Liver Cirrhosis

Ascites: spontaneous bacterial peritonitis (SBP) is determined by white cell count, treat with cefotaxime/ceftriaxone and albumin infusion (decrease hepatorenal syndrome)

Serum Ascites Albumin Gradient (SAAG)
SAAG>1.1 --> portal hypertension
SAAG<1.1> cancer or infection

General Txt
1. spironolactone to reduce ascites and edema
2. propranolol to prevent bleeding
3. neomycin and lactulose to prevent encephalopathy
4. vit K is in general useless

Primary Biliary Cirrhosis(PBC)
fatigue + pruritus + elevated alkaline phosphatase + osteoporosis
Lab: elevated alkaline phosphatase, GGTP, IgM, and antimitochondrial antibody(most specific)

Primary Sclerosis Cholangitis
PBC - antimitochondrial antibody
Dx: ERCP or transhepatic cholangiogram, No biopsy

Hemochromatosis
Cirrhosis + cancer + restrictive cardiopathy + vibrio/Yersinia infection
Dx: elevated iron, ferritin, diminished iron binding capacity, biopsy
Txt: phlebotomy, deferoxamine

Wilson Disease
choreoathetoid movement + psychosis + K-F rings + Fanconi syndrome + type II renal tubular acidosis + hemolytic anemia
Dx: low ceruloplasmin + high urinary copper level + biopsy
Txt: penicillamine + transplant

Alpha-1 antitrypsin deficiency
cirrhosis + COPD(emphysema in young non-smoker)

Txt for HBV and HCV
HBV: interferon or lamivudine or adefovir
HCV: interferon and ribavirin