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GIT > 12 Feb 24 > Flashcards

12 Feb 24 Flashcards

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1
Q

Acute cellular transplant rejection
CF

A

🥸Happens within first 3 Mo after transplant
🥸Pts own immune system targets liver allograft

🥸AS pts to fever, malaise , lathargy
🥸Elevated LFTs

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2
Q

Liver biopsy findings of Acute cellular rejection

A

🥰Mixed Inflammatory infiltration of portal tracts involving eosinophils , neutrophils , lymphocyes.

🥰Interlobular bile duct destruction (nonsuppurative cholangitis)

🥰Endothelitis (lymphocytic subendothelial invasion of portal and hepatic veins) -Most reliable sign if ACR

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3
Q

Ttt of ACR

A

Increased immunosuppresion by high dose corticosteroids (to reverse)

Repeat transplant for refractory cases

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4
Q

Side effect of mycophenolate

A

Cytopenias
GIT adverse effects ( pain vomiting diarrhea)

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5
Q

Side effects of tacrolimus

A

Acute renal injury

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6
Q

Haptic adenoma RF

A

Young female on prolonged estrogen based OCPs
Pregnancy

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7
Q

Hepatic adenoma CF

A

🤡incidental finding often A/S
🤡solitary solid lesion on right liver lobe

Rupture;
🤡 sudden episodic RUQ pain
🤡 free abdominal fluid (blood)
🤡 signs of hemorrhagic shock
Hypotension tachycardia
Low grade fever
Mild leukocytosis
Peritoneal irritation from blood in abd cavity

Episodic RUQ pain with biliary obstruction labs

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8
Q

Ttt of hepatic adenoma

A

A/S or. < 5cm. Stop OCP

symptomatic or > 5cm. Surgical resection

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9
Q

Hepatic adenoma Complications

A

Malignant transformation (10%)
rupture and hemorrhagic shock

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10
Q

Hepatic adenoma imaging

A

Solitary solid lesion in Rt liver lobe
Multiple lesions occasionally occur

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11
Q

Ttt of ruptured hepatic adenoma

A

Circulatory support

Emergency surgery

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12
Q

Reye syndrome pathophys

A

🐑Aspirin use by child in viral infections
(Varicella , influenza)
🐏Microvesicular fat deposits in liver
🐏Cerebral edema

🦭imapired fatty acid metabolism due to mitrochondrial dysfunction leads to hepaticdysfunction causing ammonia accumulation and resultant astrocyte edema

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13
Q

Reye syndrome CF

A

🦍acute liver failure
Hepatomegaly without jaundice

🦍Rapidly prog encephalopathy
Vomiting , lethargy , seizure , coma

Scenario clues:
🐟Vomiting and confusion after recovery from viral illness
🐬Initial SS of raised ICP (vomiting lethargy) progress rapidly to seizures and coma and death.

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14
Q

Reye Syndrome Labs

A

Elevated AST , ALT and Ammonia
Elevated PT , Aptt , INR
Normal bilirubin or mild inc
Dec Glucose (from impaired liver synthesis)
Metabolic acidosis

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15
Q

Ttt of reye syndrome

A

Suppotive

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16
Q

Toxicmetabolic encephalopathy

A

Acute cerebral dysfunction/mental status changes in the absence of primary CNS pathology

17
Q

Types of toxic metabolic encepahlopathy

A

Hypoxic ischemic encephalopathy;

          Near drowning event 
          Choking

Reye syndrome

         Aspirin for viral illness

Liver failure :

       Viral / autoimmune hepatitis 
       Medicines (acetaminophen)

DKA :

        Poorly controlled DM

Hyponatremia :

          SIADH
          Rapidly correction of hypernatremia
18
Q

Aspirin Is C.I in children except in????

A

Kawasaki dx

Juvenile idiopathic arthritis

19
Q

Surveillance for Cirrhosis pts

A

6 Monthly Abdominal USG

20
Q

New Onset Ascites in pts with Cirrhosis
Causes

A

HCC (mostly AS hence we do screening USG). Or

Thrombus obstructing portal or hepatic veins.

21
Q

Liver laceration trauma sites

A

RUQ
Right flank
Rt lower rib cage

22
Q

Pt with BAT without peritonitis ….

A

Do FAST scan.

If posiive
Immediate laporotomy

If negative
CT scan abd pelvis

23
Q

Which abd organs do not give peritoneal free fluids on BAT

A

Spleen , duodenum(contained bleed)

Pancreas (retroperitoneal)

24
Q

Causes of severe neonatal Indirect hyperbilirubinemia

A

🦑Perinatal factors :
Prematurity
Exclusive BF

🦑Cephalhematoma

🦑Jaundice at age <24hrs

🦑ABO incompatibility

🦑Hereditary spherocytosis

🦑Sibling who received phototherapy

🦑East Asian ethnicity

25
Q

Causes of Dec bilirubin clearance

A

Gilbert syndrome
Crigler najjar syndrome

26
Q

Causes of hyperbilirubinemia due to Inc enterohepatic circulation

A

Lactation failure jaundice
Breast milk jaundice.

27
Q

Newborn jaundice acc to time of appearance

A

Jaundice that comes at age >24h

     Physiologic

Age <24hrs

    Pathologic (ABO incompatibility) or congenital infectio.
28
Q

Ischemic hepatitis causes

A

Cardiac insults ( MI , V tach , Cardiogenic shock)
Hypovolemia (global hypoperfusion)
Septic shock

29
Q

Ischemic hepatitis which area of liver involved

A

Zone 3 (farthest from oxygen supply by hepatic artery)

30
Q

Ischemic hepatitis labs

A

Elevated Aminotransferase > 1000 after inciting incident.

Bilirubin normal (but rises several days later)

Poor prognosis

Pts who survive labs become normal in 7 days. (Bilirubin takes weeks)

31
Q

Why are premature babies at risk of hyperbili

A

Premature (<37wks) babies are at risk of hyperbili due to :
🐠Immature liver (no conjugation)
🐠Dec enteral feeds

32
Q

Biliary atresia CF

A

Child age 2-8w
Jaundice (not going away)
Light yellow stools
Elevated bilirubin
Hepatomegaly on abd exam

33
Q

Biliary atresia Dx

A

Elevated Direct hyper bili
Normal to mildy elevated LFTs

USG : (First test)

 Absent /abnormal GB 
 Absent CBD 
 Triangular cord sign(fibrous remnants seen abv porta hepatis )

Liver biopsy :

   Intrahepatic bile duct proliferation 
   Liver fibrosis 
   Portal tract inf and edema

Intraoperative Cholangiography : (Goldstandard)
Biliary obstruction

34
Q

Ttt of Biliary atresia

A

Kasai procedure (hepatoportoenterostomy)

Liver transplant

35
Q

Cause of acholic stools in BIliary atresia

A

Bile cannot reach intestines

Urine is dark yellow due to bilirubinuria

36
Q

Cause of breast milk jaundice.

A

Inc enterohepatic circulation

BReast milk has beta glucoronidase enzyme
This leads to more deconjugation of bilirubin.
Hence indirect bili.

Ttt : continue BF

37
Q

Effect of alcohol on Liver

A

😵‍💫Steatohepatitis (inflammation)
😵‍💫Sustained inflammation activates stellate cells causing Fibrogenesis
Fibrosis progresses to cirrhosis

38
Q

Effect of alcohol cessation on Cirrhosis

A

Early cirrhosis (fibrogenesis and inflammation) is reversible
Complete alcohol cessation decreases hepatic inflammation
Fibrogenesis and portal pressure.

Once end stage cirrhosis develops the benefits from alcohol cessation is less impactful.

39
Q

Use of BB in cirrhosis

A

Used to prevent varices from bleeding by reducing porta pressure.

Do not reduce liver inflammation significantly.

GIT (20 decks)

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