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% Document Info
\author{ksellybelly}
\pdfinfo{
  /Title (gi-vi-liver.pdf)
  /Creator (Cheatography)
  /Author (ksellybelly)
  /Subject (GI VI: Liver Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{GI VI: Liver Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{ksellybelly} via \textcolor{DarkBackground}{\uline{cheatography.com/19318/cs/2447/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}ksellybelly \\
  \uline{cheatography.com/ksellybelly} \\
  \end{tabulary}
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\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 11th August, 2014.\\
   Updated 11th May, 2016.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hepatitis: General}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Defined as acute or chronic hepatocellular.  \newline % Row Count 1 (+ 1)
- Most common cause of acute hepatitis is {\emph{viral}} followed by toxins (*EtOH). \newline % Row Count 3 (+ 2)
- Most common cause of chronic hepatitis is viral (can also be inherited disorders, autoimmune)% Row Count 5 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Viral Hepatitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Transmission (A + E)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fecal-oral contamination. Prevent by having a sanitary water supply and hand washing)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Transmission (B + C + D)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Parenterally or by mucous membrane contact} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Progression to serious liver disease in pts. with chronic Hepatitis C} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}20-30\% progress to serious liver disease, usually if EtOH is involved or pt. also has Hep B or HIV} \tn 
% Row Count 10 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: general} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fatigue, malaise, anorexia, nausea, tea-colored urine, vague abdominal discomfort} \tn 
% Row Count 13 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{When is Hep D found?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}In conjunction with Hep B, assoc. w/ more severe course} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Which infectious are frequently found as co-infections?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Hep C + HIV, Hep B + HIV} \tn 
% Row Count 19 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Elevated aminotransferase levels, bilirubin \textgreater{} 3.0 (=scleral icterus or jaundice), antibodies and antigens present in serology} \tn 
% Row Count 23 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment: Acute viral hepatitis} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Supportive (Hep A pts be careful to wash hands/dishes and not share food), avoid EtOG/toxins} \tn 
% Row Count 26 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{All HIV-positive pts. with chronic Hep B should be...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Treated for HIV (no matter what the CD4 count is) w/ therapies that cover both infx.} \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Viral Hepatitis (cont)}}  \tn
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Hep C. patients should also be evaluated for...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}The level of fibrosis} \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Toxic Hepatitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}EtOH, acetaminophen, isoniazid, halothane, phenytoin, carbon tetrachloride} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{How to diagnose and treat?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Eliminate the suspected agent} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{What is used for acetaminophen toxicity?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Acetylcysteine} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Prognosis?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Good if the patient survives the acute episode} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Cirrhosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Irreversible fibrosis and nodular regeneration throughout the liver} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{EtOH}} (causes \textgreater{}45\% of cases in US), or Hep B/C or congenital disorders} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Presentation} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Weakness, fatigue, weight loss, N/V, anorexia, amenorrhea, impotence, loss of libido, abdominal pain, hepatomegaly.} \tn 
% Row Count 10 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Signs/symptoms of late stage cirrhosis} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Ascites, pleural effusions, peripheral edema, ecchymosis, esophageal varices, and signs of hepatic encephalopathy} \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Signs of Hepatic Encephalopathy} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Asterixis, tremor, dysarthria, delirium, coma} \tn 
% Row Count 16 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Can be normal until late-stage disease. Anemia, mild AST elevation.} \tn 
% Row Count 19 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Abstain from EtOH use}}, salt restriction + bed rest for ascites, can do Spironolactone 100mg qd to diurese. Liver transplant for select patients} \tn 
% Row Count 24 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Liver Abscess}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Caused by {\emph{Entamoeba histolytica}} or the coliform bacteria \newline % Row Count 2 (+ 2)
- Happens after travel or secondary to an intra-abdominal infection.  \newline % Row Count 4 (+ 2)
- Presents with fever and abdominal pain \newline % Row Count 5 (+ 1)
- Treat with abx, percutaneous drainage, surgical excision% Row Count 7 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Liver Neoplasm}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{General} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Can be malignant (primary or metastatic) or benign} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Types of benign neoplasm} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Liver is a common site for...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Metastases from other cancers (esp. lung and breast). But if the primary tumor is silent, manifestations may occur in liver first.} \tn 
% Row Count 10 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{What is associated with primary hepatocellular carcinoma} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Hep B, Hep C, cirrhosis, aflatoxin B1 exposure (from {\emph{Aspergillus}} in foods)} \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Characteristics} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain.  Signs include hepatomegaly, splenomegaly, hepatic bruit, ascites, jaundice, wasting, fever} \tn 
% Row Count 19 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Elevated a-fetoprotein} \tn 
% Row Count 21 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment: Benign neoplasms} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Treat if the tumor size might be in danger of rupturing hepatic capsule} \tn 
% Row Count 24 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment: Metastatic disease} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Treat the primary lesion} \tn 
% Row Count 26 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{When may surgical resection be attempted?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}If the cancer is confined to one lobe and there is no concurrent cirrhosis. Liver transplant might be an option. Poor prognosis overall.} \tn 
% Row Count 30 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
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