CAIS - Review Flashcards
Unit 1
1
Q
What is the definition of heart failure?
A
Cardiac output unable to meet O2 demands of the body.
Or
Can only meet demands with increased filling pressure.
2
Q
What is the formula to calculate blood pressure?
A
Blood Pressure = cardiac output X total peripheral resistance
or
BP = stroke volume X heart rate X total peripheral resistance
3
Q
What is the formula to calculate cardiac output?
A
CO = stroke volume X heart rate
4
Q
What are three determinants of BP?
A
Volume
The generating force
Resistance
5
Q
If CO = SV X HR, what does this mean?
A
CO = amount of blood circulating per minute.
6
Q
What is the formula to calculate stroke volume?
A
SV = end diastolic volume - end systolic volume
7
Q
What is the formula to calculate ejection fraction?
A
ejection fraction = SV / EDV
8
Q
Stroke volume is affected by what?
A
Contractility, Afterload, and Preload
9
Q
What causes an increased stroke volume?
A
Increase in contractility
Increase in preload
or
Decrease in afterload
10
Q
A failing heart will have an (increase/decrease) in stroke volume?
A
A decrease in stroke volume.
11
Q
What are three general causes of heart failure?
A
- Myocardial Impairment
- Sudden preload increase
- Impaired ventricular filling
12
Q
What are some causes of myocardial failure?
A
- Ischemic heart disease
- cardiomyopathies
- chronic hypertension
13
Q
Chronic hypertension leads to _____ which will then lead to myocardial failure.
A
Ventricular remodeling
14
Q
Post MI, what is a likely cause of sudden AV valve regurgitation?
A
Papillary muscle rupture
15
Q
Infectious Endocarditis can cause sudden regurgitation of what heart valve?
A
Aortic valve
16
Q
A papillary muscle rupture and infectious endocarditis will suddenly (increase / decrease) the preload.
A
Increase
17
Q
What are three conditions that impair ventricular filling?
A
- constrictive pericarditis
- cardiac tamponade
- mitral and/or tricuspid valve stenosis
18
Q
Papillary muscle rupture usually occurs how many days after a myocardial infarction?
A
2-7 days
19
Q
Which valve is most likely to suffer from severe regurgitation from a post MI papillary muscle rupture?
A
Mitral valve
20
Q
Bacterial endocarditis - the acronym FROM JANE stands for what?
A
Fever Roth Spots Osler Nodes Murmur Janeway Lesions Anemia Nail-bed hemorrhage Emboli
21
Q
What is the difference between osler nodes and janeway lesions?
A
Osler nodes are tender raised lesions on finger and toe pads.
Janeway lesions are small, painless, erythematous lesions on the palm or the sole.
22
Q
Small hemorrhages (splinter like) underneath the nail bed raise concern for what kind of infection?
A
Bacterial Endocarditis
23
Q
Round white spots on the retina surrounded by hemorrhage are referred to as what? What condition is this seen in?
A
Roth spots and Bacterial Endocarditis
24
Q
Compression of the heart by fluid (blood / effusions) in the pericardial space resulting in a decrease in cardiac output is referred to as what?
A
Cardiac Tamponade
25
Define pulsus paradoxus.
Pulsus paradoxus is a decrease in amplitude of systolic blood pressure by >10mmHg during inspiration.
26
Pulsus paradoxus is commonly seen in what two cardiovascular disorders?
Caridac tamponade and pericarditis
27
Classically cardiac tamponade presents with the Beck Triad, what is the Beck Triad?
Beck Triad = hypotension, distended neck veins, and distant heart sounds.
28
Systolic heart failure is categorized as ______ and diastolic heart failure is categorized as ______.
Systolic heart failure is categorized as "Heart Failure with reduced Ejection Fraction" and diastolic heart failure is categorized as "Heart Failure with preserved Ejection Fraction."
29
Systolic Heart Failure = pump failure = failure to contract.
What are some causes for this?
Ischemic heart disease and dilated cardiomyopathy
30
Diastolic Heart Failure = Filling Failure = Failure to relax
What are some causes for this?
Chronic hypertension and hypertrophic cardiomyopathy
31
Parallel hypertrophy is considered (concentric or eccentric)?
Parallel hypertrophy is considered concentric.
32
Would you expect to see cardiomegaly on a CXR for concentric hypertrophy?
No, concentric hypertrophy has parallel inward thickening.
33
Serial hypertrophy is considered eccentric hypertrophy is caused by a direct response to what?
Eccentric hypertrophy is caused by a direct response to volume overload.
34
Eccentric (serial) hypertrophy would be considered normal in what kind of patient?
An athlete
35
What is the most common cause of right sided heart failure?
Left sided heart failure
36
Left sided heart failure can cause pulmonary venous congestion, pulmonary edema, and poor perfusion to the organs.
What would you expect to find on the CXR due to the pulmonary edema?
Pulmonary edema from Left sided heart failure CXR finding:
vascular congestion
cephalization
Kerley B lines
37
What physical exam findings would you suspect for right sided heart failure?
Jugular vein distention
Hepatojugular Reflux
RUQ fullness / distention
Pitting edema
38
Left Atrial pressure is normally 5-10mmHg, as pressure increases what kind of findings would you suspect to develop?
1. Cephalization (10-15mmHg)
2. Kerley B Lines (15-20mmHg)
3. Pulmonary Interstitial edema (20-25mmHg)
4. Pulmonary Alveolar Edema (>25mmHg)
39
How does the renal system react is response to a decrease in cardiac output?
Renal system activates the renin–angiotensin–aldosterone system, which produces more angiotension II, which increases total peripheral resistance.
This helps maintain blood pressure levels.
40
A prolonged decrease in cardiac output will cause a prolonged activation of RAAS. These patients will most likely present with (hypertension or hypotension)?
Hypertension
41
Edema depends on what two variables?
Hydrostatic pressures and oncotic pressure
42
Ischemic heart disease, hypertension, cardiomyopathy, valvular disease, and pericardial disease are all common etiologies for what umbrella term?
Heart Failure
43
What condition is usually secondary to valvular disease and a less common cause of primary heart failure?
Heart Arrhythmia
44
A nucleated biconcave cell that carries O2 to tissues and CO2 to the lungs.
Erythrocytes
45
What is the average life span of a human erythrocyte?
120 days
46
Erythrocytosis (polycythemia) will have an increase of what on a CBC?
An elevated hematocrit
47
Red blood cells that vary size is referred to as what? What will be elevated on the CBC?
Anisocytosis with an elevated RDW
48
Platelets are derived from what precursor?
Megakaryocytes
49
The majority of platelets (1/3) are stored in what organ?
The spleen
50
Platelets interact with what protein to form a platelet plug?
Fibrinogen
51
Granulocytes and agranulocytes are considered what type of blood cell?
Leukocytes (white blood cells)
52
What is the percent differential count for the following white blood cells?
```
Neutrophil
Lymphocyte
Monocyte
Eosinophil
Basophil
```
```
Neutrophil - 60%
Lymphocyte - 30%
Monocyte - 6%
Eosinophil - 3%
Basophil - 1%
```
53
Acute inflammatory response cell, phagocytic, multilobed nucleus, and numbers greatly increase during bacterial infections.
Neutrophil
54
Hypersegmented neutrophils are seen in a deficiency of?
Vitamin B12 and Folate deficiency
55
During bacterial infections or patients with CML, the peripheral smear will show an increase of what?
Band Cells (immature neutrophils)
56
Large kidney-shaped nucleus cell that differentiates into macrophages in tissues.
Monocyte
57
Phagocytose bacteria, cellular debris, and senescent RBCs.
Examples include: Kupffer cells, histiocytes, Langerhan cells, osteoclasts, and microglial cells.
Macrophages
58
Bilobed nucleus packed with large granules of uniformed size.
Defends against helminthic (parasite) infections and high phagocytic for antigen-antibody complexes.
Eosinophil
59
Causes of eosinophilia can be remembered with the acronym PACCMAN, what does PACCMAN stand for?
PACCMAN
```
Parasites
Asthma
Churg-Strauss Syndrome
Chronic adrenal insufficiency
Myeloproliferative disorders
Allergic Processes
Neoplasia (Hodgkin Lymphoma)
```
60
Densely packed granule cell that mediates allergic reactions.
Basophils
61
Another cell that mediates against allergic reactions and comes from the same precursor as basophils.
Mast Cells
62
Category that includes B cells, T cells, and NK cells.
Lymphocytes
63
What is the composition of fetal and adult hemoglobin?
```
Fetal hemoglobin (HbF) = 2 Alpha and 2 Gamma
Adult Hemoglobin (HbA) = 2 Alpha and 2 Beta
```
Remember:
Alpha Always; Gamma Goes; Becomes Beta
64
Acanthocytes are also called what?
Spur Cells
65
Spur cells are associated with what kind of disease?
Liver Disease
66
On a peripheral smear in a patient with sideroblastic anemia, what would you expect to see?
Basophilic stipping and ringed sideroblasts.
67
Basophilic stippling is associated with what kinds of pathology?
Sideroblastic anemia (lead poisoning) and thalassemia.
68
Thalassemia could cause several changes on the peripheral blood smear, what are they?
Basophilic stipping
dacrocytes (tear drop cells)
target cells
69
G6PD Deficiency Patients will have these two changes on a peripheral smear.
Degmacytes (bite cells) and Heinz Bodies
70
How do you differentiate a burr cell from a spur cell?
Burr cell projections are more uniformed and smaller.
71
Echinocytes (burr cells) are in what kind of pathology?
End-stage renal disease
Liver disease
Pyruvate Kinase Deficiency
72
Megaloblastic Anemia will show these on a peripheral smear.
Macro-ovalocytes
73
Hemolytic anemias may show schistocytes on a peripheral smear, what is another name for schistocytes?
Helmet Cells
74
Sickle cell anemia patients may have sickled RBCs present, what are some reasons for the presence of sickle cells?
Dehydration
Deoxygenation
High Altitude
75
A small spherical RBC without the normal central pallor is referred to as?
A spherocyte
76
Spherocytes are seen in patients with?
Drug and infection inducted hemolytic anemias.
It can also be hereditary.
77
What are the four MAIN causes for target cells?
HbC Disease
Asplenia
Liver Disease
Thalassemia
HALT said the hunter to the Target
78
Patients with function hyposplenia or asplenia will have what on a peripheral smear?
Howell-Jolly Bodies
79
Microcytic anemia is classified as having an MCV value lower than?
And list at least 3 different types of microcytic anemias.
MCV < 80 fL
```
Different types of microcytic anemias:
Iron Deficiency (most common)
alpha-Thalassemia
beta-Thalassemia
Lead Poisoning
Sideroblastic Anemia
```
80
RBC formation is called?
Erythropoiesis
81
Adult hematopoiesis occurs where?
The bone marrow.
82
What type of iron is found in adult Hemoglobin?
Ferrous Iron (2+)
83
Where does heme synthesis occur in the cell?
The mitochondria
84
Where does globin syntheis occur in the cell?
The cytoplasm
85
What are the normal percentages for hemoglobin types in an adult patient?
Hgb A = 98%
Hgb A2 = 2%
Hgb F = <1%
86
Hgb S is found in patients with what disease?
Sickle Cell trait/disease
87
Iron is bound and transported in the blood by what protein?
Transferrin
88
Transferrin transport most of the iron to the bone marrow, where what occurs?
Hemoglobin synthesis
89
Where is iron stored within the body?
In the liver bound to ferritin.
90
What substance improves the absorption of iron?
Ascorbic acid (orange juice)
91
Iron is not cleared well from the body, it is generally eliminated by sloughed enterocytes in stool or from bleeding.
Therefore iron overload is toxic, over does needs what form of treatment?
Chelation treatment
92
What form is iron in when it binds to transferrin?
What protein puts iron into this state?
Ferric state (3+)
Ferroxidase Protein oxidizes Fe2+ to Fe3+
93
What are the three primary values for a CBC?
RBC count, Hgb, and Hct
Remember the rule of 3's
94
Define MCV
Mean Corpuscular Volume
| volume / size of the RBC
95
Define MCH
Mean corpuscular Hgb (mean cell Hgb)
content or weight per RBC
96
Define MCHC
Mean corpuscular Hgb Concentration.
Reveals concentration and color per RBC
This value should not be increased.
97
Define RDW
Red Cell Distribution Width
size and uniformity
```
Anisocytosis = size variability
Poikilocytosis = shape variability
```
98
Explain TIBC
TIBC = Total Iron Binding Capacity
This value reflects the number of unbound transferrin, or the empty seats.
99
What is serum ferritin?
Reflects the level of iron bound to ferritin and stored.
100
What is transferrin saturation?
The percentage of iron bound to transferrin.
101
When would you use hemoglobin electrophoresis?
To diagnose different hemoglobinpathies (sickle cell, thalassemia, etc).
102
List at least four causes of macrocytic anemia.
```
B12 Deficiency
Inherited
GI Disease or Surgery
Folic Acid Deficiency
Alcoholism
Thiamine Responsive
Reticulocyte miscount
Endocrine
Dietary
Chemotherapy
Erythrocyte decrease
Liver disease
Lesch-Nyhan syndrome
Splenectomy
```
103
List at least two normocytic anemias.
Aplastic anemia
Anemia of Chronic Disease
G6PD Deficiency
Sickle Cell Disease
104
There are four major pathology categories for abnormal hemoglobin synthesis.
Name them and provide an example for each.
1. Globin Chain Qualitative Problem: Sickle Cell Disease
2. Globin Chain Quantitative Problem: Thalassemia
3. Heme Synthesis Problem: Porphyrias
4. Iron not incorporated normally into the Heme: Sideroblastic
105
Valine is substituted for glutamic acid on what chain causes sickle cell disease?
The beta chain
106
Hgb S Polymerization occurs when?
When there is an increased demand for O2 from the tissues, leading to an increase in O2 release from the RBCs.
107
Infection, Decreased pH, Temperature changes, Dehydration, high altitude, and overexertion are all triggers for?
A sickling episode in a patient with sickle cell disease.
108
Describe the Bohr Effect
O2 dissociates from Hgb more readily when the pH is lowered.
Increased O2 demand due to increased metabolism.
Increased metabolism = more CO2 = lower intracellular pH
H+ loads onto Hbg and O2 unloads = sickling
109
There are several complications in sickle cell disease.
Name at least two.
- Aplastic Crisis
- Autosplenectomy
- Splenic Infarct
- Osteomyelitis
- Painful Crises
- Sickling in renal medulla
110
Why is hydroxyurea used for treatment in patients with sick cell disease?
Hydoxyurea increases Hbg F production, thus reducing the chance of a sickling crisis.
111
What are some complications from a painful crisis in a patient with sickle cell disease?
Painful crisis = vaso-occlusion
This leads to dactylitis, priapism, acute chest syndrome, avascular necrosis, and possible stroke.
112
What is "crew cut" ?
Crew cut skull can be seen on xray due to marrow expansion from increased erythropoiesis.
This is seen in sickle cell and Thalassemia patients.
113
Sickle cell anemia decreases immunity. Poor cellular flow leads to decreases in what?
Decreased:
- WBC delivery
- O2 delivery
- Tissue support and repair
114
Sickle cell trait is protective against what kind of parasite and related disease?
Sickle Cell Trait is protective against Plasmodium Invasion, therefore reducing risk of a malarial infection.
115
How does the sickle cell trait for protection against malaria work?
The Plasmodium invasion produces intracellular hypoxia, this causes the cells to sickle, phagocytes respond and rid the body of the abnormal cells with the parasite.
116
Acute chest syndrome is caused by pneumonia, infection, and sickling red cells.
It can be hard to determine the difference in the cause of ACS, so how is treatment decided?
Patient is generally treated for both infection and sickling cells.
Infections are treated with antibiotics and sickling is treated with a blood transfusion.
117
Leg ulcers are commonly seen in patients with sickle cell disease, what are the common causes for this leg ulcers?
Leg ulcers in sickle cell patients are commonly caused by insect bites or cuts that fail to heal. This is due to poor blood circulation to the skin.
118
A normal red blood cell's life span is about 120 days. What is the average life span for a red cell in sickle cell anemia?
About 10-20 days.
119
The reticulocyte count in sickle cell anemia will be increased or decreased?
Increased
120
Define plasia
Formation or development
121
Define metaplasia
cellular transformation
122
Define dysplasia
Disordered cellular transformation
123
Define Neoplasia
Irreversible
124
List out malignant progression in order
1. Metaplasia
2. Dysplasia
3. Neoplasia
125
Define Hyperplasia
Increase in cell number
126
Define Hypertrophy
Increase in cell size (muscle cell or fiber)
127
The esophagus has what kind of cellular lining?
Nonkeratinized stratified squamous epithelium
128
List the three embryonic gut regions.
Foregut, Midgut, and Hindgut
129
What structures are found in the foregut?
Pharynx, lower esophagus to proximal duodenum, liver, gallbladder, pancreas, and spleen.
130
What structures are found in the Midgut?
Distal duodenum to proximal 2/3 of transverse colon.
131
What structures are found in the Hindgut?
Distal 1/3 of transverse colon to upper portion of the rectum.
132
A condition where the epithelium in the distal esophagus changes from stratified squamous to columnar cells.
Barrett's Esophagus
133
Barrett's Esophagus is caused by what other GI condition?
Chronic gastroesophageal reflux disease (GERD)
134
Barrett's esophagus increases a patients risk for what?
Esophageal adenocarcinoma
135
List the three types of pain discussed during the GI review lecture.
1. Somatic Pain
2. Visceral Pain
3. Referred Pain
136
What are two GI disorders we commonly associate with having referred pain?
1. Appendicitis (epigastric region)
| 2. Cholecystitis (right shoulder pain)
137
What is a visceral ligament?
Visceral ligaments attach organs to the body wall or another organ. Typically this ligaments will have a rich nerve supply.
138
McBurney's Point tests for what?
Appendicitis
139
Describe the progression of appendicitis.
Periumbilical pain that migrates to the RLQ of the abdomen. Nausea and Fever and usually present. Peritonitis is expected on physical exam.
140
How do you differentiate between an upper and lower GI bleed?
Bleeds above the ligament of Treitz is an upper GI bleed and below the ligament are a lower GI bleed.
141
A disorder in which the lower esophageal sphincter fails to relax and a "birds beak" appearance on radiograph.
Achalasia
142
What are two compounds produced by the stomach parietal cells?
Intrinsic factor and Gastric Acid
143
What is intrinsic factor used for?
Intrinsic factor is a B12 binding protein that is required for the uptake of B12 at the terminal ileum.
144
Where is gastrin produced?
In the G cells of the antrum of the stomach and duodenum.
145
Gastrin stimulates the production of what?
Gastric Acid
146
D cells of the pancreatic islets and GI mucosa produce what major regulatory substance?
Somatostatin
147
Chief cells located in the stomach produce what? What is this product used for?
Pepsin, which aids in protein digestion.
148
Name the three enzymes produced by the pancreas for macronutrient digestion.
```
alpha-amylase = starch/polysaccarhide digestion
Lipase = fat digestion
Protease = protein digestion
```
149
Gallstones are caused by what gallbladder disorder?
Cholelithiasis
150
What are the four F's for cholelithiasis?
Female
Fat
Fertile
Forty
151
Name and describe the two types of stones seen in cholelithiasis.
Cholesterol stones: 80% of stones and opaque due to calcifications.
Pigment Stones: black, radiopaque
152
How is cholelithiasis diagnosed?
Using ultrasound.
153
Cholelithiasis is a gallstone, so what is choledocholithiasis?
Choledocholithiasis is the presence of a gallstone in the common bile duct. This condition leads to an elevated ALP, GGT, direct bilirubin, and/or AST/ALT levels.
154
Cholecystitis is defined as?
Acute or chronic inflammation of the gallbladder.
155
Name the three types of cholecystitis.
1. Calculous cholecystitis (most common)
2. Acalculous cholecystitis
3. Gallstone Ileus
156
Choledocholithiasis can lead to inflammation of what neighboring organ?
The pancreas, causing pancreatitis.
157
What is the triangle of Calot?
It is a surgical landmark made up of the cystic duct, common hepatic duct and the cystic artery.
158
What is the triangle of Calot important?
As a surgical landmark, it helps the surgeon identify the cystic artery for ligation during a cholecystectomy.
159
Define ascending cholangitis.
A bacterial infection of the biliary tract (common bile duct) originating from the duodenum. The bacteria move up the bile duct causing inflammation, this is usually secondary to some type of obstruction within the bile duct.
160
What is Charcot's Triad?
Used for ascending cholangitis
1. Jaundice
2. Fever
3. RUQ Pain
161
What is Reynold's Pentad?
Also used for cholangitis
Reynold's Pentad is Charcot's Triad (jaundice, fever, RUQ Pain) +
Mental Status Change and Shock (hypotension)
162
In hemorrhagic pancreatitis what are two signs you suspect to see?
Cullen's sign (periumbilical bleeding) and Grey Turner Sign (flank bleeding)
163
Where is Traube's space?
Left - Mid Axillary Line 6 ICS
164
Where is Castell's Sign?
Left - Anterior Axillary Line Lowest ICS
165
What are the two most common causes of peptic ulcer disease?
H. pylori infection and NSAIDS
166
An ulcer associated with pain during meals and weight loss?
Gastric Ulcer
167
What are three complications of having a peptic ulcer?
1. Hemorrhage
2. Obstruction
3. Perforation
168
Duodenal ulcers usually cause pain during or after eating?
Patients may find relief of pain while eating, but the pain can return a few hours after consuming a meal.
169
Gastroesophageal Reflux Disease (GERD) commonly presents with what symptoms?
Heartburn, regurgitation, and dysphagia. Patient may also complain of having a cough.
170
A condition where the stomach herniates upward through the esophageal hiatus of the diaphragm.
Hiatal Hernia
171
What is the most common type of hiatal hernia?
A sliding hiatal hernia, also referred to as an hourglass stomach.
172
What are the two major liver enzymes seen on a Liver Function Test?
Alanine Transaminase (ALT) and Aspartate Transaminase (AST)
173
Besides ALT and AST, what are two other lab values one can order to access liver function?
Alkaline Phosphatatse (ALP) and gamma-Glutamyl Transferase (GGT)
174
Micronodular nodular growth on the liver indicates what kind of etiology?
Alcohol or hemochromatosis
175
Macronodular nodular growth on the liver indicates what kind of etiology?
Chronic viral hepatitis
176
Virchow's node (left-sided supraclavicular lymph node) is a sentinel lymph node for cancer and can denote metastasis. What is this sign called when Virchow's node it enlarged and hard?
Troisier's Sign
177
What are the two primary veins that conjoin and make up the portal vein?
The splenic vein and the superior mesenteric vein
178
A portal triad consists of what?
A hepatic artery, hepatic portal vein, and a hepatic duct. (Lymph and nerve innervation runs with portal triad too)
179
The portal branches of the portal vein take blood to the ______ to then be absorbed by the hepatocytes.
Sinusoids to be absorbed by the hepatocytes
180
Hepatic veins drain directly into what major venous vessel?
The inferior vena cava
181
The portosystemic system consists of what three major veins and the portal vein.
The splenic vein, the inferior mesenteric vein, and the superior mesenteric vein.
182
The common bile duct and the pancreatic duct conjoin to form what structure?
The hepatopancreatic ampulla (ampulla of vater)
183
The spleen separates RBCs into Heme and Globin. Heme interacts with the enzyme heme oxygenase to become what compound?
Biliverdin
184
Biliverdin is converted into unconjugated bilirubin by biliverdin reductase. Unconjugated bilirubin is lipid or water soluble?
Lipid soluble
185
What protein transports unconjugated bilirubin to the liver?
Albumin
186
Unconjugated bilirubin interacts with the enzyme UGT to be converted into Conjugated Bilirubin, which is soluble in?
Conjugated bilirubin is water soluble
187
After bilirubin is conjugated and it is secreted what are the three things that can happen to it?
Excreted via urine as urobilinogen
Recycled via enterohepatic circulation
Excreted via feces as stercobilin
188
Indirect Hyperbilirubinemia is most commonly caused by?
Hemolysis
189
Direct Hyperbilirubinemia is most commonly caused by?
Biliary tract Disease or biliary obstruction
190
Antibodies are produced by what lymphocyte?
B lymphocytes
191
B lymphocytes produce several different immunoglobin classes:
- IgA
- IgD
- IgE
- IgM
- IgG
Which one means a patient was previously exposed to the antigen?
IgG
192
A patient with a Acute Viral Hepatitis A, with no previous exposure, would be expected to have what positive lab finding?
+ anti-HAV IgM
193
A person who was vaccinated for Hep A would be expected to have what positive lab finding?
+ anti-HAV IgG
194
A patient that has tested positive for HBsAg within the past 6 months ( <6 months ) has what disease?
Acute Hepatitis B
195
Hepatitis B is considered chronic when?
A patient has tested + for HBsAg for more than 6 months
196
A patient has a + HBeAg, this would indicate what?
A patient with chronic HBV with high levels of virus within the hepatocytes.
197
What lab values would you expect to see for patient with a past exposure to HBV that was resolved?
- HBsAg
+ anti-HBs IgG
+ anti-HBc IgG
198
Someone who was immunized against the HBV would have what positive lab finding?
+ anti-HBs IgG
199
Hepatitis D can only infect patients with past or current exposure to what disease?
Hepatitis B
200
Elevated AST and ALT values where the AST is double the amount of ALT is indicative of what disorder?
Alcoholic Hepatitis
201
ALT and AST values of > 3000IU is seen in what kind of situation?
Toxic injury due to drugs/medications
202
Acute hepatitis usually shows AST and ALT levels between what two values?
AST and ALT will generally be between 500-3000 IU
203
Ammonia in the body comes from where?
Broken down amino acids
204
Explain how ammonia is metabolized in a healthy liver.
Ammonia is absorbed by the GI tract, it is transported in the portal blood to the liver, the liver converts ammonia into urea, the urea enters systemic circulation and enters the kidneys, finally the urea is excreted via urine.
205
What is the most common reason for build up of ammonia in the body?
Portal hypertension, the ammonia is unable to enter the hepatocytes to be metabolized.
206
When ammonia is allowed to build up and enter other cells of the body what condition can eventually develop?
Hepatic Encephalopathy.
207
What is the primary treatment for hepatic encephalopathy?
Lactulose - converts ammonia (NH3+) into ammonium (NH4+) which is then excreted in the feces.
Patient should also be treated with an antibiotic (rifaximin) to reduce ammonia producing gut bacteria.
208
What are signs and symptoms of ammonia toxicity?
- Disorientation
- asterixis
- difficult to arouse
- coma
- overall mental confusion
209
What is asterixis?
A flapping tremor of the hands
210
A condition that shows macrovesicular fatty changes in the liver and may be reversible with alcohol cessation.
Hepatic Steatosis
211
Intracytoplasmic eosinophilic inclusions of damaged keratin filaments are more commonly referred to as?
Mallory bodies
212
In alcoholic hepatitis which value is generally greater, AST or ALT?
AST > ALT (ration is usally > 2:1)
213
What is the final and irreversible form of alcoholic liver disease?
Alcoholic cirrhosis
214
In alcoholic cirrhosis, regenerative nodules surrounded by fibrous bands are in response to what?
Chronic liver injury, portal HTN, and end-stage liver disease.
215
In nonalcoholic fatty liver disease which lab value is greater AST or ALT?
ALT > AST
216
Nonalcoholic fatty liver disease is suspected in patients would are?
Suffering from metabolic syndrome (insulin resistance) and who are obese.
217
What is a classic lab finding in a patient with primary biliary cholangitis (cirrhosis)?
+ anti-mitochondrial antibody and increase in IgM
218
This disease is an autoimmune reaction leading to lymphocytic infiltrate and granulomas, and eventual destruction of lobular bile ducts.
Primary Biliary Cholangitis (Cirrhosis)
219
Primary Biliary Cholangitis is most commonly seen in what patient population?
Middle-aged Women
220
Alternating strictures and dilation with beading of intra- and extrahepatic bile ducts on ERCP is classic for this disease.
Primary Sclerosing Cholangitis
221
Primary Sclerosing Cholangitis is most commonly seen in what patient population?
Middle-aged men with IBD
222
Primary Sclerosing Cholangitis is most common associated with what disorder?
Ulcerative Colitis
223
Primary Sclerosing Cholangitis increases at patients risk for what type of cancer?
Cholangiocarcinoma and gallbladder cancer
224
A positive anti-smooth muscle lab finding indicates what disease?
Autoimmune hepatitis type 1
225
What is the most common primary cause of a malignant tumor of the liver in adults?
Hepatocellular Carcinoma
226
Hepatocellular Carcinoma is strongly associated with what other disease?
Hepatitis B Virus (and other forms of cirrhosis)
227
Hepatocellular cancer may lead to this syndrome.
Budd-Chiari Syndrome
228
How is hepatocelluar cancer diagnosed?
1. +alpha-fetoprotein lab
2. ultrasound or contrast CT/MRI
3. Biopsy
229
What lab values will be severly elevated in acute pancreatitis?
Serum amylase and lipase (up to 3x the normal limit)
230
A patient would is a long time alcoholic, with diabetes, and a history of steatorrhea is at risk for?
Chronic Pancreatitis
231
Pancreatic Cancer is most common in what part of the pancreas?
The head of the pancrease
232
Describe Courvoisier Sign
Obstructive jaundice with palpable, nontender gallbladder.
233
What is the treatment of choice for a patient with confirmed Pancreatic Adenocarcinoma of the head of the pancreas?
The Whipple Procedure
234
Risk factors for pancreatic cancer include:
- Tob use
- Chronic Pancreatitis
- Diabetes
- Age >50
- Jewish or African-American
