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GI Final > Diseases Of The Liver > Flashcards

Diseases Of The Liver Flashcards

1
Q

Dunlap disease

A

My belly dun lapped over my belt

-just means obesity

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2
Q

What reduces the risk of NFLD

A

Drinking coffee

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3
Q

What was the bonded cause of NAFLD on that slide?

A

Vinyl chloride

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4
Q

What to do to definitively diagnose ascites

A

Physical exam only!

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5
Q

What do we HAVE to rule out if someone comes in with uncompensated cirrhosis

A

Spontaneous bacterial peritonitis

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6
Q

What is important about ammonia levels

A

It means encephalopathy

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7
Q

What is a SAG score?

A

Serum albumin ascites gradient

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8
Q

If you find bilirubin in the acsitic fluid, what’s going on?

A

Gallbladder problems!

-not liver like you think

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9
Q

What do we need to look for in the ascitic fluid if they are malnourished in a liver cirrhosis test?

A

They are at super risk for TB, so we need to look for adenosine deaminase

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10
Q

What significant number in the SAAG score?

A

1.1

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11
Q

How to calculate SAAG score

A

Serum album- ascitic albumin

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12
Q

What do we have to look for in an alcoholic liver disease patient?

A

Esophageal varices

-do an EGD scope

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13
Q

If the patient has HBcAb IgM, what is that?

A

The window period

-that shows up before HBsAg

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14
Q

Where is chronic HBV endemic?

A

Asia and sub Saharan Africa

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15
Q

What do we have to look at to see if someone has an HCV antibodies .

A

Order HCV RNA to see if there is an active infection

  • you can’t just look at the antibodies
  • if the RNA is negative, that means they cleared it
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16
Q

Which cancer do HCV patients have a higher risk for?

A

HCC and non Hodgkin lymphoma

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17
Q

What goes with Hep B?

A

Polyarteritis nodosa

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18
Q

What vasculitis is associated with hep C?

A

Mixed cryoglobulinemia

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19
Q

What slows progression of HCV?

A

DRINKING COFFEE

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20
Q

What kind of hepatitis do people taking tacrolimus get?

A

Hep E

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21
Q

Autoimmune hepatitis

A

Smooth muscle antibodies
At risk for HCC
-positive ANA

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22
Q

What lab value is crazy high in acetaminophen overdose

A

AST and ALT

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23
Q

What is Reynaud’s Pentad

A

Charcot’s triad with hypotension and altered mental status changes

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24
Q

What do you have to give an alcoholic person who is having neurological problems before anything else

A

Thiamine: Vitamin B1

-or else their eyes will start moving everywhere

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25
Q

Wernicke-Korsakoff syndrome

A

Confusion
Ataxia
Goofy eye movements (this and above is wernicke
Severe memory issues (korsakoff)

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26
Q

What is the key feature of decompensated cirrhosis?

A

Altered mental status changes

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27
Q

Child-Pugh…. What is it

A

.

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28
Q

Meld score

A

.

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29
Q

What gene goes with hemochromatosis?

A

HFE

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30
Q

What is related to PBC?

A

Hair dye
Anti mitochondrial antibodies
Smoking

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31
Q

Where does iron get absorbed in hemochromatosis?

A

The duodenum

-bile gets absorbed by the ileum

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32
Q

Where will we see iron overload on MRI in someone with hemochromatosis?

A

The heart

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33
Q

RUQ ultrasound with pulsed Doppler flow is associated with….

A

Budd Chiari syndrome

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34
Q

“Beads on a string”

A

Primary sclerosing cholangitis

35
Q

Apple core appearance on barium swallow?

A

Colon cancer

36
Q

What does budd Chiari lead to

A

Congestion

37
Q

What does congestion present as?

A

Nutmeg liver!

38
Q

Hepatocellular adenoma

A

39 yo female no oral contraception

  • no smoking or alcohol or drugs
  • CT shows a mass in the liver
39
Q

What is more specific for liver injury, AST or ALT?

A

ALT

40
Q

What do we see in hepatocellular problems?

A

elevations in ALT and AST

-alanine and aspartate aminotransferase

41
Q

What do we see in cholestasis?

A

elevation in ALP (alkaline phosphatase)

42
Q

What viruses are responsible for hepatitis?

A

ABCDE and in immunocompromised patients, Mono, CMV, HSV

43
Q

What were the bolded liver function tests?

A

PT and serum albumin

44
Q

what is the most common cause of Ascites?

A

portal HTN from chronic liver disease

-non-portal causes are infections, malignancy, inflammatory disorders…. etc.

45
Q

What are some causes of Fatty liver… hepatic steatosis?

A

alcohol related fatty liver disease
NAFLD
-Vinyl chorlide, carbon tetrachloride and yellow phosphorus (occupational exposure leads to angiosarcoma)

46
Q

How do calculate SAAG?

A

Serum albumin-ascitic fluid albumin

47
Q

If someone has acites, what do we need to do imperatively?

A

get a paracentesis and rule out spontaneous bacterial peritonitis (SBP)

48
Q

What is the most important test to run on the ascitic fluid?

A

WBC count

49
Q

What do we think if theres an elevated WBC count and lymphocyte predominance?

A

TB or peritoneal carcinomatosis

50
Q

Hepatitis A virus?

A

Acute

-high aminotransferases… elevated Alk phos and bilirubin (marked cholestasis)

51
Q

Hepatitis B virus

A

Acute or chronic

  • fever, tender, hepatomegaly, jaundice
  • mother to baby at delivery
  • previously been incarcerated or treated for STI
52
Q

Acute HBV

A

similar to HAV but there’s no marked choestasis so the Amniotransferase levels are higher than they are in HAV

53
Q

Where is HBV endemic?

A

Asia and sub-Saharan africa

-90% of infants with maternal transmission

54
Q

HDV

A

needs HBV to go… so there must be HBsAg present

  • chornic HBV with superinfection by HDV is bad
  • has defective RNA
55
Q

HCV

A

body piercing, tattoos, and hemodialysis are risk factors

  • no vaccine
  • high rate of acute progressing to chronic
56
Q

Dx HCV

A

confirmed by HCV RNA

-anti HCV in serum but negative HCV RNA= recovery from past infection

57
Q

HCV complications

A

myxed cryoglobulinemia

  • membranoproliferative GN
  • cirrhosis and HCC
  • decrease in serum cholesterol and LDL
  • HCV genotype 3 can lead to hepatic steatosis
58
Q

HCV recommendations

A

CDC and USPSTF recommend screening persons born between 1945-65 (baby boomers)

  • dont share toothbrushes or razors
  • curable with proper treatment
59
Q

Chronic HCV

A
  • black ppl have higher rate of chronic HCV but lower fibrosis
  • coffee slows progression
  • pts can have normal AST/ALT
  • high risk of cirrhosis and HCC
  • MOST HCV IS CURABLE
60
Q

HEV

A
  • major cause of acute hepatitis throughout central and SE Asia, the middle east, and North Africa
  • *transplant recipients: particularly those treated with tacrolimus rather than cyclosporine for immunosuppression
61
Q

How do you treat a tylenol OD?

A

treat with NAC if in the toxicity area

  • important to get a 4 hour acetaminophen level so we can plot it on a nomogram
  • if we can’t find out when it was taken, use empiric treatment of acetylcysteine
62
Q

Autoimmune hepatitis

A
  • young to mid age women
  • +ANA and/or smooth muscle AB
  • Anti-LKM1 (liver-kidney microsome type 1)
  • super high AST/ALT (1000)
  • Tx with steroids and maybe azathioprine
  • maybe liver transplane
  • increased risk of cirrhosis and HCC
63
Q

`Wernicke-Korsakoff Syndrome

A
  • Wernicke encphalopathy: confusion, ataxia, involuntary abnormal eye movements
  • Korsakoff Syndrome: severe memory issues, confabulate/Make-up stories to fill in the gaps
64
Q

Alcoholic liver disease

A

AST is actually higher than ALT for a change

  • increased hepatic iron stores
  • Bx: mallory bodies… like in NASH
  • Reversible
  • Most common precursor to cirrhosis in US
  • Tx: abstinence from alcohol
65
Q

What do we have to watch out for when treating ALD?

A

glucose administration increases the thiamine requirement and can precipitate Wernicke-Korsakoff syndrome if thiamine is not co-administered

66
Q

Risk of alcoholic cirrhosis

A

> 50 grams daily for over 10 years

67
Q

Maddrey Discriminant function

A
  • how we estimate disease severity in pts with alcoholic hepatitis
  • Pts with a DF value >32 have high short-term mortality and may benefit from tx with glucocorticoids
  • those with lower scores have hlow short-term mortality and do not appear to benefit from glucocorticoids
  • you need PT and Control PT and Serum bilirubin
68
Q

Glasgow alcoholic hepatitis score

A

GAH

  • mortality in alcoholic hepatitis
  • > 9, glucocorticoids
69
Q

Sign of CLD or Cirrhosis

A

jaundice, palmar eythema, spider angioma, gynecomastia, ascites and caput medusae, muscle wasting

70
Q

What is Dupuytren’s contracture?

A

when the 4 and 5 digits flex I guess….

71
Q

What do Cirrhosis labs look like?

A

Macrocytic anemia… folic acid deficiency from alcohol use

  • low WBC (hypersplenism)
  • high infection (SBP)
  • thrombocytopenia
  • long PT… reduced levels of clotting factors
  • decrease in albumin
  • Vitamin D deficiency
72
Q

What are the 5 things that go into a Child-Pugh scoring system?

A
  • Ascites
  • Encephalopathy
  • Bilirubin
  • Albumin
  • Prothrombin time
  • all given a score 1-3… higher score is bad*
73
Q

PBC

A

Autoimmune destruction of small intrahepatic bile ducts and cholestasis

  • isolated elevated Alk phos
  • anti mitochondrial Ab
  • increased IgM
  • Risk factors: Hx of UTI, smoking, HRT, hair dye
74
Q

How do you treat PBC?

A

Ursodeoxycholic acid

75
Q

What major syndrome is associated with PBC?

A

Sjogren syndrome

76
Q

Hemochromatosis

A

increased iron absorption from the duodenum

-risk of infection with vibrio vulnificus, listeria, and yersinia enterocolitica

77
Q

Tx Hemochoromatosis

A

avoid food rich in iron, alcohol, vitamin C, raw shellfish, and supplemental iron

  • phlebotomies
  • PPI reduces intestinal iron absorption
  • Deferoxamine is another consideration- chelating agent
78
Q

What gene is wrong is Wilson Disease?

A

ATP7B

79
Q

Tx for Wilson

A
  • oral penicillamine (increases urinary excretion of chelated copper)
  • liver transplant
80
Q

What is Budd Chiari?

A

occlusion of flow to hepatic vein of IVC

  • hypercoagulable state
  • complicated by HCC
81
Q

Dx budd chiari

A

imaging will show prominent caudate lobe, due to occlusion of its venous drainage

  • direct venography will have spider web patter
  • Bx: centrilobular congestion with likely fibrosis and multiple regenerative nodules (nutmeg liver)
82
Q

Alpha-1 antitrypsin deficiency

A

production of defective A1AT accumulates in hepatocytes and causes liver damage and low serum levels of the protease inhibitor

  • PI gene chromosome 14
  • Micronodular cirrhosis… increased risk of HCC
  • Panacinar emphysema
83
Q

Tx of A1AT

A

smoking abstinence/cessation and liver transplant

-MC genetic cause requiring liver transplant in children

GI Final (13 decks)

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