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Gastrointestinal 3 > Clinical > Flashcards

Clinical Flashcards

1
Q

What are the 2 aminotransferases found in hepatocytes?

A

ALT and AST

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2
Q

Which aminotransferase is more specific for liver injury?

A

ALT

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3
Q

Other than the hepatocyte membrane, where else can u find alkaline phosphate?

A

bone and placenta

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4
Q

So if u test and find a high alk phos, why must u need to further test?

A

to see if the increase is from the liver or other tissues

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5
Q

Which test can u do to test for liver alk phos?

A

Alk phos isoenzyme

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6
Q

How can u test for liver fxn by using an enzyme of intrahepatic biliary ducts that is more specific than alk phos?

A

GGT

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7
Q

Case: your pt has highly conjugated bile. What could be the 2 etiologies?

A

hepatocyte dysfxn or impaired bile flow

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8
Q

Case: your pt has lowly conjugated bile. What could be the 2 etiologies?

A

Hemolysis and resorption of hematomas

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9
Q

Which 4 factors does INR measure the level of, as a part of liver fxn tests?

A

II, V, VII, X

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10
Q

Factors II, V, VII, and X are also dependent on what vitamin?

A

Vitamin K

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11
Q

What are the 3 main causes of vitamin K deficiencies?

A
  1. taking an antibiotic while fasting
  2. small bowel mucosal disorders (celiacs)
  3. severe cholestasis
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12
Q

If you’re missing vitamin K, do u bleed longer or shorter?

A

Longer.

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13
Q

So to determing if prolonged PT is from vit K deficiency or liver dysfxn, what will be the results of the PT if it is indeed a vitamin K deficiency?

A

it will normalize once u give 10mg x 3 days of vit K

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14
Q

Which 2 enzymes are elevated in hepatocellular disorders?

A

ALT + AST

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15
Q

The differentating point between acute and chronic disorders of the liver is before/after what time?

A

3 months

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16
Q

What are the most common Sx of acute hepatitis?

A

malaise, anorexia, abd pain, jaundice, AST/ALT > 500 U/L

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17
Q

How much is AST increased vs ALT in alcoholic hepatitis?

A

AST:ALT > 2:1

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18
Q

In alcoholic hepatitis, what other substance is elevated within the blood?

A

bilirubin

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19
Q

How much are the aminotransferases increased in chronic hepatitis?

A

2-5 fold

20
Q

Jaundice will occur in a patient with a serum bilirubin over what level?

A

2.5 mg/dL

21
Q

What Sx suggest biliary obstruction to cause jaundice?

A

abd pain, fever, or palpable gallbladder

22
Q

How can u Dx cholestatis?

A

US

23
Q

How often should u do a liver US for PHC in a pt with HBV and liver cirrhosis?

A

6-12 months

24
Q

IF there is an accidental needle-stick with a pt with HCV, what is the necessary followup testing?

A

HCVAb and ALT at 4-6 months.

25
Q

What % of NEONATAL pt’s develop chronic hepatitis in HBV infections?

A

90%.

26
Q

What % of adult pt’s develop chronic hepatitis in HBV infections?

A

5%

27
Q

During the prolonged immune tolerant phase of chronic HBV infections, what is the ALT levels?

A

normal

28
Q

During the HBeAg+ chronic HBV phase of chronic HBV infections, what is the ALT levels?

A

elevated (its an active infection)

29
Q

Case: a young female presents to the office with signs of chronic liver disease + amenorrhea. She has a Hx of Hashimoto thyroiditis. What is the most likely Dx?

A

autoimmune hepatitis

30
Q

What things will show up on the labs for autoimmune hepatitis?

A

ANA, SMA, SLAA, LKM Abs

31
Q

What is the first choice for treatmetn of autoimmune chronic hepatitis?

A

corticosteroids (prednisone, 30-60mg daily)

32
Q

Which drug can u give with prednisone so u can lower the dose of the steroid?

A

azathioprine

33
Q

Which enzyme is incrased in hepatomas?

A

α-fetoprotein level

34
Q

What is the equation for serum-ascitic fluid albumin gradient (SAAG)?

A

SAAG = [serum albumin] - [ascetic fluid albumin]

35
Q

A SAAG . 1.1 g/dL indicates what?

A

portal HTN

36
Q

What can cause a SAAG of , 1.1g/dL?

A

ascites from peritoneal carcinomatosis or TB

37
Q

What are the 2 drugs u can give for the Tx of ascites?

A

sprionolactone and furosemide

38
Q

What is the goal (in volume) of fluid loss per day in the Tx of ascites?

A

1 L/day

39
Q

This is a bacterial infection of ascetic fluid without an intra-abdominal source of infection.

A

spontaneous bacterial peritonitis (SBP)

40
Q

What are the Sx of SBP?

A

fever, abd pain, and abd tenderness

41
Q

How do u Dx SBP?

A

paracentesis and a WBC count and culture

42
Q

Which antibiotic should u give for the Tx of SBP?

A

3rd generation cephalosporin

43
Q

Which antibiotic should u give for the prophylaxis of SBP, typically in cirrhotic pts?

A

norfloxacin

44
Q

What 3 things can predispose u to hepatic encephalopathy?

A

increased dietary protein, constipation, or sedatives.

45
Q

Which 2 beta blockers can u give to prevent bleeding of esophageal vasices?

A

nadolol or propranolol

46
Q

In which patients should u use TIPS?

A

to control refractory variceal bleeding

47
Q

Should you Tx pt’s with asymptomatic gallstones?

A

No

Gastrointestinal 3 (6 decks)

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