B5-024 Jaundice

Question 1

first place you can see signs of jaundice

Answer 1

oral mucosa

oral mucosa -> eyes -> skin

Question 2

most common place for a gallstone to lodge

Answer 2

distal to cystic duct

Question 3

an elevated alkaline phophate indicates an issue with

what structure

Answer 3

bile duct

Question 4

if Alk Phos, AST, ALT and bili are high
but INR and albumin are normal

acute or chronic?

Answer 4

acute

INR and albumin take a long time to change

Question 5

• AST/ALT in a 2:1 ratio
• INR high but corrects 24-48 hours after vitamin K

Answer 5

acute alcoholic hepatitis

Question 6

• liver is small, spleen is large
• thrombocytopenia
• low albumin
• increasing INR

Answer 6

chronic alcoholic hepatitis

Question 7

• very high transaminases (ALT > 1000)
• subacute

Answer 7

• acute viral hepatitis (hep A)
• or acetaminophen/carbon tetrachloride OD

Question 8

• infant
• ceasarean delivery

Answer 8

neonatal jaundice

Question 9

would you expect AST/ALT to be elevated in neonatal jaundice?

Answer 9

no

Question 10

repeated or chronic injury leads to

Answer 10

cirrhosis

Question 11

• decreasing albumin
• increasing INR
• hypoglycemia

Answer 11

NASH

Question 12

NASH significantly increases the risk of

Answer 12

Hepatocellular carcinoma

Question 13

hepatic encephalopathy is a symptom of

Answer 13

cirrhosis (NASH)

Question 14

causes esophageal varices and hemorrhoids

Answer 14

portal hypertension

Question 15

2 signs on hands that patient may have cirrhoisis

Answer 15

• palmar erythema
• dupuytren’s contracture

Question 16

• spider angiomas
• ascites
• caput medusa

can indicate…

Answer 16

cirrhosis

Question 17

TIPS procedure places a shut between the […] and […] to help alleviate portal hypertension

Answer 17

hepatic vein
portal vein

Question 18

elevated indirect/unconjugated bilirubin suggests..

Answer 18

hemolysis
or benign jaundice

FA pg 402

Question 19

elevated PTT and INR or decreased platelets would indicate

Answer 19

chronic liver disease

Question 20

what would you expect the AST:ALT ratio to look like in alcoholic liver disease?

Answer 20

AST> ALT usually 2:1

make a toAST with alcohol

FA pg 399

Question 21

in most liver disease AST […] ALT

less or greater

Answer 21

ALT > AST

except alcoholic liver disease

FA pg 399

Question 22

AST> ALT in nonalcoholic liver disease suggests

Answer 22

fibrosis/cirrhosis

FA pg 399

Question 23

aminotransferases over 1000 indicate

Answer 23

• drug induced liver injury
• acute viral hepatitis
• autoimmune hepatitis

FA pg 399

Question 24

elevated direct/conjugated bilirubin suggests

5

Answer 24

• pancreatic/liver cancer
• biliary tract obstruction
• cholangiocarcinoma
• liver fluke
• biliary tract disease (PSC, PBC)

FA pg 402

Question 25

thrombocytopenia, ascites, and spider nevi are common findings in patients with

Answer 25

cirrhosis

Question 26

histological definition of cirrhosis

Answer 26

stage 4 fibrosis

Question 27

mixed hyperbilirubinemia (both direct and indirect) suggests

Answer 27

• hepatitis
• cirrhosis

FA pg 402

Question 28

lysosomal enzyme that degrades bilirubin

Answer 28

B-glucoronidase

FA pg 402

Question 29

Dubin-Johnson would cause […] hyperbilirubinemia

conjugated/unconjugated

Answer 29

conjugated

excretion defect

FA pg 402

Question 30

Crigler-Najjar, Gilbert’s would cause [….] hyperbilirubinemia

conjugated/unconjugated

Answer 30

unconjugated

FA pg 402

Question 31

causes of hyperbilirubinemia

4

Answer 31

• Hemolysis
• Obstruction
• Tumor
• Liver disease

HOT Liver

FA pg 402

Question 32

best test to determin hepatic encephalopathy?

Answer 32

asterixis

Question 33

leads to a decrease in bile flow due to impaired secretion of bile or an obstruction of bile flow

Answer 33

cholestatic liver disease

Question 34

what signs would you expect to see in decompensated cirrhosis?

Answer 34

• asterixis
• peripheral edema
• hepatosplenomegaly
• muscle wasting

Question 35

how does cirrhosis cause muscle wasting?

Answer 35

catabolic state

Question 36

correction of INR with administration of vitamin K suggests

Answer 36

vitamin deficiency
malnutrition