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Section 9: Gastrointestinal Disorders > Chapter 80: Hepatic Disorder > Flashcards

Chapter 80: Hepatic Disorder Flashcards

1
Q

Vitamin K dependent clotting factors

A

II, VII, IX, X; protein C and S

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2
Q

A pivotal characteristic of chronic liver disease and is a hallmark of liver failure

A

Encephalopathy

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3
Q

Hyperbilirubinemia can occur for one of three reasons

A
  • Overproduction
  • Inadequate cellular processing
  • Decreased excretion of bilirubin
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4
Q

Risk factors specific to NAFLD

A
  • Obesity
  • DM2
  • Hyperlipidemia
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5
Q

Laboratory tests for hepatobiliary disease can be divided into four categories

A

(1) markers of acute hepatocyte injury or death
(2) measurements of hepatocyte synthetic function
(3) indicators of hepatocyte catabolic activity
(4) tests to diagnose specific disease entities

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6
Q

Tests that reflect hepatocyte synthetic function the liver

A

Prothrombin time and albumin

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7
Q

Tests that reflect hepatocyte catabolic function of the liver

A

Ammonia

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8
Q

Less than 5 times elevation of transaminases indicates?

A

Alcohol liver disease and nonalcoholic steatohepatitis

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9
Q

An aspartate aminotransferase–to–alanine aminotransferase ratio of greater than 2 indicates?

A

Alcoholic hepatitis

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10
Q

This may rise γ-Glutamyl transpeptidase production

A
  • Alcohol
  • Phenobarbital
  • Warfarin
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11
Q

How many increase above normal result of alkaline phosphatase is suggestive of cholestasis?

A

Four times

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12
Q

Viral hepatitis serologies for screening panels

A

Hepatitis A - antiHAV antigen IgM
Hepatitis B - HbsAg
Hepatitis C - antiHCV antibodies

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13
Q

How long will you see masking of result in hepatitis C?

A

6 to 8 weeks

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14
Q

Diagnosis for spontaneous bacterial peritonitis

A

A total WBC count >1000/mm3 or a neutrophil count >250/mm3 diagnoses SBP

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15
Q

True or False

Will you wait for gram stain and culture media to start antibiotic in ascitic fluid aspirate?

A

False
Gram stains and culture results can be falsely negative 30% to 40% of the time, so empiric antibiotics should be started in the ED based on clinical suspicion

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16
Q

The test of choice for identifying portal vein and hepatic vein thrombosis

A

US with duplex doppler

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17
Q

Most common cause of acute hepatitis

A

Viral infection and toxic ingestion

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18
Q

Most common cause of toxic cause of acute hepatitis

A

Alcohol and Acetaminophen ingestion

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19
Q

The most common transmission of hepatitis A

A

Asymptomatic children to adult

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20
Q

Incubation period of Hepatitis A

A

15 to 50 days

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21
Q

True or False

Hepatitis A virus does not have a chronic component, and death from hepatic failure is rare

A

True

Hepatitis A virus does not have a chronic component, and death from hepatic failure is rare

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22
Q

Incubation period of Hepatitis B

A

1 to 3 months

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23
Q

When is the hepatitis B infectious?

A

5 to 15 weeks after onset of symptoms

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24
Q

Side effect of interferon in hepatitis B infection

A

Neutropenia and thrombocytopenia

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25
Q

True or False

Hepatitis C virus is most often asymptomatic in the acute phase of infection

A

True

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26
Q

Percent of acute hepatitis C that progress to chronic hepatitis C

A

> 75%

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27
Q

The most sinister side effect of treatment with direct-acting antivirals in hepatitis C is ____

A

The most sinister side effect of treatment with direct-acting antivirals in hepatitis C is the reactivation of dormant hepatitis B infection

28
Q

How many bottles of alcohol patient needs to develop alcoholic liver disease

A

6 bottles per day

29
Q

True or False

Treatment with N-acetylcysteine should be consider in paracetamol intoxication only?

A

False
Treatment with N-acetylcysteine should be considered whether the insult is from acetaminophen, nonacetaminophen medica- tion, or mushroom toxicity, according to the American Association for the Study of Liver Diseases guidelines

30
Q

One of the hallmarks of cirrhosis

A

Ascites

31
Q

Recommended diuretics for mild ascites?

A

Spironolactone, 50 to 200 milligrams/d

Amiloride, 5 to 10 milligrams/d

32
Q

True or False
For therapeutic paracentesis, American Asso- ciation for the Study of Liver Diseases guidelines recommend the use of IV albumin, 6 to 8 milligrams/L of fluid removed, for amounts greater than 5 L

A

False
For therapeutic paracentesis, American Asso- ciation for the Study of Liver Diseases guidelines recommend the use of IV albumin, 6 to 8 milligrams/L of fluid removed, for amounts greater than 4 L

33
Q

The most common life- threatening complication of ascites

A

Spontaneous bacterial peritonitis

34
Q

The most common isolates in SBP are

A

Escherichia coli, Klebsiella pneumoniae, and Streptococcus pneumoniae

35
Q

Accepted first-line parenteral treatment for SBP

A

Cefotaxime

36
Q

In addition to antibiotic therapy it may may reduce renal failure and hospital mortality in patients with SBP

A

IV albumin (1.5 grams/kg at diagnosis, 1 gram/kg on day 3)

37
Q

Common complication after transjugular intrahepatic portosystemic shunt

A

Hepatic encephalopathy

38
Q

Stages of Clinical Hepatic Encephalopathy

A

I - General apathy
II - Lethargy, drowsiness, variable orientation, asterixis
III - Stupor with hyperreflexia, extensor plantar reflexes
IV - Coma

39
Q

True or False

Another manifestation of asterixis is back-and-forth tongue movement when the tongue is extended

A

True

Another manifestation of asterixis is back-and-forth tongue movement when the tongue is extended

40
Q

True or False

Hepatic encephalopathy is a diagnosis of exclusion

A

True

Hepatic encephalopathy is a diagnosis of exclusion

41
Q

Is the current mainstay of therapy for hepatic encephalopathy

A

Lactulose

42
Q

How lactulose is given?

A

The oral dose is 20 grams diluted in a glass of water, fruit juice, or carbonated drink. For rectal administration, dilute 300 mL of syrup with 700 mL of water or normal saline. The enema should be retained for 30 minutes

43
Q

Second line antibiotic for hepatic encephalopathy

A
  • Rifaximin (best tolerated)
  • Neomycin (limited use d/t adverse effects)
  • Vancomycin
  • Metronidazole
44
Q

It is defined as acute renal failure in a patient with histologically normal kidneys in the presence of preexisting chronic or acute hepatic failure

A

Hepatorenal syndrome

45
Q

Type of hepatorenal syndrome that is more serious and is identified by progressive oliguria and doubling of serum creatinine over a 2 week period

A

Type 1 hepatorenal syndrome

46
Q

One of the more dangerous complications of cirrhosis

A

Coagulopathy

47
Q

The final common pathway for several types of liver disease

A

Liver failure

48
Q

What are the clinical hallmarks of acute liver failure?

A
  • Hepatic encephalopathy
  • Hepatorenal syndrome
  • Coagulopathy
49
Q

The most ominous complications of hepatic failure

A
  • Cerebral edema

- Intracranial hypertension

50
Q

Recommended resuscitation fluid for hypotension with liver disease

A

PNSS

51
Q

The initial vasopressor of choice with liver failure

A

Norepinephrine

52
Q

The American Association for the Study of Liver Diseases also recommends a trial of ____ in cases of persistent hypotension

A

The American Association for the Study of Liver Diseases also recommends a trial of hydrocortisone in cases of persistent hypotension

53
Q

Prophylaxis to give in patient with liver failure to reduce cerebral edema

A

Goal of sodium level of 145 - 155mEq/L

54
Q

For patient with confirmed increased intracranial pressure. What to give?

A

Mannitol 0.5 to 1 gram/kg

55
Q

The second most common diagnosis among patients awaiting liver transplant

A

NAFLD cirrhosis

56
Q

The most common manifestation of NAFLD is

A

Hepatic steatosis or simply fatty liver,

57
Q

Mainstay of treatment for NAFLD

A

Weight loss and exercise

58
Q

A familial liver disorder that produces occasional elevations in liver function tests and bilirubin

A

Gilbert’s syndrome

59
Q

Acute thrombosis, the major symptom is ____

A

Acute thrombosis, the major symptom is colicky abdominal pain

60
Q

Thrombotic obstruction of the posthepatic portal venous system and also has both acute and chronic presentations

A

Hepatic vein thrombosis, or Budd-Chiari syndrome

61
Q

Treatment of thrombotic liver disease

A

Depends if presence or absence of cirrhosis

If non-cirrhosis use anticoagulant

62
Q

Who to admit in patient with hepatitis?

A

bilirubin ≥20 mg/dL, prothrombin time 50% above normal, hypoglycemia, or GI bleeding

63
Q

Safe options for neuropathic pain in patient with hepatic disease

A

Gabapentin and Pregabalin

64
Q

Opioids would not be use in patient with hepatic disease except

A

Fentanyl and Tramadol at reduced doses and increased dosing intervals are possible choices in select patients because they lack the toxic metabolites of traditional opioids

65
Q

True or False
For drugs with high hepatic extraction, reduce the initial and maintenance doses. For drugs with intermediate hepatic extraction, initially use the low range of the normal dose, and reduce maintenance dosing. For drugs with low hepatic extraction, initial dosing remains unchanged, but reduce the maintenance dose

A

True
For drugs with high hepatic extraction, reduce the initial and maintenance doses. For drugs with intermediate hepatic extraction, initially use the low range of the normal dose, and reduce maintenance dosing. For drugs with low hepatic extraction, initial dosing remains unchanged, but reduce the maintenance dose

Section 9: Gastrointestinal Disorders (17 decks)

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