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CK_GI > DIT 2 > Flashcards

DIT 2 Flashcards

1
Q

findings in PBC besides fatigue and itching

A

skin - hyperpigmentaiton, xerosis
xanthomas/xanehtelasma
cirrhosis, jaundice, Malays, steatorrea

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2
Q

two rheum markers PBC and lab findings

A
  • antimitochondrial
  • ANA
  • elevated Alk phos/bili/cholesterol (later disease)
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3
Q

PSC associated with….

A

UC

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4
Q

lab markers PSC

A

pANCA
elevated alk phos
ANA NEGATIVE

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5
Q

PSC increases risk for…

A

cholangiocarcinoma

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6
Q

enzyme that conjugates bilirubin

A

UDPGT

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7
Q

adolescent patient, mild asymptomatic jaundice that following exercise…dx and deficiency

A

Gilbert

increased indirect bilirubin 2/2 mild UDPGT deficiency

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8
Q

neonate, severe neonatal jaundice, kernicterus, usually fatal

A

Crigler Najjar type 1 (evil) …severe UDPGT deficiency

milder form Crigler Najjar type 2 (presents in childhood/adolescence)

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9
Q

rx crigler najjar 2

A

phenobarbital (increases UDGPT)

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10
Q

extra hepatic manifestations Hep C

A 
membranoproliferative glomeruloneph
mixed cryoglobulinemia
lymphoma
porphyria cutanea tarda
lichen planus
DM
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11
Q

extra hepatic manifestations Hep B

A

membranous nephropathy

polyarteritis nodosa, aplastic anemia

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12
Q

which hepatitis increases risk for HCC

A

hep B > hep C

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13
Q

HbsAg

A

active infection

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14
Q

HbsAb

A

recovered or vaccinated

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15
Q

HbcAb

A

ANY HISTORY OF HAVING DISEASE
IgM - early
IgG- late

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16
Q

HbeAg

A

active viral replication, HIGH INFECTIVITY

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17
Q

HbeAb

A

low infectivity

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18
Q
  • HbsAg -HbsAB +IgG HBcAb
A

active infection window period

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19
Q

+ HbsAg -HbsAb +IgG HbcAb, low high Hbv DNA

A 
chronic infection (immune tolerance)
high disease state, no damage
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20
Q

pathological development of alcoholic liver disease

A

steatosis (reversible) -> steatohepatitis -> cirrhosis (increased HCC risk)

21
Q

overweight patient, chronically elevated LFTs, no inflammation on imaging, no hx of alcohol or hepatitis

A

NAFLD -> NASH

increased risk obesity, DM, metabolic syndrome, insulin resistance

22
Q

rx NASH for T2DM

A

TZDs (i.e. pioglitazone)

improves LFTs and possible histology

23
Q

hand findings in cirrhotic patient

A

DUPUYTREN CONTRACTURE
asterexis
palmar erythema
digital clubbing

24
Q

patient with ascites, hepatomegaly, jaundice….acutely can have RUQ pain, hepatomegaly, RAPID DEVELOPMENT jaundice and ascities

A

think Budd Chari (thrombosis of hepatic vein or intrahepatic/suprahepatic portion of IVC)

25
Q

best initial study for Budd Chiari

A

US

26
Q

how to differentiate between portal hypertension ascites and something else?

A

SAAG
serum albumin - ascites albumin

SAAG >1.1 = portal hypertension

27
Q

Causes of non-portal hypertension ascites

A

SAAG <1.1
high albumin in ascites - TB, pancreatitis, serositis, infection, heart failure,
low albumin - nephrotic syndrome

28
Q

SAAG in SBP?

A

greater than 1.1

associated with portal HTN

29
Q

dx SBP

A 
ascites gram stain/culture
neutrophil ?250
elevate ascites LDH
SAAG>1.1
low ascites glucose
30
Q

rx SBP

A

third generation cephalopo (cefotaxime, ceftriaxone)

albumin to maintain plasma volume and preserve renal function

31
Q

manifestations hemocrhomatosis

A 
bronze diabetes
heart - dilated/restrictive cardiomyopathy
liver - hepatomegaly, cirrhosis
joints - arthralgia
skin - hyperpigmentation
pancreas - DM
32
Q

rx hemochromatosis (2)

A 
serial phlebotomy
iron chelators (deferoxamine)
33
Q

what test to get to screen for hemochromatosis

A

ferritin (will be elevated)

transferrin will be elevated too

34
Q

test to get for Wilson’s

A

ceruloplasmin (will be low)

35
Q

rx Wilson’s (4)

A 
copper chelators (pencil amine  + trientene)
restrict dietary copper
liver transplant
zinc supplements (interfere with copper absorption)
36
Q

difference between pathologies of Wilson’s and hemochromatosis

A

wilson - LESS SECRETION (of copper)

hemochromatosis - LESS ABSORPTION (of iron)

37
Q

patient comes in with emphysema and cirrhosis

dx and mode of inheritance

A

a1 antitrypsin deficinecy

CODOMINANT

38
Q

a1 antitrypsin leads to OVERactivity of what

A

elastase (too much destruction of elastic tissue)

39
Q

anti smooth muscle abx

A

type 1 AIH

40
Q

liver-kidney microsomal (LKM) antigens

A

type 2 autoimmune hepatitis

41
Q

liver cytosol antigen

A

type 2 autoimmune hepatitis

42
Q

young female with vague RUQ comes in, incidentally finds a liver mass on imaging

A

hepatic adenoma

MAIN RISK FACTOR: OCP USE!!!

43
Q

main risk factor for hepatic adenoma

A

OCP use

44
Q

MCC malignant liver mass

A 
LIVER METS!
NOT HCC (MCC primary liver tumor)
45
Q

next step in patient with incidentally found liver mass with malignant features

A

ASSESS FOR OTHER CANCERS
CT chest, abd, pelvis
colonoscopy

46
Q

risk factors for HCC

A

Hep B
Hep C
cirrhosis
aflatoxin (food infected with aspergillius)

47
Q

what paraneoplastic syndromes can HCC cause (4)

A

EPO - polycythemia
VIP - watery diarrhea
PTHr P - hypercalcemia
hypoglycemia

48
Q

What cancers can cause polycythemia (4)

A 
"Potentially Really High Hct"
pheochromocytoma
RCC
HCC
hemangioblastoma
49
Q

elevated AFP

A

HCC

CK_GI (3 decks)

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