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GI II Final DF > diseases of the liver > Flashcards

diseases of the liver Flashcards

1
Q

cholestasis if isolated elevation of alk phos then consider

A

bone involvment

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2
Q

chronic hepatitis is what time from

A

over 3-6 months

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3
Q

what is anasarca and what is it from

A

full body swelling due to nephrotic syndrome or heart failure

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4
Q

ascites most common cause from

A

portal HTN from chronic liver disese

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5
Q

risk factors for chronic liver disedase

A 
alcohol
transfusions
tattoos
IVDU
viral hepatitis
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6
Q

non portal HTN causes

A

infections
malignancy
inflammatory disorders
ductal disruption

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7
Q

risk factors for NAFLD

A

hispanics
people with psoriasis
cholecystecomy and heavy soft drink consumption

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8
Q

non alcoholic fatty liver cna lead to

A

CVD
cirrhosis
colorectal cancer
CKD

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9
Q

other causes of fatty liver

A

vinyl chloride
CCl4
yellow phosphorus

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10
Q 
non alcoholic fatty liver disease 
symptoms
labs
etiology
histology 
diagnose
tx
A

usually asymptomatic
-mild RUQ discomfort, hepatomegaly

normal or increased transaminase and alk phos

obesity, DM, hypertriglyceridemia, metabolic syndrome

histo: NAFLD macrovesicular steatosis
- NAFLD–>NASH: macrovesicular steatosis and focal infiltration by PMNs and mallory hyalin

US to demonstrate macrovascular steatosis

liver bx diagnositc

tx: lifestyple modification

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11
Q

what is first step with pt with ascites

A

abdominal ultrasound

noninvasive

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12
Q

someone who comes in with abdominal pain with known ascites and a fever and altered mental status must rule out

A

spontaneous bacterial peritonitis

-this is the #1 differential in any cirrotic that comes in with ascites and showing decompensation

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13
Q

in person with liver cirrhosis that is severely malnourished maybe from alcohol is super at risk for ____ for cause of acites
what test preformed

A

TB

adenosine deaminase

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14
Q

with a chylous ascites what level test do you do

A

triglyceride level

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15
Q

how do you calculate SAAG

A

serum albumin - ascitic fluid albumin

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16
Q

what test looks for esophageal varices

A

esophagoduodenoscopy
EGD
pt with HCV and liver scarring

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17
Q

spontaneous bacterial peritonitis most common pathogens

A

E coli, or klebsiella pneumonia

or strep pneumo or viridans or engerococus

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18
Q

SBP in what pts

A

10-20% of known cirrhoti pts

presenting with decompensation–> worsening encephalopathy, fever, ab pain, worse renal function

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19
Q

PMN highly suggestive of bacterial peritonitis

A

PMN >250/mcL with >75% of all white cells

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20
Q

symptoms of hepatitis A
labs
treatment

A 
anorexia
malaise
aversion to smoking
mild RUQ
acute
increased aminotransferases--> eleevated alk phos and bilirubin
self limited
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21
Q

HBV labs

A

increased aminotransferases–>elevated alk phos and bilirubin

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22
Q

where is chronic HBV endemic

A

asia and sub saharan africa

maternal transission

23
Q

risk of what with chronic HBV

A

HCC

cirrhosis

24
Q

endemic areas of HDV

A

africa
central asia
eastern europe
amazon region of brazil

25
Q

in pt with anti hcv positivity what should you do with them

A

recommend ordering HCV RNA

26
Q

what does anti-HCV in serum but negative HCV RNA mean

A

recovery from past infection

27
Q

complications of CV

A 
mixed cryoglobulinemia
membranoproiferative GN
increased risk for non-hodkin lymphoma
cirrhosis and HCC
decrease in serum cholesterol and LDL
28
Q

HCV genotype 3 increases risk for

A

hepatic steatosis

29
Q

hcv screening recommendations

A

people born between 1945 and 1965

30
Q

HEV risk factors

A

those treated with tacrolimus for immunosuppression tend to get Hep E
africa
liver transplant pts
(a1-antitrypsin deficiency is #1 reason for child to get liver transplant)

31
Q

HEV is spread how

A

waterborne
spread by swine
pets in home
consuming undercooked organ meats

32
Q

treatment of HEV

what kind of virus

A

self limited

RNA hepevirus

33
Q

fulminant acute liver failure

subfulminant

A

hepatic encephaolpathy w/in 8 wks after onset of acute liver disease. INR over 1.5
8w-6m after onset

34
Q

leading causes of death in acute liver failure

A

cerebral edema and sepsis

35
Q

treatment of acute liver failure

tylenol OD

A

supportive
corticosteroids of uncertain value
stress gastropathy prophylaxis
N-acetylcysteine in tyleono OD

36
Q

tylenol OD treat with
important to get a ___ hr acetaminophen level
criticial ingestion treatment interval for max protection against severe hepatic injury is btwn ___ and __ hrs

A

N-acetylcysteine
4 hour acetaminophen level
0 and 8 hours

37
Q

autoimmune hepatitis

A 
most common in young mid age women
\+ANA and or SM AB
anti-LKM1 
AST/ALT can be >1000 units/L
billi increased
38
Q

treatment autoimmune hepatitis

A

steroids and azathioprine

39
Q

increased risk with autoimmune hepatitis

A

cirrhosis and HCC

40
Q

drugs that cause hepatitis that histologicaly mimic autoimmune hepatitis are

A 
nitrofurantoin
minocyline
ASA
NSAIDs
terbinafine
TNF inhibitor
isoniazid
41
Q

what cant you give in a thymine deficient alcoholic before administering thymine (B1)

A

dextrose

will cause wernecke korsakoff

42
Q

what gives you a megaloblastic anemia

A

folic acid and B12 deficiency

43
Q

when do you get severe alcoholic hep with 50% mortality

A

when total bili over 10 mg/dL and PTT over 6 sec

susceptible to infections too

44
Q

risk of alcoholic cirrhosis with

A

over 50g daily for over 10 years

45
Q

what is the maddrey discriminant function

A

disease severity and mortality risk in pts with alcoholic hepatitis estimated by this (DF)
need PTT, and bilirubin

if value over or = to 32 then have high short term ortality and may benefit from treatment with gluocorticois

lower score doesn’t benefit

46
Q

glasgow alcoholic hepatitis score

A 
age
bilirrub
bun
ptt
peripheral wbc

score over 9 or =9 then survival benefit with glucocorticoids

47
Q

hepatic encephalopathy grading:

somnolence to semistupor, responive to verbal stimuli
confusion
gross disorientation, bizarre behavior

A

grade 3

48
Q 
hepatic enceph
alopathy grading:
trivial lack of awareness 
shortened attention span
impaired performance of addition 
euprhoia or anxiety
A

grade 1

49
Q

hepatic encephalopathy grading:

lethargy or apathy
min disorientation for time or place
subtle personalitiy change
inapprop behavior
impaired performance of subtraction
A

grade 2

50
Q

hepatic encephalopathy grading:

coma

A

grade 4

51
Q

cirrhosis labs

A 
macrocytic andemia
decreased wbc
infection SP
thrombocytopenia
prolonged PTT
modes elevation in AST (ALT) and alk phos and total bili
decrease albumin
increased risk DM
vitamin D deficiency--> osteoporosis
52
Q

cirrhosis imaging

A 
lUS
contrasted CT or MRI, biopsy
fibrosure
liver iopsy
egd
53
Q

criteria in child pugh score

A

APE AB
ascites
bilirubin
encephalopathy

albumin
ptt

GI II Final DF (9 decks)

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