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GI- Week 6 > Bernadino: Liver Dysfunction and Gallbladder Disease > Flashcards

Bernadino: Liver Dysfunction and Gallbladder Disease Flashcards

1
Q

What is the most common etiology of jaundice in an infant?

A

physiologic (goes away in a few weeks)

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2
Q

What are the most common causes of jaundice in an adolescent?

A

Gilbert’s syndrome

HAV

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3
Q

What are the MC causes of jaundice in young adults?

A

mostly viral hepatitis
followed by EtOH, autoimmune
biliary tract

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4
Q

What are the MC causes of jaundice in the elderly?

A

malignancy
toxins/drugs
stones

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5
Q

What can cause jaundice in the first and second trimester?

A

viral hepatitis

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6
Q

What causes jaundice in the 3rd trimester?

A

preeclampsia

cholestasis of pregnancy

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7
Q

What is Gilbert syndrome?

A

AD-benign
An increase in unconjugated bilirubinemia brought on by illness, fasting stress, fatigue, EtOH, nicotinic acid intake, premenstrual periods in some women

*my dad has this!

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8
Q

What indicates hepatocellular jaundice?

A

AST/ALT elevation > bilirubin or alk phos

Suggests parenchymal inflam.

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9
Q

What causes unconjugated hyperbilirubinemia?

A

Hemolysis
Gilbert’s syndrome
Medication (typically abx)

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10
Q

What causes conjugated hyperbilirubinemia?

A

Intrinsic liver disease
Medication
Biliary tract obstruction

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11
Q

What are the 3 ways that jaundice can present?

A
  1. Jaundice= >2-3 mg/dl
  2. first noticeable in sclera (icterus)
  3. Intense itching–seen w/ cholestasis but does NOT correlate w/ degree of hyperbilirubinemia
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12
Q

What causes the intense itching associated w/ jaundice? How do you tx itching caused by jaundice?

A

retained bile acids

correct obstruction or use bile acid binding agents

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13
Q

Spider hemangiomas, dupuytren’s contractures, caput medusa, palmer erythema and xanthelasma are all…..

A

physical evidence of chronic liver disease

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14
Q

What are spider hemangiomas? Are they specific to cirrhosis? How does number and size correlate to severity of liver disease?

A

altered estrogen metabolism in chronic liver ds.>
small pulsating arteriole>
usually on face or chest

-Not specific to cirrhosis, seen in prego and normal ppl

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15
Q

What increases the risk of variceal hemorrhage?

A

Increased number of spider hemangiomas

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16
Q

What are dupuytrens contractures? In what populations are they seen in?

A

progressive fibrosis of palmar fascia → abnormal flexion of fingers

MC in EtOH related liver ds and WHITE males
-Also seen in diabetes, repetitive use injuries, and malignancies

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17
Q

What is caput medusa?

A

Portal HTN →
blood from portal venous system shunted through periumbilical veins →
umbilical vein →
abdominal wall vessels

*Presence of caput medusa → increased risk of mortality in 1 yr

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18
Q

What is a palmer erythema? Is it specific for liver disease?

A

vasodilation and increased blood flow>
occurs on thenar and hypothenar eminences and finger tipes

*Not specific for liver disease
Seen in:
prego
hyperthyroidism
RA
hematologic malignancies
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19
Q

What is an xanthelasma?

A

chronic cholestasis marked by hypercholesterolemia>
Lipid deposition in the dermis and subcutaneous tissue>
extensor surfaces of extremities and around eyes

20
Q

What is the first choice for diagnosing gallstones or cholecystitis

A

Transabdominal US

21
Q

How does cholecystitis appear on US?

A

pericholecystic fluid

GB wall thickening (4 mm)

22
Q

What complications are associated w/ cholelithiasis and cholelocholithiasis?

A
  • Biliary pain
  • Acute cholecystitis
  • Chronic cholecystitis – scarring wall → no contraction
  • Choledocholithiasis - stones in bile duct
  • Cholangitis - infxn of bile duct
  • Gallstone pancreatitis - reflux into pancreas
23
Q

***What characterizes biliary pain?

A 
colic- crescendo/decrescendo
minutes to hurs
spasm of GB if cystic duct obstruction
often POST PRANDIAL
RUQ
Radiates to interscapular region of right shoulder
N and V
Pain > 6 hrs; fever suggests cholecystitis/cholangitis
24
Q

What causes biliary type pain w/ NO stones?

A

missed stones
Microlithiasis (stones too small to see on US)
HIDA scan → can show bile leak

25
Q

How does Acute cholecystitis present?

A

Murphy sign- RUQ tenderness on inspiration

Palpable gallbladder

26
Q

Labs come back and show elevated WBC, mild increase in amylase and lipase and normal liver functions. The US shows gallbaldder w/ wall thickening > 4 mm.

Dx?

A

acute cholecystitis

27
Q

How do you tx acute cholecystitis?

A

Broad spectrum abx
Pain management
Cholecystectomy w/in 96 hrs of Sx onset - 70% of pts w/ biliary colic will develop complications w/in 2 yrs of onset of Sx

28
Q

What is Acalculous cholecystitis?

A

Occurs in 5-10% of acute cholecystitis cases.
Usually in hospitalized, critically ill pts after major surgery or trauma.
Leads to gallbaldder stasis and ischemia.

29
Q

How do ou tx acalculous cholecystitis?

A

broad spectrum abx
cholecystectomy
cholecyst tube

30
Q

What are serious complications of laprascopic cholecystectomys?

A

bleeding, abcess formation, leaks

31
Q

What is cholangitis? MC cause?

A

Infection of the bile duct

85% are caused by gall stones

32
Q

What pathogens can cause cholangitis?

A

E. coli, Klebsiella, Pseudomonas, enterococci, and Proteus

33
Q

How do you tx cholangitis?

A

broad spectrum abx

ERCP for bile duct decompression

34
Q

What causes 40% of acute pancreatitis cases?

A

gallstones and EtOH>
stone passage, stone obstruction>
biliopancreatic reflux

35
Q

How do you manage pancreatitis?

A

hydration
bowel rest
pain control
possibly abx

36
Q

What are complications associated w/ necrotizing pancreatitis?

A

organ failure, pseudocyst, diabetes, disconnected duct, etc.

37
Q

What cancer is an uncommon adenocarcinoma that often causes proximal obstruction and has a poor prognosis w/ 5 yr survival?

A

Gallbladder cancer

38
Q

What is cholangiocarcinoma? What is the diference between intrahepatic and extrahepatic tumors?

A

adenocarcinoma of biliary epithelium

intrahepatic> early sx
extrahepati> late sx (worse prognosis)

39
Q

How to you tx cholangiocarcinoma?

A

surgical resection

40
Q

What is the most sensitive method to detect ascites?

A

transabdominal US

41
Q

What is good at detecting pancreatic cancer and liver metasteses?

A

CT

42
Q

What is used to dx liver lesions seen on US or CT?

A

MRI or MRCP

43
Q

What is used to dx sclerosing cholangitis?

A

MCRP

44
Q

What imaging method is best for looking at stones?

A

EUS

45
Q

What is a HIDA scan?

A

IV technetium labeled> taken up and excreted by hepatocytes>
visualization of bile duct, gall bladder, small bowel

*non-visualization of GB is considered a + test

GI- Week 6 (14 decks)

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