Jaundice/Ascites/Hepatic Encephalopathy/Liver Failure

1. Describe normal bilirubin metabolism.

2. Describe pathophysiologic mechanisms of jaundice.

3. Outline the diagnostic tests used in approaching patients with jaundice and
    discuss liver function tests.

4. Define jaundice.

5. Describe mechanisms of ascites formation.

6. List five conditions that associate with ascites.

7. Describe the techniques and diagnostic tests used to detect ascites.

8. Discuss the indication of abdominal paracentesis and interpret the findings.

9. Recognize the complications of ascites.

10. Outline the management of ascites.

11. Give indications for LeVeen's shunt.

12. Interpret serum and urinary electrolytes in patients with ascites.

13. Discuss the mechanisms of action and side effects of drugs used in the
      treatment of ascites.

14. Demonstrate clinical skills in approaching patients with hepatic
      encephalopathy and hepatic failure.

15. List the stigmata of chronic liver disease.

16. List neurotransmitters that possibly have pathogenetic roles in hepatic
      encephalopathy.

17. List precipitating factors of hepatic encephalopathy.

18. Discuss the use of ammonia blood level in hepatic encephalopathy.

19. Outline the management of hepatic encephalopathy.

20. Discuss the mechanisms of action of lactulose and metronidazole in the
      treatment of hepatic encephalopathy.

21. Discuss the role of liver transplantation.

22. Differentiate between hepatorenal failure and prerenal azotemia.

23. Discuss the management of hepatorenal failure.

Cirrhosis

1. List underlying causes of cirrhosis.

2. List complications of cirrhosis.

3. List major mechanisms contributing to portal hypertension.

4. Discuss diagnostic methods used in patients with cirrhosis.

5. Describe complications of liver biopsy.

6. Classify portal hypertension.

7. List the consequences of portal hypertension.

8. Describe the management of patients with bleeding esophageal varices.

9. Discuss the use of the Sengstaken-Blakemore tube in patients with bleeding
    esophageal varices.

10. Discuss the efficacy, mechanisms of action and side effects of vasopressi
      and somatostatin used in treating bleeding esophageal varices.

11. Discuss the role of sclerotherapy and banding in patients with bleeding
      esophageal varices.

12. List major complications of sclerotherapy and banding.

13. Discuss the surgical management of portal hypertension.

Hepatitis

1. List causative agents for acute hepatitis.

2. Discuss serologic tests used in hepatitis.

3. Discuss the significance of delta agent.

4. Give indications for hepatitis A and B vaccination.

5. Discuss the clinical manifestations of hepatitis A and hepatitis B infections.

6. Discuss the clinical manifestations of hepatitis C.

7. List causes of chronic liver disease.

8. Describe histologic features of mild, moderate and severe chronic hepatitis.

9. Discuss the role of corticosteroids and/or azathioprine in the treatment of
    chronic liver disease.

10. List possible complications of corticosteroids.

11. Describe major drug-metabolizing pathways of the liver.

12. List five drugs that cause chronic liver disease.

13. Describe alcohol metabolism.

14. Give the spectrum of alcohol-related liver diseases.

15. Discuss clinical manifestations of alcoholic hepatitis.

16. Discuss the management of alcoholic hepatitis.

Cholestasis/PBC/Hemochromatosis/Wilson's Disease

1. Define cholestasis.

2. List conditions associated with cholestasis.

3. Discuss the approach to neonatal jaundice.

4. Discuss diagnostic tests used in patients with cholestasis.

5. Define primary biliary cirrhosis.

6. Discuss the clinical manifestations of primary biliary cirrhosis and diagnostic
    tests.

7. Give histologic staging of primary biliary cirrhosis.

8. Discuss the treatment of PBC.

9. List the complications of PBC.

10. Discuss normal iron metabolism.

11. Describe salient clinical features of hemochromatosis.

12. Discuss diagnostic tests used in hemochromatosis.

13. Differentiate homozygotes for hemochromatosis from heterozygotes for
      hemochromatosis.

14. Discuss the management of hemochromatosis.

15. Define Wilson's disease.

16. Describe clinical manifestations of Wilson's disease.

17. Discuss the diagnostic tests for Wilson's disease.

18. Discuss the use and side effects of penicillamine in treating Wilson's
      disease.

19. List the diagnostic methods that differentiate liver abscesses, neoplasms
      and cysts.

Jaundice and Liver Disease in Children

1. Understand bilirubin metabolism in the neonate. Understand the significance
    of bilirubin metabolism in the fetus, and the changes that occur during the
    first 72 hours after birth.

2. Understand "physiologic jaundice of the newborn."
    a. Why does it occur?
    b. What brings it to an end?
    c. Under what circumstances will it be "unphysiologic"?
    d. What treatment modalities are available to modify and treat this disorder?

3. Understand the importance of careful choice of drugs in the newborn and
    in the nursing mother.

4. Understand the significance of unconjugated versus conjugated bilirubin in the
    plasma.

5. Be aware of kernicterus and its various manifestations.

6. Be aware of "hydrops fetalis," "RhoGAM^®," Rh and ABO immunization.

7. Be aware of "neonatal hepatitis syndrome," and understand that it is a
    spectrum of specific and nonspecific disorders of the liver.

8. Know the normal age presentation.

9. Be aware of "giant cell hepatitis," including its histologic abnormality.

10. Be aware of "biliary atresia," including its pathology.

11. Be aware that a number of metabolic disorders may present as "neonatal
      hepatitis syndrome," including galactosemia; a₁-antitrypsin deficiency;
      tyrosinemia; cystic fibrosis.

12. Be aware that a number of perinatal infections may present as "neonatal
      hepatitis syndrome," including first-degree cytomegalovirus infection and
      rubella.

13. Understand the significance in investigation of:
       a. HIDA scan
       b. Liver biopsy
       c. Mini lap and operative cholangiogram
       d. Alpha-fetoprotein

14. Know the prognosis of giant cell hepatitis and biliary atresia.

15. Be aware of the Kasai procedure and liver transplantation.