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Describe the evalution of chronically abnL liver tests and some ddx's you may arrive at.
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what's the difference b/w acute and chronic abnL liver tests?
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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
- MRCP/ERCP
- **liver biopsy needed if dx remains unclear
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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
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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
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what testing would need to be done for CHRONIC cholestatic pattern of LFTs?
- Drug Hx
- AMA
- P-ANCA
- US
- MRCP/ERCP
- **liver biopsy valuable for dx as well as staging&grading liver dz
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what LFTs test "synthetic fn" of the liver?
serum albumin [ ] & PTT
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what LFT's test the "excretory fn" of the liver?
serum bili (measures liver's ability to detox metabolites & transport organic anions into bile).
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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
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what are the risk factors for NASH?
- type II DM or IGT
- insulin resistance
- metabolic syndrome (central obesity, dyslipidemia, HTN)
- ethnicity: Hispanics>Af Am
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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!!!)
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list the d/o included in the NAFLD category.
- hepatic statosis
- steatosis w/minor non-specific inflammation
- NASH
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describe the pathophys of NASH
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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
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what are the clinical manifestations of cirrhosis?
- ascites
- caput medusae
- Spider angiomata
- may have cholelithiasis and splenomegaly
- gynecomastia
- scleral icterus
- jaundice
- pitting edema
- bilirubinuria
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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
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