B5-024 Jaundice Flashcards
first place you can see signs of jaundice
oral mucosa
oral mucosa -> eyes -> skin
most common place for a gallstone to lodge
distal to cystic duct
an elevated alkaline phophate indicates an issue with
what structure
bile duct
if Alk Phos, AST, ALT and bili are high
but INR and albumin are normal
acute or chronic?
acute
INR and albumin take a long time to change
- AST/ALT in a 2:1 ratio
- INR high but corrects 24-48 hours after vitamin K
acute alcoholic hepatitis
- liver is small, spleen is large
- thrombocytopenia
- low albumin
- increasing INR
chronic alcoholic hepatitis
- very high transaminases (ALT > 1000)
- subacute
- acute viral hepatitis (hep A)
- or acetaminophen/carbon tetrachloride OD
- infant
- ceasarean delivery
neonatal jaundice
would you expect AST/ALT to be elevated in neonatal jaundice?
no
repeated or chronic injury leads to
cirrhosis
- decreasing albumin
- increasing INR
- hypoglycemia
NASH
NASH significantly increases the risk of
Hepatocellular carcinoma
hepatic encephalopathy is a symptom of
cirrhosis (NASH)
causes esophageal varices and hemorrhoids
portal hypertension
2 signs on hands that patient may have cirrhoisis
- palmar erythema
- dupuytren’s contracture
- spider angiomas
- ascites
- caput medusa
can indicate…
cirrhosis
TIPS procedure places a shut between the […] and […] to help alleviate portal hypertension
hepatic vein
portal vein
elevated indirect/unconjugated bilirubin suggests..
hemolysis
or benign jaundice
FA pg 402
elevated PTT and INR or decreased platelets would indicate
chronic liver disease
what would you expect the AST:ALT ratio to look like in alcoholic liver disease?
AST> ALT usually 2:1
make a toAST with alcohol
FA pg 399
in most liver disease AST […] ALT
less or greater
ALT > AST
except alcoholic liver disease
FA pg 399
AST> ALT in nonalcoholic liver disease suggests
fibrosis/cirrhosis
FA pg 399
aminotransferases over 1000 indicate
- drug induced liver injury
- acute viral hepatitis
- autoimmune hepatitis
FA pg 399
elevated direct/conjugated bilirubin suggests
5
- pancreatic/liver cancer
- biliary tract obstruction
- cholangiocarcinoma
- liver fluke
- biliary tract disease (PSC, PBC)
FA pg 402
thrombocytopenia, ascites, and spider nevi are common findings in patients with
cirrhosis
histological definition of cirrhosis
stage 4 fibrosis
mixed hyperbilirubinemia (both direct and indirect) suggests
- hepatitis
- cirrhosis
FA pg 402
lysosomal enzyme that degrades bilirubin
B-glucoronidase
FA pg 402
Dubin-Johnson would cause […] hyperbilirubinemia
conjugated/unconjugated
conjugated
excretion defect
FA pg 402
Crigler-Najjar, Gilbert’s would cause [….] hyperbilirubinemia
conjugated/unconjugated
unconjugated
FA pg 402
causes of hyperbilirubinemia
4
- Hemolysis
- Obstruction
- Tumor
- Liver disease
HOT Liver
FA pg 402
best test to determin hepatic encephalopathy?
asterixis
leads to a decrease in bile flow due to impaired secretion of bile or an obstruction of bile flow
cholestatic liver disease
what signs would you expect to see in decompensated cirrhosis?
- asterixis
- peripheral edema
- hepatosplenomegaly
- muscle wasting
how does cirrhosis cause muscle wasting?
catabolic state
correction of INR with administration of vitamin K suggests
vitamin deficiency
malnutrition
