Decrease in Ceruloplasmin
Inadequate copper excretion
Liver
Brain
Kidney
Cornea
Joints
Treat with Penicillamine
2 mins
Wilson's Disease Symptoms
Cirrhosis
Hepatocellular Carcinoma
Basal Ganglia Degeneration
Dementia
Dyskinesia
Asterixis
Kayser-Fleischer Rings
Slit Lamp Exam
Hemolytic Anemia
2 mins
Hyperammonemia
Pathophysiology
Hereditary Urea Cycle Defects
Acquired Through Liver Disease
Inhibits the Citric Acid Cycle
Signs & Symptoms
Somnolence
Slurring of Speech
Tremor
Cerebral Edema
Vomiting
Blurring of Vision
Treatment
Limit Protein in Diet
Lactulose
Benzoate Binds Amino Acid for Excretion
Phenylbutyrate
4 mins
Jaundice
General
Due To Elevated Conjugated Or Unconjugated Bilirubin
Unconjugated
Hemolysis
Crigler-Najjar Or Gilbert's Syndrome
Physiologic Jaundice Of Newborn
Conjugated
Biliary Obstruction From Stone Or Mass
Cholangitis
Dubin-Johnson And Rotor Syndrome
Mixed
Cirrhosis
Hepatitis
5 mins
Nonalcoholic Fatty Liver Disease
Characteristics
Fat Infiltration of Hepatocytes in Absence of Alcohol Consumption
Obesity
Hyperlipidemia
Type II Diabetes
Diagnosis
Often Found Incidentally
Elevated Liver Enzymes
Ultrasound
Treatment
Weight Loss
Abstinence From Alcohol
3 mins
Hepatic Encephalopathy
Characteristics/Definition
Seen in the Setting of Cirrhosis
Hyperammonemia
Altered Mental Status
Coma
TIPS
Asterixis
Management
Lactulose
Rifaximin
Liver Transplant
3 mins
Esophageal Varices
Pathophysiology
Cirrhosis
Portal Hypertension
Left Gastric Vein and Esophageal Veins
Clinical Features
Hematemesis
Melena
Hypotension
Acute Management
IV Fluids
Antibiotics
Octreotide
Endoscopic Band Ligation or Sclerotherapy
Balloon Tamponade
Prophylaxis
Nonselective Beta Blockers
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
3 mins
Spontaneous Bacterial Peritonitis
Characteristics
Cirrhosis
Ascites
Monomicrobial
Clinical Features
Often Asymptomatic
Change in Mental Status
Abdominal Pain
Diagnosis
Paracentesis
PMN >250/mm3
Management
3rd Generation Cephalosporin
Albumin
Antibiotic Prophylaxis
2 mins

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