Day 2 Flashcards
jaundice begins gradually, pruritus is common
• Large, smooth, nontender liver, pale stools, steatorrhea. Dark urine- positive for bilirubin. Elongated prothrombin time
Marked elevated of alkaline phosphate
Mild LFT
normal albumin
Intrahepatic cholestasis
o Stone, stricture or tumor blocks flow of bile w/I extrahepatic biliary tree
o Patient may have hx of gallstone, biliary tract surgery, malignancy
o Liver is usually enlarged
o Dark stool, pale urine
o Sudden onset of pain from stones
hihg alkaline phosphatase
moderate high LFTs
Extrahepatic obstruction
o Hepatitis + anorexia, nausea, abdominal pain, malaise before jaundice
o Hepatic tenderness and some hepatomegaly
o Ecchymoses may be presents
o Transaminases may become very elevated
o Hep C and alcoholism transaminases only 5x normal
o Dark urine, pale stools
Hepatocellulcar injury
No bilirubin in urine, but jaundice
Unconjugated hyperbilirubinemia
is cirrhosis symptomatic?
usually not
common cause of cirrhosis
Alcohol consumption
Hep C
Nonalcoholic fatty liver
most common autosomal condition for cirrhosis. Excessive iron overload.
Hemochromatosis
Other causes of cirrhosis
Wilson’s
Gaucher’s (lyposomal storage disorder)
Primary biliary cirrhosis
Fanconi’s (kidney problem)
if a person presents with varices, ascities, hypersplenism, encephalopathy, peripheral edema. Have GI bleeding, abdominal discomfort, confusion, early satiety.
Chronic viral or alcoholic hepatitis
Women presents with hepatomegaly, jaundice, hyperlipdemia, excoriation what do you suspect? Elevated alk phos, SED. Anti-Mito Antibody
Primary biliary cirrhosis
Gold standard of diagnosis for liver cirrhosis.
Liver biopsy
Patient presents with dyspnea, arthritis, skin discoloration, fatigue. Have damage to liver, heart, pancreas and gonads. Will look grey or bronze like. Elevation transferrin saturation and ferritin
Hemochromatosis
What does TIPS stand for?
transjugular intrahepatic portosystemic shunt
takes pressure off the portal system
Tx for primary biliary cirrhosis
transplant
diet- Vit A, D, K, zinc
meds- (a variety)
caused by HBV (most common) HCV, cirrhosis, hemochromatosis.
Elevated alpha-fetorprotein
will ahve hemorrhage, necrosis
Hepatocellucular carcinoma
Tx for hepatocellular carcinoma
curative resection
transplant
Uncommon in cirrhotic liver
hematogenous, lymphatic or direct spread
will have hemorrhage and replacement of hepatocytes by malignant cells
metastatic carcinoma
cancer due estrogens or anabolic steroids. will ahve hemorrhage, necrosis.
Hepatocellcular adenoma
tx of hepatocellular adenoma
discontinue estrogens/ androgens
resect if possible
do periodic imaging
Presents with URQ pain, ascities. occlusion of hepatic veins or inferior vena cava caused by hematogenous disease. Dx via doppler US
budd chiari syndrome
Due to congenital problems, estrogens. Is a blood filled cysts lined single layer of flat epithelium.
Cavernous hemangioma
Thin walled cyst with clear fluid. Has simple cuboidal endothelium. no co-existing liver dz, congenital. Tx with percutaneous aspiration or surgical
Simple liver cyst
Present with fever, RUQ colicky pain that radiates. N/V
acute cholecystitis
will have fatty food intolerance, jaundice, pale feces, pruritus, weight loss
chronic cholecystitis
What are pigmented stones
increased production of bilirubin conjugated
increased biliary calcium and bicarb
where can biliary colic refer to?
tip of scapula
right shoulder
tx for biliary colic (recurrent)
laproscopic cholecystectomy
distention, edema, ischemia, inflammation along with fever. Acute onset of upper abdominal pain that lasts for several hours and doesn’t subside spontaneously. In epigastrium and radiates to right lumbar and shoulder
Acute cholecystitis
distention, edema, ischemia, inflammation along with fever. Acute onset of upper abdominal pain that lasts for several hours and doesn’t subside spontaneously. In epigastrium and radiates to right lumbar and shoulder
Acute cholecystitis
Profound jaundice as a result of compression of common hepatic duct by a cystic duct in the neck of the gallbladder. Dx via US
Mirizzi Syndrome
Most acute study for acute cholecystitis
HIDA
scan is an imaging procedure used to diagnose problems in the liver, gallbladder and bile ducts.
prolonged fasting, immobility and hemodynamic instability. Usually in someone with AIDS. WIll have positive Murphy’s and thickened gallbaldder wall. Tx w/ antibiotics and take out gallbladder
noncalculus acute cholecystitis
cholangitis
infection of the common bile duct
medical surgrical emergnecy
why is cholangitis a medical/ surgical emergency.
Can lead to sepsis, shock and death
idiopathic condition, chronic inflammatory fibrosis of the bile ducts. Normally in young men who also have UC
primary sclerosing cholangitis
common in males with alcoholics, females with gallstones. presents with R or L UQ abdominal pain. Worse when laying down. Swift onset- maximal intensity in 30 minutes. Persists for 24 hours. Can have N/V/ fever
acute pancreatitis
what serum tests can you do for pancreatitis
Serum amylase of lipase (3x ULN)
how do you test pancreatic function?
seretin stimulation
Tx for chronic pancreatitis
enzymes replacements
analgesics
nerve blocks
endoscope decompression (obstruction)
most common type of gastric cancers.
adenocarcinomas (most common)
lymphoma
what do most colorectal cancers arise from?
adenomatous polyps
