52.3 🩺 內科專科考前版

52.3.0.1 📌 䞀頁重點

  • 22E: MASLD (NAFLD rename), resmetirom approved for MASH, semaglutide
  • HBV / HCV high in Taiwan
  • Tokyo Guidelines for cholangitis
  • King’s College Criteria for acute liver failure transplant

52.3.0.2 💊 進階

52.3.0.2.1 Acute Liver Failure
  • King’s College Criteria for transplant
  • N-acetylcysteine for acetaminophen + non-acetaminophen ALF
  • ICU + ICP monitor + dialysis
52.3.0.2.2 Alcoholic Hepatitis
  • Severe (Maddrey > 32) → prednisolone × 28 d
  • Lille score day 7 — non-responder stop steroid
  • Pentoxifylline declining evidence
  • Transplant evaluation early
52.3.0.2.3 MASLD / MASH
  • Weight loss > 10%
  • GLP-1 agonist (semaglutide, tirzepatide)
  • Resmetirom (THR-β agonist) — 22E approved for non-cirrhotic MASH
52.3.0.2.4 PBC
  • UDCA first
  • Obeticholic acid (FXR agonist) second
  • Transplant if cirrhosis
52.3.0.2.5 Cholangitis (Tokyo Guidelines)
  • Empiric pip-tazo or ceftriaxone + metronidazole
  • ERCP within 24-48h (severe < 24h)

52.3.0.3 🌟 Pearls (10)

  1. MASLD rename (22E)
  2. Resmetirom breakthrough MASH
  3. GLP-1 semaglutide / tirzepatide for MASLD weight
  4. King’s College Criteria for ALF transplant
  5. Maddrey + Lille for alcoholic hep
  6. Tokyo Guidelines for cholangitis grading
  7. PBC AMA + UDCA
  8. PSC + UC common
  9. HCC screening in cirrhosis (US + AFP q6mo)
  10. Mirizzi syndrome: stone in cystic duct compress CBD

52.3.0.4 📍 Taiwan Context

  • HBV / HCV 高 (台灣國家 hepatitis program)
  • HCC #1 cancer death (m), HBV-related
  • 健保 DAA for HCV
  • 健保 transplant
  • MASLD 䞊升

52.3.0.5 🎓 內專重點

  1. 3 分類 + LFT pattern
  2. Alcoholic hep severity
  3. MASLD / MASH (22E)
  4. PBC / PSC
  5. Acute liver failure
  6. HCC screening
52.3.0.5.1 跚章節
  • Ch 51 GI bleed
  • Ch 53 Ascites
  • Ch 358 Approach to liver
  • Ch 358-359 Pancreatitis

⚠ AI 草皿。