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IM > Diseases Of The Liver And Biliary System IM Plat > Flashcards

Diseases Of The Liver And Biliary System IM Plat Flashcards

1
Q

Basic patterns of liver disease

A

Hepatocellular
Cholestatic
Mixed

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2
Q

Hepatocellular examples

A

Viral hepatitis

Alcoholic liver disease

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3
Q

Cholestatic

A

Obstructive biliary diseases

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4
Q

Mixed

A

Drug induced liver diseases

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5
Q

Major risk factors for liver diseases

A 
Alcohol use
Medications - herbal compounds
Birth control pills, OTC meds
Personal habits
Sexual activity
Travel
Exposure to jaundiced or other high-risk persons
Injection drug use
Recent surgery
Remote or recent transfusion with blood and blood products
Occupation 
Accidental exposure to blood or needle stick injury
Familial history of liver disease
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6
Q

Most common and most characteristic symptom of liver disease

A

Fatigue

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7
Q

Hallmark of liver disease and the most reliable marker of severity

A

Jaundice

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8
Q

Constitutional symptoms of liver disease

A 
Fatigue
poor appetite
Weakness 
Nausea 
Malaise
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9
Q

Liver-specific symptoms

A

Jaundice,dark urine, light stools, itching, abdominal pain

Bloating

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10
Q

Signs of hepatic disease(12)

A 
Icterus
Palmar erythema 
Spider angiomata
Hepatomegaly
Splenomegaly 
Ascites
Peripheral edema
Hepatic encephalopathy
Fetor hepaticus 
Umbilical hernia
Caput medusa
Hyperestrogenemia (for males)- gynecomastia, testicular atrophy, loss of male pattern hair distribution
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11
Q

Superficial tortuous arterioles seen on the arms, face, upper torso, fill outwards from the center

A

Spider angiomata

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12
Q

Icterus can be noted on the

A

Sclerae, skin

Mucous membrane below the tongue

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13
Q

The most reliable physical finding in examining the liver

A

Hepatic tenderness

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14
Q

Hepatomegaly is seen in

A

Venoocclusive disease, infiltrative disorders, hepatic malignancy, alcohol hepatitis

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15
Q

Subtle significant finding in liver disease and portal hypertension

A

Splenomegaly

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16
Q

Ascites is best appreciated by

A

percussing for Shifting dullness

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17
Q

How much volume of ascitic fluid should be present before dullness is appreciated

A

~1500 mL

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18
Q

Contributing factors to peripheral edema in liver disease

A

Hypoalbuminemia, venous insufficiency
Heart failure
Medications

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19
Q

First signs of hepatic encephalopathy

A 
Change in sleep patterns
Change in personality
Irritability
Mental dullness
Confusion
Disorientation
Stupor
Eventually coma supervene
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20
Q

Acute liver failure neurologic signs

A

Excitability , mania

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21
Q

Slightly sweet, ammonia-like odor in patients especially if there is portovenous shunting of blood

A

Fetor hepaticus

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22
Q

Umbilical hernia develops in liver disease due to

A

Increased intraabdominal pressures from ascites

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23
Q

Appearance of distended and engorged superficial epgastric veins which are seen radiating from the umbilicus across the abdomen

A

Caput medusae

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24
Q

Golden-brown copper pigment deposited in the periphery of the cornea

A

Kayser-fleischer rings

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25
Q

Kayser-fleischer rings are found in

A

Wilson’s disease

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26
Q

Is a condition in which one or more fingers become permanently bent in a flexed position

A

Dupuytren’s contracture

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27
Q

Dupuytren’s contracture and parotiod enlargement is found in

A

Alcoholic liver disease

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28
Q

Slate-gray pigmentation of skin is found in

A

Hemochromatosis

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29
Q

Also called as bronze diabetes

A

Hemochromatosis - because it can lead to darkening of the skin and hyperglycemia

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30
Q

Tests based on detoxification and excretory functions

A

Serum bilirubin

Aminotransferases

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31
Q

Enzymes that reflect cholestatsis

A

Alkaline phosphatase (ALP)
5’ Nucleotidase (5NT)
Y- glutamyl transpeptidase (GGT)

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32
Q

Tests that measure biosynthetic function of the liver

A

Serum albumin

Serum globulins

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33
Q

presence of icterus

Total serum bilirubin is at least

A

3 mg/dL

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34
Q

Unconjugated bilirubinemia

A

Indirect

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35
Q

Conjugated bilirubinemia

A

Direct

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36
Q

Uncojugated bilirubinemia is seen in

INDIRECT

A

Hemolytic disorders
Crigler-Najjar
Gilbert’s syndrome

37
Q

Conjugated bilirubinemia (DIRECT) is seen in

A

Liver or biliary tract disease

38
Q

Enzymes that reflect damage to hepatocytes

A

Aminotransferases

39
Q

Which is the more specific indicator of liver injury

ALT VS AST

40
Q

Elevatins of >1000 U/L aminotransferases occur almost exclusively in

A

Viral hepatitis
Ischemic liver injury (prolonged hypotension or acute heart failure)
Toxin- or drug- induced liver injury
Autoimmune hepatitis
Acute phase of biliary obstruction caused by passage of gallstone into the CBD

41
Q

ALP >4X UPPER LIMIT NORMAL

Indicates

A

Cholestatic liver disease
Infiltrative liver diseases
Rapid bone turnover

42
Q

AST/ALT <1

A

Chronic viral hepatitis

Non-alcoholic fatty liver disease

43
Q

AST/ALT >2

A

Alcoholic liver disease
Development of cirrhosis
Wilson disease

44
Q

Low ALP may be seen in

A

Wilson disease (esp those presenting with
Fulminant hepatitis and hemolysis) - due to reduced activity of the enzyme from the displacement of the cofactor zinc by copper
(ALP : BILIRUBIN <4)

45
Q

ALP/AST >3

A

Cholestatic conditions like primary biliary cirrhosis

46
Q

ALP/AST <1.5

A

Autoimmune hepatitis

47
Q

5NT is elevated in

A 
Cholestatic liver disease
Hepatitis
Biliary cirrhosis
Hepatotoxic drugs
Metastasis
48
Q

Primary use of GGT

A

Identify the source of an isolated elevation in ALP

GGT not elevated in bone disease

49
Q

Half-life of serum albumin is

A

18-20 days

Thus not a good indicator of acute or mild hepatic dysfunction

50
Q

Hypoalbuminemia is

51
Q

Hypoalbuminemia is more common in

A

Chronic liver disorders - cirrhosis, reflecting severe liver damage and decreased albumin synthesis

52
Q

Y-globulins are increased in

A

Chronic liver disease (inc antibody synthesis to fight off intestinal bacteria that the cirrhotic liver failed to clear from the hepatic circulation

53
Q

Single best acute measure of hepatic synthetic functio

A

Clotting factors

54
Q

All clotting factors are synethesized in the liver except for factor

55
Q

PT measures clotting factors

A

II, V, VII, X

56
Q

Prolongation of PT >5 s above the control not corrected by IV Vitamin K portends

A

Poor prognosis

57
Q

Clotting factors have prognostic value in

A

Alcoholic hepatitis

Acute acetaminophen and non acetaminophen related liver injury

58
Q

most commonly employed imaging of the liver

A

Ultrasound
CT
MRI

59
Q

Is the first line if initial blood test suggest cholestasis

A

Ultrasound - to check for dilated ducts/ gallstones

60
Q

Procedures of choice to visualize the biliary tree

61
Q

Assessment of hepatic vasculature and hemodynamics

A

Doppler UTZ and MRI

62
Q

Is the first test ordered if suspecting for Budd-Chiari syndrome

A

Doppler US

63
Q

The criterion standard in the evaluation of patient with liver disease

A

Liver biopsy

64
Q

Liver biopsy is subject to this error in focal infiltrative disorders

A

Sampling error

65
Q

Contraindications to percutaneous approach are

A 
Significant ascites
Prolonged INR (may use transjugular approach instead)
66
Q

Diagnostic tests for autoimmune hepatitis

A

ANA or SMA
Anti-LKM1
Elevated IgG levels

67
Q

Diagnostic tests for Primary Biliary Cirrhosis

A

AMA (anti-mitochondrial antibody)

Elevated IgM

68
Q

Diagnostic tests for primary sclerosing cholangitis

A

Cholangiography

p-ANCA

69
Q

Diagnostic tests for Wilson’s disease

A

Decreased serum ceruloplasmin and increased urinary copper

Increased hepatic copper level

70
Q

Diagnostic tests for hepatocellular cancer

A

Elevated alpha-fetoprotein level >500

US or CT image of mass

71
Q

Stratifies liver disease patients into risk groups

A

CHILD-PUGH SCORE

72
Q

Predicts the likelihood of major complications of cirrhosis (e.g. variceal bleeding, spontaneous bacterial peritonitis)

A

CHILD-PUGH SCORE

73
Q

What are the parameters needed to evaluate for Child-Pugh score

A 
Serum bilirubin
Serum albumin
Prothrombin time
Ascites and 
Hepatic encephalopathy
74
Q

Child-Pugh score of 5-6

75
Q

Child Pugh score of 7-9

76
Q

Child-Pugh score of 10-15

77
Q

Decompensation indicates

A

CIRRHOSIS, with a score of >/= 7

78
Q

Has been the accepted criterion for listing a patient for liver transplant

A

Decompensation

Score of >/=7

79
Q

Maximum score of Child-Pugh score

80
Q

Minimum score of Child-pugh score

81
Q

Child Pugh score of 1

Per parameter

A 
SERUM BILIRUBIN: <2 mg/dL
SERUM ALBUMIN >3.5 g/dL
PT 0-4
INR <1.7
No ascites
No hepatic encephalopathy
82
Q

Child Pugh score of 2

Per parameter

A 
SERUM BILIRUBIN: 2-3 mg/dL
SERUM ALBUMIN 2.8-3.5 g/dL
PT 4-6
INR 1.7-2.3
ASCITES - easily controlled
HEPATIC ENCEPHALOPATHY - minimal
83
Q

Child Pugh score of 3

Per parameter

A 
SERUM BILIRUBIN: >3mg/dL
SERUM ALBUMIN <2.8 g/dL
PT >6 seconds
INR >2.3 
ASCITES - poorly controlled
HEPATIC ENCEPHALOPATHY - advanced
84
Q

MELD SCORE stands for

A

Model for end-stage liver disease score

85
Q

scoring system to predict prognosis of patients with liver disease and portal hypertension

A

Model of End-Stage Liver disease (MELD SCORE)

86
Q

MELD SCORE is calculated using three non-invasive variables

A

PT-INR
Serum bilirubin
Serum creatinine

87
Q

Budd-Chiari syndrome is caused by

A

Occlusion of the hepatic veins that drain the liver

88
Q

Classical triad of Budd-chiari syndrome

A

Abndominal pain
Ascites
Liver enlargement

89
Q

Complications of cirrhosis

A

Variceal bleeding

Spontaneous bacterial peritonitis

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