Ascites and jaundice addt'l

Question 1

Infiltrative hepatic dz

Liver mets come from

These lead to

Answer 1

sarcoid, HCC, mets

colon, gastric, breast, pancreatic, lung

Compression/obstruction of portal veins

Question 2

Peritoneal carcinomatosis

2 causes

Tb ascites

Translocation of intestinal bacteria into ascitis fluid

Answer 2

tumor cells in liver

ovarian cancer, peritoneal mesothelioma

Peritoneum studded with tubercles, secreting a proteinaceous exudate leading to fluid accumulation

Spontaneous bacterial peritonitis

Question 3

Mech of nephrotic ascites

Ascites sx

Mech of peripheral edema

SBP

Answer 3

dec oncotic pressure, fluid moves to interstitial spaces

Ab distension, discomfort, SOB, weight gain

Weight of peritoneal fluid compresses ab/pelvic veins, leading to dec VR

Fever, ab pain, altered mental status

Question 4

Dx test

Urobilinogen reabsorption

Answer 4

paracentesis

Conjugated in liver or excreted by kidneys

Question 5

Gilbert vs CN enzyme levels

Results in

Answer 5

Diminished vs low/absent

Inc unconjugated bilirubin (more in CN)

Question 6

Causes of intrahepatic cholestasis

Other extrahepatic etiologies

Hypertonicitiy with

Answer 6

viruses, alcohol, NAFLD, drugs

Inflitrative liver dz, PBC, PSC, enzyme def

Retrocollis and opisthotnonos

Question 7

Sx of cholestasis

Triggers of jaundic

CN jaundice develops in

Answer 7

Pruritis- worse at night/stress

Fasting, illness, exercise, alcohol, menstruation

childhood

Question 8

Normal serum bilirubin levels

24 hrs
48 hrs
72hrs

Answer 8

8
12
16

Question 9

Gilbert
CN
DJS/RS

Bilirubin levels

Answer 9

<7, <20% is conjugated
7-20, <20% is conjugated
2-20, >50% is conjugated