CPD II Quiz UGI II and Lower GI I Flashcards
1
Q
Pathology of Cirrhosis
A
extensive fibrosis that disrupts normal liver architecture
2
Q
PE Cirrhosis
A
Nail clubbing, small liver
3
Q
What are the effects of liver disease on drug metabolism?
A
Liver dz can alter intestinal absorption, plasma protein binding, liver blood flow, etc.
- This increases level of bioavailable drug = toxic effects.
4
Q
What are the two types of liver injury due to Drug-induced liver injury (DILI)?
A
- hepatocellular (serious): from acetomenophine
- malaise, RUQ pain - cholestatic (less serious): from amoxicillin
- pruritis and jaundice
5
Q
Fibrosis
A
excessive connective tissue accumulates in the liver in response to chronic, repeated liver cell injury (scar tissue)
6
Q
Sx fibrosis
A
no sx, but secondary sx can develop
7
Q
Cirrhosis
A
late stage of hepatic fibrosis that is widespread distortion of hepatic architecture
8
Q
sx cirrhosis
A
non specific (anorexia, wt loss, fatigue) late sx: portal HTN
9
Q
Lab workup cirrhosis
A
LFT normal albumin and bilirubin PT CBC viral tests for causes *liver biopsy
10
Q
PE for cirrhosis
A
- liver edge bumpy
- pallor, jaundice, petechiae, purpura, ascites, splenomegaly, nail clubbing
11
Q
Primary biliary cirrhosis
A
autoimmune
- destruction of bile ducts
- leads to cholestasis, cirrhosis, liver failure,
12
Q
Sx primary biliary cirrhosis
A
insidious fatigue, pruritis, dry mouth, RUQ pain, jaundice, Middle aged women.
13
Q
PE primary biliary cirrhosis
A
enlarged, firm, non-tender liver
14
Q
work-up
A
elev GGT and alk phos
biopsy
15
Q
causes of vascular liver disorders
A
ischemia: reduced blood flow, reduced O2 delivery, inc metabolic activity
insufficient venous drainage
16
Q
Hepatic ischemic hepatitis
A
- impaired hepatic profusion due to heart failure or acute hypotension
- hyoxemia: resp failure or CO2 toxicity
- increased metabolic demand (sepsis)
17
Q
SX ischemic hepatitis
A
nausea, vomitting, tender hepatomegaly
18
Q
lab for schemi hepatitis
A
high aminotransferase
inc in bilirubin
LDH increases (septic)
*US, MRI
19
Q
ischemic cholangiopathy
A
focal damage to biliary tree due to disrupted flow from the hepatic artery
20
Q
causes of cholangiopathy
A
vascular injury during procedures that result in bile duct injury
21
Q
what does bile duct injury cause?
A
cholestasis, chalngitis, biliary strictures
22
Q
Sx cholangiopathy
A
pruritis, pale stool
23
Q
congestive hepatopathy
A
diffuse venous congestion in the liver that results from RCHF
24
Q
SX congestive hepatopathy
A
asx, RUQ discomfort
- if severe cong = jaundice
25
PE congestive hepatopathy
acites, hepatomegaly
26
causes of hepatic artery occlusion
thrombosis, emboli, iatrogenic causes, vasculitis, structural abn, eclampsia, cocaine, sickle cell crisis
27
sx hepatic artery occlusion
infarction can be asx or cause RUQ pain, fever, nausea, vomitting, jaundice
28
Bud chiari syndrome
obstruction of hepatic venous outflow from small hepatic veins inside liver to inferior vena cava and R atrium
29
Causes bud chiari syndrome
hypercoagulable states
30
sx bud chiari syndrome
| - acute and chronic obstruction sx
none to fulminant liver failure
- acute obstruction: fatigue, RUQ pain, nausea, vomitting, mild jaundice
- chronic: asx, or fatigue, abdominal pain, hepatomegaly, edema
31
prognosis bud chiari syndrome
die within 3 years of liver failure if untreated
32
cause of veno-occlusive disease
endothelial injury leading to non-thrombotic occlusion of terminal hepatic venues and hepatic sinusoids
- irradiation, graft, hepatotoxins
33
ssx veno-occlusive disease
sudden jaundice
34
PE veno-occlusive disease
ascites, tender, smooth, hepatomegaly
35
Portal vein disorders
cause portal HTN
36
causes of portal vein thrombosis
surger, hypercoagulability, cancer, cirrhosis, trauma
37
Peliosis hepatatits
multiple blood filled cystic spaces develop randomly in the liver
38
causes peliosis hepatitis
damage to sinusoidal lining cells from use of hormones
39
sx peliossis hepatitis
asx, but if cysts rupture, hemorrhage and death can result
40
causes Portal HTN
cirrhosis, schistosomiasis, hepatic vascular abnormalities
41
SX Portal HTN
asx
| sx arise from complications
42
PE Portal HTN
```
low systolic BP
splenomegaly
ascites, peripheral edema
dilated abdominal wall veins, caput madusae
skin jaundice, spider angioma
```
43
lab?
US and CT = dilated intraabdominal collateral arteries
44
Portal Systemic encephalopathy
neuropsychiatric syndrome
45
causes of portal systemic encephalopathy
fulminant hepatitis caused by viruses, drug, or toxins
cirrhosis, portal HTN
liver disease
cerebral depressants (alcohol, sedatives)
46
Primary liver cancer
hepatocellular carcinoma
47
cause hepatocellular carcinoma
cirrhosis
48
risk factors for hepatocellular carcinoma
HBV, HCV, hemochromatosis, alcoholic cirrhosis
49
SSX hepatocellular carcinoma
RUQ pain, weight loss, RUQ mass
50
workup hepatocellular carcinoma
alpha-fetoprotein (AFP) high
| CT, US, MRI
51
Metastatic liver cancer
more common than primary liver cancer
| - GI, breast, lung, pancreas
52
Hepatic Granulomas
localized collections of chronic inflammatory cells with epithelia cells and giant multinucleate cells
53
causes hepatic granulomas
drugs, infections (TB and schistosomiasis)
54
SSX hepatic granulomas
asx
55
Risk factors for cholelithiasis
5Fs: female, fat, forty, fertile, family hx
| SAD diet, American indian ethnicity
56
SX cholelithiasis
asx, RUQ pain that radiates
57
cholecystitis
inflammation of gallbladder
58
acute cholecystitis
develops in hours becomes a gallstone that obstructs the cystic duct
59
SSX acute cholecystitis
pain like biliary colic but lasts longer
| vomitting
60
PE acute cholecystitis
R subcostal tenderness
+ Murphy sign
- courvosier sign
fever
61
Chronic cholecystitis
due to stones
| porcelain gallbladder if extensive calcification due to fibrosis
62
SX chronic cholecystitis
recurrent biliary colic
63
PE chronic cholecystitis
upper abdominal tenderness
| afebrile
64
acalculous biliary pain
biliary colic without stones from structural or functional disorders
65
causes acalculous biliary pain
microscopic stones
| abnormal GB emptying
66
causes postcholecystectomy syndrome (PCS)
alterations in bile flow due to loss of function of gallbladder as a reservoir
67
Sx postcholecystectomy syndrome
dyspepsia, persistent abdominal pain
68
workup for PCS
biliary manometry
69
Choledocholithiasis
stones in the bile ducts causing biliary colic, biliary obstruction, cholangitis
70
Cholangitis
Acute is EMERGENCY
| bile duct obstruction allows bacteria to ascend from duodenum
71
SX acute cholangitis
Charcot's Triad:
abdominal pain
jaundice
fever or chills
72
PE cholangitis
RUQ tenderness
liver tender and enlarged
confusion and hypotension = 50% mortality rate
73
Recurrent Pyogenic Cholangitis
inrahepatic brown stone formation leading to repeating cycles of obstruction, infection, and inflammation.
SE Asia
74
cause of recurrent pyogenic cholangitis
undernutrition and parasitic infxn
75
What would you expect if you saw biliary colic and jaundice?
What would you expect if you saw these symptoms plus fever and leukocytosis?
choledocholithiasis and cholangitis
cholangitis
76
What would you expect to see on labs suggesting stone/extrahepatic obstruction?
Elev bilirubin, alk phos, ALT, GGT
77
What would you expect to see on labs due to acute cholangitis
CBC leukocytosis
| LFT: AST and ALT hepatic necrosis
78
primary sclerosing Cholangitis SX
progressive fatigue and pruritis, jaundice later, steatorrhea, gallstones 75% of pt, cirrhosis, hepatosplenomegaly
79
Cholangiocarcinoma
rare but malignant tumor of extra hepatic bile duct
80
Risk factors for cholangiocarcinoma
primary sclerosing cholangitis
older age
infestation with liver flukes
81
sx cholangiocarcinoma
```
pruritis
painless obstructive jaundice
abdominal pain
anorexia
weight loss
```
82
PE chalangiocarcinoma
non-tender palpable mass (courvoiser's sign)
| hepatomegaly
83
risks gallbladder carcinoma
```
uncommon
native american ethnicity
large gallstones
GB calcification due to chronic cholecystitis
most have gallstones
```
84
what are the extra PE steps for lower GI issues?
```
peritonitis: Blumberg sign
Appendicitis: signs
Ascites: fluid wave and shifting dullness
Cholecystitis: Murphys sign
Kidney inflmm: CVA tenderness
DRE
Gyn and male genitalia exam
```
85
Labs for lower GI
```
CBC
CMP
amylase/lipase
stool culture
CDSA
GI health panel
abdominal X-rays
US
endoscopy/sigmoidoscopy/colonoscopy
```
86
List 3 causes of RUQ pain
Hepatitis
cholecystitis
Budd Chiari syndrom
87
List 3 causes of Epigastric pain
GERD
Gastritis
PUD
Pancreatitis
88
List 3 causes of LUQ pain
Spleen infarct
splenic rupture
gastritis
89
List 3 causes of right or left flank pain
kidney infl
pyelonephritis
polyscystic kidney disease
90
List 3 causes of periumbilical pain
Early appendicitis
gastroenteritis
bowel obstruction
91
List 3 causes of RLQ pain
appendicitis
IBD
Ovarian cyst
inguinal hernia
92
List 3 causes of LLQ pain
Diverticulitis
IBD
IBS
ovarian cyst
93
osmotic diarrhea
too much water drawn into bowels and increased amount of poorly absorbable solutes
94
causes of osmotic diarrhea
maldigestion
| ions (mag sulfate, mg, vit C, sugar alcohols)
95
causes of secretory diarrhea
```
enterotoxins (cholera, E.coli, staph)
horomones (serotonin)
gastric hypersecretion (ZE)
laxatives
bile salts
```
96
causes of exudative diarrhea
idiopathic
crohns
ischemic
infections - shigela, salmonella
97
causes of motility diarrhea
hyperthyroidism
| DM
98
diarrhea red flags
```
blood
pus
fever
signs of dehydration
chronicity
unintended wt loss
```
99
red flags for constipation
abdominal distention
vomitting
blood in stool
weight loss
100
cause of acute constipation
obstruction
adynamic ileus
medications
101
cause of chronic constipation
carcinoma
hypothyroid
CNS disorders
IBS
102
red flags for gas
weight loss, blood in stool
103
Dyschezia
difficulty evacuating
urge but can't go
due to disco ordination of rectal muscles and sphincter
104
O and P test
done to find protozoa, worms, eggs, parasites
105
History for acute abdomen
```
LMNOPQRST
concomitants
drug hx
PMHx
previous surgery
```
106
Causes of inflammation
```
appendicitis
cholecystitis
pancreatitis
diverticulitis
abscess
```
107
Causes of ischemia
Ischemic colitis
108
CBC findings for appendicitis
WBC count > 10,000 with left shift
109
DDX appendicitis
females: PID
males: epidiymitis, testicular torsion
acute gastroenteritis
110
Acute Mesenteric Ischemia
EMERGENCY
| decrease in mesenteric blood flow, leading to bowel wall ischemia, inflammation, and infarction.
111
causes of acute mesenteric ischemia
1. diminished bowel perfusion due to low cardiac output often seen with CHF
2. occlusive disease of vascular supply if bowel due to thrombosis or embolism
112
risk factors for acute mesenteric ischemia
CAD, a fib, hypercoagulability, portal HTN
113
SX acute mesenteric ischemia
severe and pain with minimal PE findings
sudden onset suggests embolism
gradual suggests thrombosis
later: guarding, absent bowel sounds
114
Ischemic colitis
episodic transient reduction of blood flow to bowel
115
hernia of abdominal wall
Emergency if strangulated
116
Intestinal obstruction
EMERGENCY
| complete or partial blockage of small bowel or colon
117
causes of intestinal obstruction
```
adhesions
hernia
tumor
diverticulitis
foreign body
```
118
sx intestinal obstruction
sudden onset periumbilical or epigastric cramping, vommiting,
119
ileus
temporary arrest of intestinal peristalsis
120
causes of ileus
post-surgical
appendicitis
diverticulitis
perforation
121
sx of ileus
distention
vomiting
abdominal discomfort
colicky pain
