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Liver Disease tutoring Part 1
By Alaina Darby
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JR is 44 yo wm with a history of alcohol abuse
JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which of the following functions of the liver is typically altered for this to occur? Metabolism Secretion Synthesis Storage a… altered protein metabolism
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JR is 44 yo wm with a history of alcohol abuse
JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which value would most likely be normal? INR AST Ammonia Albumin b
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FK is a 22 yo wf who presents to the ed after a MVA
FK is a 22 yo wf who presents to the ed after a MVA. The triage nurse notes that the sclera of her eyes is yellowed. What is the mechanism for this? Increased hemoglobin breakdown Decreased hemoglobin breakdown Increased conjugated bilirubin formation Decreased conjugated bilirubin formation d
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FK is a 22 yo wf who presents to the ed after a MVA
FK is a 22 yo wf who presents to the ed after a MVA. The triage nurse notes that the sclera of her eyes is yellowed. Which of the following would most likely be elevated in this patient at this time? AST ALT GGT AlkPhos a
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Which of the following would not be elevated in acute liver failure?
INR Albumin ALT Tbili b
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ST is a 24 yo aaf who presents with confusion with onset over the past 24 hours. Her inr is 2.3. pmh includes epilepsy and adhd. Her current medications include progestin, valproate, levetiracetam, and amphetamines. Which is the most likely drug cause of her liver failure? Progestin OCD Valproate Levetiracetam Amphetamines b
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ST is a 24 yo aaf who presents with confusion with onset over the past 24 hours. Her inr is 2.3. pmh includes epilepsy and adhd. Her current medications include progestin, valproate, levetiracetam, and amphetamines. How would the liver failure be best treated? Discontinuation of valproate N-acetylcysteine therapy Gastric lavage Prednisone 60 mg/day a
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For which of the following conditions would prednisone be preferred?
Mushroom poisoning APAP overdose Hepatitis A Autoimmune hepatitis d
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kF is a 35 yo wm who has kayser-fleishner rings as pictured below
kF is a 35 yo wm who has kayser-fleishner rings as pictured below. Which of the following would not be appropriate treatment for this patient? Penicillin Trientine Zinc plasmapheresis a
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JR is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 9-10 beer per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. Which of the following Should not be used to evaluate her liver function? INR Albumin ALT Tbili a
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JR is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 9-10 beer per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. Her AST and ALT are both elevated >3x ULN and liver biopsy shows accumulation of fat in the hepatocytes. How should she be diagnosed? b Non-alcoholic fatty liver disease Alcoholic liver disease Autoimmune hepatitis Wilson’s disease
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JR is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 9-10 beer per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. liver biopsy shows accumulation of fat in the hepatocytes. Which of the following is most indicative of ALD? AST 38 and ALT 11 AST 47 and ALT 163 AST 163 and ALT 47 AST 11 and ALT 38 c
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JR is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 9-10 beer per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. liver biopsy shows accumulation of fat in the hepatocytes. Which of the following is the best treatment for her present condition? c Prednisone 40 mg/day x 28 days Prednisone 60 mg/day x 28 days Pentoxifylline 400 mg TID x 28 days Pentoxifylline 400 mg/day x 28 days
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NA is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 1 glass of wine per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. Her AST and ALT are both elevated >3x ULN and liver biopsy shows accumulation of fat in the hepatocytes. How should she be diagnosed? a Non-alcoholic fatty liver disease Alcoholic liver disease Autoimmune hepatitis Wilson’s disease
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NA is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 1 glass of wine per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. Her AST and ALT are both elevated >3x ULN and liver biopsy shows accumulation of fat in the hepatocytes. What puts her at risk for NAFLD? b… also HLD African American Diabetes CKD Iron supplement
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NA is a 54 yo aaf who presents to you with ruq pain and yellowing of her sclera. Pmh includes dm, af, HLD, HTN, and CKD. sHe admits to drinking 1 glass of wine per week. Current medications include metformin, warfarin, atorvastatin, amlodipine, and an iron supplement. Her AST and ALT are both elevated >3x ULN and liver biopsy shows accumulation of fat in the hepatocytes. How should she be treated? c… probably continue metformin too Vitamin E Insulin Pioglitazone Continue metformin
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ALD vs NASH ALD (AST/ALT usually >3) DEFINITION OF EXCESS ALCOHOL
Per day Per week Male >4 >14 Female >3 >7 Elevated LFTs Alcohol Excess ALD (AST/ALT usually >3) No Alcohol Excess Liver Biopsy Positive NASH Negative Look for something else!
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Which of the following would be least likely to lead to cirrhosis?
ALD NAFLD Wilson’s disease Hepatitis A d
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Hepatitis in short ONLY Chronic causes Cirrhosis!! Hep A Hep B Hep C
Hep D Hep E Acute Chronic Needs Hep B AcutE ONLY Chronic causes Cirrhosis!!
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Back to Our previous patient… JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which of the following would be used for dosing his medications? Child Pugh because it is a more short-term assessment Child Pugh because it is a more long-term assessment MELD because it is a more short-term assessment MELD because it is a more long-term assessment b
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JR is 44 yo wm with a history of alcohol abuse
JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which of the following would be used for allocating a liver for transplant? Child Pugh because it is a more short-term assessment Child Pugh because it is a more long-term assessment MELD because it is a more short-term assessment MELD because it is a more long-term assessment c
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JR is 44 yo wm with a history of alcohol abuse
JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which of the following predicts mortality? Child Pugh because it is a more short-term assessment Child Pugh because it is a more long-term assessment MELD because it is a more short-term assessment MELD because it is a more long-term assessment c
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JR is 44 yo wm with a history of alcohol abuse
JR is 44 yo wm with a history of alcohol abuse. He has encephalopathy secondary to cirrhosis. Which of the following predicts life expectancy? Child Pugh because it is a more short-term assessment Child Pugh because it is a more long-term assessment MELD because it is a more short-term assessment MELD because it is a more long-term assessment b
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Child pugh vs MELD Child Pugh (long term) MELD (3 months)
Encephalopathy X Ascites Bilirubin Albumin INR (or PTT) SCr
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JR is 44 yo wm with a history of alcohol abuse and cirrhosis
JR is 44 yo wm with a history of alcohol abuse and cirrhosis. Which of the following symptoms would also be a sign that he has portal hypertension? High systolic blood pressure Renal failure Bacterial peritonitis Hemorrhoids d
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JR is 44 yo wm with a history of alcohol abuse and cirrhosis
JR is 44 yo wm with a history of alcohol abuse and cirrhosis. His hr is 54 and bp is 120/80 and HVPG is 4 How should you treat him for portal hypertension? Propranolol for treatment Atenolol for treatment Propranolol for prophylaxis Atenolol for prophylaxis No treatment e
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JR is 44 yo wm with a history of alcohol abuse and cirrhosis
JR is 44 yo wm with a history of alcohol abuse and cirrhosis. His hr is 54 and bp is 120/80 and HVPG is 13 How should you treat him for portal hypertension? Propranolol for treatment Atenolol for treatment Propranolol for prophylaxis Atenolol for prophylaxis No treatment e
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JR is 44 yo wm with a history of alcohol abuse and cirrhosis
JR is 44 yo wm with a history of alcohol abuse and cirrhosis. His hr is 94 and bp is 120/80 and HVPG is 13 How should you treat him for portal hypertension? Propranolol for treatment Atenolol for treatment Propranolol for prophylaxis Atenolol for prophylaxis No treatment a
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