Al-Mehdi: Hepatobiliary Pharm Flashcards by Madeline Wing | Brainscape

Q

____used for emulsification of fat (breakdown and absorption)

A

bile acids

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Q

cholic acid
deoxycholic acid
chenodeoxycholic acid

A

human bile acids

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Q

cholesterol gallstone formation in a nutshell

A

cholesterol into larger vesicles and then cholesterol crystal

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Q

why can a gallstone cause pain that comes and goes

A

the pain is due to the contraction of gallbladder by CCK

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Q

what blocks CCK from being released from I cells

A

Trypsin

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Q

oral dissolution therapy used to treat cholesterol gallstones

A

URSODIOL

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Q

used in cholestatic disease (primary biliary cholangitis)

A

URSODIOL

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Q

simple gallstone is _____ predominant

A

female

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Q

chronic pancreatitis is _____ predominant

A

male

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Q

diagnostic tests for chronic pancreatitis

A

IV secretin (for volume and HCO3-)
IV CCK (for pancreatic digestive enzymes)

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Q

elevation in anti-smooth muscle antibody

A

autoimmune pancreatitis

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Q

COX 3 inhibitor used to treat pain in chronic pancreatitis

A

acetaminophen

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Q

u-opioid agonist used to treat pain in chronic pancreatitis

A

tramadol

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Q

alpha2 subunit VGCC N-type inhibitors used to treat pain in chronic pancreatitis

A

Gabapentin and pregabalin

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Q

drug used to treat pain + loss of exocrine function in chronic pancreatitis

A

PANCRELIPASE

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Q

____ cells can be stimulated and transformed and produce collagen, leading to fibrosis of liver

A

stellate cells

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Q

highly specific for hepatocyte and cholangiocyte membranes and used if ALP is elevated to distinguish from bone damage

A

GGTP

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Q

hepatocellular damage markers

A

ALT/AST

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Q

This 43-year-old man with 3-year history of mild UC presents with pruritus and an ↑ serum ALP. 7 months later, jaundice and weight loss developed. ERCP: a 2-cm mass obstructing the common hepatic duct (arrows). A catheter passed beyond the obstructing mass shows marked dilatation of the left main duct proximal to the obstruction; the right main duct is completely occluded.

A

primary sclerosing cholangitis

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Q

young men
autoimmune/toxic trigger (LPS)
strong association with IBD

A

primary sclerosing cholangitis

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Q

jaundice, hepatomegaly, pruritis, fatigue, abd pain
pANCA +
AMA -

A

primary sclerosing cholangitis

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Q

A

primary sclerosing cholangitis

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Q

UDCA (Ursodiol) has no benefit treating what

A

primary sclerosing cholangitis

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Q

high risk for cholangiocarcinoma

A

PSC

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Q

3 ways to Rx PSC:

A

vanco + metronidazole
fecal microbiota transplant
FXR agonist

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Q

_____ activation decreases synthesis of bile acids and also increases their transport out of hepatocytes

A

FXR

Q

FXR agonist (used to treat primary biliary cholangitis)

A

OBETICHOLIC ACID

Q

middle-aged elderly women
anti-microbial antibodies
chronic granulomatous inflammation
fatigue, pruritis, cirrhosis
AMA +
pANCA -

A

primary biliary cholangitis

Q

first line treatment for primary biliary cholangitis

A

UDCA (ursodiol)

Q

2nd line treatment for primary biliary cholangitis

A

FXR agonist (OBETICHOLIC ACID)

Q

portal tract expanded and lymphocytes surrounding destructive granulomatous rxn centered on bile duct

A

primary biliary cholangitis

Q

major labs for biliary obstruction

A

ALP and GGT

Q

major lab elevation for hepatitis

A

AST/ALT

Q

alcohol and enzyme-inducing drugs elevate what lab

A

GGT

Q

level of bilirubin to see jaundice clinically

A

3.0

Q

what is characteristic for bacterial infection

A

neutrophil bands

Q

immature neutrophils produced by bone marrow that are increased in the blood when your body is fighting infection

A

neutrophil bands

Q

charcot triad in cholangitis

A

jaundice + abd pain + fever

Q

raynolds pentad in cholangitis

A

charcot triad + confusion + hypotension

Q

to treat autoimmune hepatitis

A

PREDNISONE + AZATHIOPRINE

Q

ALP > ALT/AST

A

biliary obstruction

Q

palmar erythema is pathognomonic for what

A

liver disease

Q

Asterixis (“flapping tremor”) is pathognomonic for what

A

liver disease

Q

to treat alcoholic hepatitis

A

PREDNISONE
PENTOXYFILLINE

Q

non specific TNF inhibitor to treat alcoholic hepatitis

A

PENTOXYFILLINE

Q

to treat non-alcoholic fatty liver disease

A

no drugs approved yet

Q

vitamin E
pentoxyfilline
metformin
pioglitazone

A

used to help in non-alcoholic liver disease but doesn’t treat

Q

GLP-2 analogue used to treat short bowel syndrome

A

TEDUGLUTIDE

Q

multiple protein kinase inhibitor used to treat hepatocellular carcinoma

A

SORAFENIB

Q

HFE gene mutation
loss of hepcidin (increase of iron release and absorption)

A

hereditary hemochromatosis

Q

Rx hereditary hemochromatosis

A

phlebotomy

Q

how to deal with iron overload in thalassemia major

A

blood transfusions
DESFEROXAMINE

Q

ATP7B mutation

A

Wilson Disease

Q

hepatolenticular degeneration (basal ganglia damage)

A

Wilson’s Disease

Q

Rx Menkes disease

A

copper

Q

pathognomonic for what

A

Wilson Disease

Q

Rx Wilson Disease

A

copper chelators (TRIENTINE)

Q

splanchnic vasoconstrictor used to treat variceal bleeds

A

Octreotide

Q

to Rx ascites

A

Spironolactone (K+ sparing diuretic)
Furosemide (loop diuretic)

Q

bacteria produce NH3 from proteins in the gut, cirrhotic liver cannot convert NH3 to urea—–> hyperammonemia

A

hepatic encephalopathy

Q

Asterixis (“flapping tremor”), lethargy, confusion, ataxia, slurred speech, coma

A

hepatic encephalopathy

Q

Rx hepatic encephalopathy

A

LACTULOSE (ammonia to ammonium)
RIFAXIMIN (inhibits RNA polymerase)
ACARBOSE

Q

avoid copper____ in patients with wilson’s disease

A

IUD