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EXAM 2 (LIVER & Flashcards

1
Q

What is Hepatitis?

A

Inflammation of liver w/ change of function

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2
Q

What are the 2 forms of Hepatitis?

A

Acute and Chronic

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3
Q

How long does Acute Hepatitis last?

A

Less than 6 months

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4
Q

How long does Chronic Hepatitis last?

A

More than 6 months

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5
Q

What are the etiologies of Hepatitis?

A
  1. Viral
  2. Toxic
  3. Bacteria
  4. Protozoa
  5. Parasites
  6. Fungi
  7. Autoimmune disorder
  8. Obesity
  9. Genetic
  10. Ischemic Hepatitis or (Liver shock)
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6
Q

What are the different types of Viral Hepatitis?

A 
HAV
HBV
HCV
HDV
HEV
HFV
HGV
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7
Q

What is HAV +ssRNA?

A

INFECTIOUS HEPATITIS

  • Spreads through fecal contamination of food and water, causes an acute and self limiting infection, does not cause chronic hepatitis
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8
Q

What is HBV +dsDNA?

A

SERUM HEPATITIS

  • Spreads through blood, body fluids, sexual contacts, tattoos, mother to child by breast feeding
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9
Q

Which Viral Hepatitis can cause chronic hepatitis, can cause cirrhosis and cancer?

A

HBV +dsDNA (serum hepatitis)

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10
Q

What is HCV +ssRNA ?

A

SERUM DELTA HEPATITIS

  • Spreads through sexual contacts and hemotransfusions, cross the placenta**
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11
Q

What is the MC viral hepatitis that causes chronic hepatitis, cirrhosis, and liver cancer?

A

HCV +ssRNA (Serum non-A, non-B hepatitis)

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12
Q

What is HDV -ssRNA?

A

SERUM DELTA HEPATITIS

  • The most aggressive form, with high mortality rate, CANNOT exist without B virus**, spreads through blood, typical for IV drug users and hemophilia patients

Causes chronic hep, cirrhosis, liver cancer

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13
Q

What is HEV +ssRNA?

A

INFECTIOUS HEPATITIS

  • Spreads through contaminated food and water, often causes an acute and self limiting infection, but (UNLIKE to hep A) causes severe: Intralobular necrosis, acute cholangitis, but does NOT cause chronic hepatitis
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14
Q

Which Hepatitis does NOT cause chronic hepatitis?

A

HEV +ssRNA

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15
Q

What does HEV+ssRNA cause?

A

Severe, intralobular necrosis acute cholangitis

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16
Q

What is HFV?

A

DNA (SERUM* MUTATED B VIRUS)

  • Spreads through blood transfusion, or oral fecal route, causes chronic hepatitis
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17
Q

What is HGV?

A

RNA (GB virus C)

  • This is a new discovered hepatitis virus, spreads by blood and sexual contact
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18
Q

What does HGV - RNA (GB virus C) not appear to do?

A

Replicate primarily in the liver, its characteristics are in the process of study

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19
Q

What is the incubation period of Hep A?

A

28 days (range: 15-50 days)

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20
Q

What is incubation period of Hep B?

A

90 days (30-150 days)

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21
Q

What is incubation period for Hep C?

A

50 days

15-160

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22
Q

What is incubation period for Hep D?

A

60-90 days

30-180

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23
Q

What is incubation period for Hep E?

A

40 days

14-60 days

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24
Q

What viruses are associated with the Etiologies of Hepatitis ?

A
  • Cytomegalovirus
  • Epstein-Barr virus
  • Yellow fever virus
  • Ebola virus and Marburg virus
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25
Q

What can Toxic Hepatitis be caused by?

A
  • Medications (Tylenol, birth control pills, Lipitor)
  • Mushroom poison
  • ALCOHOL (MC**)
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26
Q

What are the Bacteria that can cause Hepatitis?

A
  • Staphylococci and Streptococci, causes Toxic Shock Syndromes
  • Leptospira (gram-neg spirochete)
  • Listeria (gram-positive, no spore forming, rod)
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27
Q

What are the Protozoa that can cause Hepatitis?

A
  • Toxoplasma

- Leishmania

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28
Q

What are the parasites associated with Hepatitis?

A
  • Echinococcus
  • Toxocara
  • Shistosoma
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29
Q

What are the Fungi associated with Hepatitis?

A
  • Aspergillus
  • Histoplasma Capsulatum
  • Candida
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30
Q

What is the Autoimmune disease associated with Hepatitis?

A

Sjogren’s Syndrome

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31
Q

How is obesity an etiology for Hepatitis?

A

Non alcoholic steatosis

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32
Q

What are the genetic causes of Hepatitis?

A
  1. Alpha 1 Antitrypsin Deficiency
  2. Hemochromatosis
  3. Wilson Disease
  4. Glycogen storage disorders
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33
Q

What is Alpha 1 antitrypsin deficiency?

A

Abnormal accumulation of the PROTEIN within liver cells

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34
Q

What is Hemochromatosis ?

A

IRON accumulate in multiple body sites, including the liver

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35
Q

What is Wilson’s disease?

A

COPPER accumulate in the liver and brain

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36
Q

What is Ischemic Hepatitis (Shock liver) often associated with?

A
  • Heart Failure
  • Shock
  • Sepsis
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37
Q

What is the MC cause of Chronic liver disease according to her graph picture?

A

Hep C

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38
Q

Can acute hepatitis get better?

A

Yes, and it can get better quickly (typical for ACUTE)

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39
Q

What different Hepatitis forms will NOT progress to chronic Hepatitis?

A

HAV and HEV

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40
Q

What signs and symptoms normally result in progression to chronic hepatitis?

A

Autoimmune, parasites, Protozoa, obesity, genetic, and ischemic etiological agents

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41
Q

What happens within the first 2-4 days of Hepatitis ?

A

NON**- Specific, and characterized by flu-like signs and symptoms

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42
Q

What are the specific symptoms of Acute Hepatitis for the first 2-4 days?

A
  • Fever
  • Malaise
  • Joint aches
  • Headache
  • Nausea, Vomiting
  • Diarrhea
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43
Q

What are the symptoms in the Overt stage of Hepatitis?

A
  • Hepatomegaly
  • Abdominal discomfort and pain
  • Jaundice (yellowing of skin and eyes)
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44
Q

Chronic hepatitis usually results from ____

A

Acute Hepatitis, but sometimes develops insidiously

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45
Q

What are the symptoms of Chronic Hepatitis?

A

“Non-Specific”

  • Weakness and Fatigue
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46
Q

What are the Signs and Symptoms typical for all forms and etiologies of Hepatitis in Overt Stage?

A
  • Weight loss
  • Easy bruising
  • encephalopathy
  • hepatosplenomegaly
  • lymphadenopathy
  • dark colored urine
  • white stool
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47
Q

What are the ways in which you test for Hepatitis?

A
  1. Bilirubin
  2. Three types of blood tests
  3. Anti-Viral Antibodies and Viral Genetic Materials
  4. Serum Proteins
  5. Ultrasound
  6. Liver Biopsy
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48
Q

What does Bilirubin have to do with diagnosis of Hepatitis ?

A
  • There is considerable increase of BLOOD total and conjugated (direct) bilirubin
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49
Q

What will you find in the urine with Hepatitis?

A

BILIRUBIN (which results in dark brown color of the urine, dark beer)

  • And an increase concentration of urobilirubinogen
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50
Q

What are the 3 types of blood test for evaluation of patients with Hepatitis ?

A
  1. Liver Enzymes aka Aminotransferases
  2. Anti-Viral antibodies and viral genetic materials
  3. Serum Proteins
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51
Q

What are the liver enzymes that are measured for Hepatitis?

A
  • Aspartate aminotransferase (AST)
  • Alanine Aminotransferase (ALT)
  • Gamma Glutamyltransferase (GGT)
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52
Q

Aspartate aminotransferase (AST) aka

A

Serum glutamic Oxaloacetic transaminase (SGOT) is intracellular enzymes

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53
Q

Where is Aspartate Aminotransferase (AST) significantly increased in?

A
  • Acute toxic hepatitis
  • Acute viral hepatitis
  • Alcoholic liver disease
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54
Q

What are the non-specific flu like symptoms of Hepatitis?

A
  • Fever
  • Malaise
  • Joint aches
  • Headache
  • Nausea, vomiting
  • Diarrhea
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55
Q

What are the signs and symptoms typical for acute hepatitis in the “Overt” stage?

A
  • Hepatomegaly
  • Abdominal discomfort and pain
  • Jaundice: Yellowing of skin (icterus)
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56
Q

What are the signs and symptoms of Hepatitis in the Overt stage?

A
  • Weight loss
  • Easy bruising
  • Encephalopathy
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Dark colored urine
  • White stool
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57
Q

Finding a dark like color urine would be _____ in the urine, associated with what disease?

A

Bilirubin, and associated with Hepatitis

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58
Q

What would you test in the urine for Hepatitis?

A

Direct Bilirubin or urrbilirubinogen

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59
Q

What are the 3 types of blood test for evaluation of patients with Hepatitis?

A
  • Liver enzymes aka aminotransferases
  • Anti-viral antibodies and viral genetic materials
  • Serum proteins
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60
Q

What do liver enzymes aka Aminotransferases typically mean in the blood?

A

(Measures liver homeostasis)

  • Their high concentrations develop as a result of destruction or inflammation NOT only in liver, but other tissues as well
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61
Q

What are the liver enzymes, or “Aminotransferases” ?

A
  • Aspartate Aminotransferase (AST)
  • Alanine Aminotransferase (ALT)
  • Gamma Glutamyltransferase (GGT)
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62
Q

What is Aspartate (AST) aka

A

Serum glutamic oxaloacetic transaminase (SGOT) is intracellular enzymes

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63
Q

Aspartate Aminotransferase (AST), aka SGOT is simnifically increased in:

A
  • Acute toxic hepatitis
  • Acute viral hepatitis
  • Alcoholic liver disease
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64
Q

Where else besides the liver can Aspartate Aminotransferase aka SGOT be found?

A
  • Skeletal muscles
  • Heat muscle
  • Brain
  • Lungs
  • Pancreas
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65
Q

Alanine Aminotransferase (ALT) aka

A

Serum Glutamic Pyruvic Transaminase (SGPT) is intracellular enzymes

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66
Q

Alanine aminotransferase (ALT) aka SGPT is normally ______

A

Most concentrated within liver cells and (in lesser degree) in the heart muscle cells, kidneys, pancreas

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67
Q

Why would Alanine Aminotransferase (ALT) aka SGPT be elevated?

A

Acute hepatocyte destruction, or severe, heart, kidney, or pancreas damage*

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68
Q

Gamma-glutamyltransferase (GGT) is found predominantly:

A

In the hepatobiliary cell membranes, but also present in the cell membranes of other tissues (kidney, heart, brain)

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69
Q

Gamma glutamyltransferase (GGT) blood concentration is significantly increased in liver diseases associated with:

A

**

Hepatocyte necrosis, cirrhosis, and alcoholic liver disease

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70
Q

Anti-viral antibodies and viral genetic materials can be helpful in diagnosis of:

A

Acute and chronic viral hepatitis

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71
Q

What are the anti-viral antibodies?

A
  • anti-HAV (for Hep A)
  • anti-HBV (for Hep B)
  • anti-HCV (for Hep C)
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72
Q

When examining Serum Proteins in the diagnosis of Hepatitis, what are the rules?

A

IgM = Acute case

IgG = Chronic case

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73
Q

What is Hypoalbuminemia?

A

Indicates a decreased function of hepatocytes

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74
Q

What is “Increased Prothrombin Time” ?

A

Indicates the decreased production of clotting factors

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75
Q

What are the most SPECIFIC tests for liver destruction?

A

Hypoalbuminemia and Increased prothrombin time

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76
Q

What are the complications of Hepatitis?

A
  • Liver Cirrhosis (Hep B, C, D, F, toxic, autoimmune, genetic)
  • Hepatic Failure
  • Hepatocellular Carcinoma (Hepatoma)
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77
Q

What is Liver Cirrhosis?

A

A consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to loss of liver function

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78
Q

What is the major etiological factor for liver cirrhosis?

A

Alcoholism

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79
Q

Alcoholic steatosis aka

A

Fatty liver

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80
Q

What will you see under the microscope with Liver cirrhosis?

A

Mallory bodies - an eosinophilic cytoplasmic inclusion, alcoholic hyaline, found in liver cells

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81
Q

What are the Etioligies of Liver Cirrhosis?

A
  • Non-alcoholic steatohepatitis
  • Chronic Hepatitis B, C, D, F
  • Autoimmune hepatitis
  • Some medicines (eg corticosteroids)
  • Genetic diseases (genetic hemochromatosis, Wilson’s Disease)
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82
Q

What are the signs and symptoms of Liver Cirrhosis?

A

There may be no symptoms or symptoms may come on slowly, depending on how well the liver is working

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83
Q

What do early symptoms of Liver Cirrhosis include?

A
  • Fatigue and loss of energy
  • Poor appetite and weight loss
  • Nausea and upper abdominal discomfort
  • Small, red, spider like blood vessels on the skin (telengiectasia, spider angioma)
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84
Q

As liver function worsens, what other symptoms may include?

A
  • Ascites

- Ascites with “caput medusae”

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85
Q

What does Caput Medusae represents:

A

The dilation of periumbilical collateral veins, and is an important sign of portal hypertension

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86
Q

Liver cirrhosis is the MAJOR cause of ____

A

Esophageal varicies

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87
Q

What are the signs and symptoms on your physical exam that you’ll see with Liver Cirrhosis?

A

Ankle swelling (non-pitting, non-pedal edema)

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88
Q

What is Ankle swelling (non-pitting) edema due to?

A

Hypoalbuminemia

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89
Q

What is the hand sign that you will see with Liver Cirrhosis?

A

Palmar Erythema and nail clubbing

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90
Q

What will be seen on the skin of someone with Liver cirrhosis?

A

Easy bruising

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91
Q

Abnormal bleeding is associated with what disease?

A

Liver Cirrhosis

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92
Q

Confusion or Problems thinking will be associated with what disease?

A

Liver Cirrhosis

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93
Q

What is a late stage finding with Liver Cirrhosis?

A

Hepatic encephalopathy

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94
Q

What are the Signs and Symptoms of liver cirrhosis in men?

A
  • Impotence
  • Hypogonadism (small balls)
  • Gynecomastia (breast swelling)
95
Q

With liver cirrhosis, what can the size of the liver be?

A
  • Normal
  • Enlarged
  • Shrunken
96
Q

What is often found with Liver Cirrhosis ?

A

Splenomegaly

97
Q

What will the Complete Blood count look like with Liver Cirrhosis?

A
  • Thrombocytopenia
  • Leukopenia
  • Neutropenia
98
Q

What is the Prothrombin time with Cirrhosis?

99
Q

What disease is associated with Hypoalbuminemia?

A

Liver Cirrhosis

100
Q

What are the aminotransferases that are elevated with Liver Cirrhosis?

A

AST, ALT, GGT

101
Q

Which is higher with Liver cirrhosis, AST or ALT?

102
Q

What is typically much higher in alcoholic cirrhosis?

103
Q

What is elevated with Liver Cirrhosis?

A

ALP and Bilirubin

104
Q

What is the gold standard for diagnosis of Liver Cirrhosis?

A

Liver biopsy

105
Q

What are the other ways to diagnose Liver Cirrhosis?

A
  • CT of abdomen
  • MRI of abdomen
  • Upper endoscopy for esophageal varicies
  • Ultrasound of abdomen
106
Q

What are the complications of Liver Cirrhosis?

A
  • Bleeding disorders
  • Esophageal varicies
  • Hepatocellular Carcinoma
  • Hepatic encephalopathy
107
Q

What is the treatment for Liver cirrhosis?

A

It is an Irreversible disease, and the treatment usually focuses on preventing of it progression and complications

108
Q

What is the one of the only real options for today with liver cirrhosis?

A

Liver transplantation

109
Q

What do most liver transplant recipients receive?

A

Immunosuppressive drugs (corticosteroids) for prevention of graft rejection

110
Q

What are the 2 forms of Liver Cancer?

A

1 Primary

2 Secondary (Mets)

111
Q

What is secondary liver cancer?

A

Begins in another area of the body (colon, breast, stomach) and spreads to liver

112
Q

Liver cancer occupies, in cancer mortality?

A

3rd position in frequency among MC cancer mortality

113
Q

What are the classifications of Primary liver cancer?

A

a) Hepatocellular Carcinoma aka Hepatoma
b) Cholangiocarcinoma
c) Angiosarcoma aka Hemangioendothelioma

114
Q

What is the most frequent liver cancer?

A

Hepatocellular carcinoma aka hepatoma, originates from HEPATOCYTES **

115
Q

Where does Cholangiocarcinoma originate from?

A

The bile duct cells

116
Q

Angiosarcoma aka Hemangioendothelioma originates from:

A

Originates from the blood vessel cells in the liver

117
Q

What are the first 3 etiologies of Liver cancer?

A
  1. Chronic infectious hepatitis B, C, D
  2. Liver cirrhosis
  3. Aflatoxins
118
Q

What are Aflatoxins?

A

Poisons produced by the plant mold Aspegillus, that grows on wheat, rice, corn, and peanuts

119
Q

What are the last 4 etiologies of Liver Cancer?

A
  1. Wilson’s Disease
  2. Hemochromatosis
  3. Non-alcoholic fatty liver disease
  4. Estrogen and anabolic steroids
120
Q

What are the first 3 Signs and symptoms of liver cancer? (late stage)

A
  1. Loss of weight
  2. Loss of appetite
  3. Upper abdominal discomfort and pain
121
Q

What are the 4-6 signs and symptoms of liver cancer?

A
  1. Nausea, vomiting
  2. General weakness, fatigue
  3. Jaundice with skin itching
122
Q

What are the 7-9 signs and symptoms of liver cancer?

A
  1. Hepatosplenomegaly
  2. Sudden Ascites
  3. Back pain
123
Q

During the physical examination of Liver Cancer, what will be found?

A

Hepatic bruit, it develops because hepatoma

124
Q

Why do you hear a Hepatic bruit during Liver cancer?

A

It develops because hepatocarcinoma has a lot of blood vessels with turbulent blood flow

125
Q

What would suggest that a patient has developed a Hepatoma?

A

Hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis developed hepatoma

126
Q

Where will Mets from the liver go to?

A

To local veins and then to the lungs

  • ADVANCED: Bone, spine, brain
127
Q

What are major sources of METS to the liver?

A

The ones from GI tract organs

  • It results from specific venous blood flow from GI tract to v. Porta, which brings the blood to the liver for detoxification
128
Q

How do you diagnose liver cancer?

A
  1. Blood test
  2. Ultrasound
  3. CT
  4. MRI
  5. Liver biopsy
  6. PET-CT
129
Q

What is the most important increased marker in the blood during liver cancer?

A

Increased Alfa-fetoprotein

Normal for infants before 1 year old

130
Q

What else is increased Alfa-fetoprotein found in?

A

Cancer of testicles and ovaries

131
Q

What are the tumor markers for primary liver cancers?

A
  • Carbohydrate antigen 19-9 (CA 19-9)
  • Carcinoembryonic antigen (CEA)
  • Cancer antigen 125 (CA125)
132
Q

What does PET-CT do?

A

Position Emission Tomography Computer Tomography for determination of biochemical activity of the organ and cancer stage

133
Q

What is the treatment for liver cancer?

A
  • Cryotherapy in early stage
  • Chemoembolisation
  • Radiotherapy
  • Liver transplantation
134
Q

Cholelithiasis aka

A

Gallstone Disease (formation of stones in gallbladder)

135
Q

What is Choledocholithiasis?

A

Formation and migration of stones inside the biliary tree or common bile duct

136
Q

What are the 3 types of gallstones?

A
  1. Cholesterol stones
  2. Pigment stones
  3. Mixed
137
Q

What type of stones are radiolucent?

A

Cholesterol stones (80%)

138
Q

What type of gallstones are radiopaque?

A

Pigment stones (contain bilirubin and calcium)

139
Q

What are the risk factors for CHOLESTEROL gall stones?

A
  1. Decreased gallbladder motility w/bile stasis
  2. Obesity
  3. Family history (genetic predisposition)
  4. Rapid weight loss
  5. Long intervals between meals
140
Q

Risk factors for PIGMENT gallstones:

A
  1. Hemolytic conditions (sickle cell anemia, hereditary spherocytosis, thalassemia)
  2. Liver cirrhosis
  3. Introductal stasis (choledochal cyst, postsurgical biliary stricture)
141
Q

What are the risk factors for MIXED gallstones?

A
  1. Crohn‘s Disease
  2. Partial removal of ilium
  3. Decreased gallbladder motility:Trauma, burns, paralysis
142
Q

Are gallstones asymptomatic?

A

They may be present for decades before the symptoms develop, and 70-80% of patients remain asymptomatic through their lives

143
Q

What is the major danger of gallstones?

A

Their ability to move to the bile ducts resulting in duct obstruction

144
Q

With Cholelithiasis, is it worse to get a large or small stone?

A

The larger the calculi , the less likely they are to enter he cystic or common ducts (obstruction)

SMALL = DANGEROUS

145
Q

What are the signs and symptoms of the sudden “gallstone attack” ?

A
  • Sudden acute pain in the RUQ, lasts 30 min to several hours, until gallbladder relaxes
  • Pain radiates to back, between blades, right shoulder, behind sternum
  • Change of posture, defecation DO NOT relieve pain
146
Q

When is Murphy’s sign positive w/Cholelithiasis ?

A

Murphy’s sign is positive in Cholelithiasis only when it’s complicated with Cholecystitis

147
Q

When is Murphy’s sign negative w/Cholelithiasis ?

A

Murphy’s sign is negative with the stone in BILE DUCT (Choledocholithiasis)

148
Q

What are the signs and symptoms of Cholelithiasis ?

A
  • Tachycardia
  • Nausea, vomiting (vomiting does NOT relieve pain)
  • Increased production of gas
  • Fat Intolerance
149
Q

What are the signs and symptoms of Choledocholithiasis ?

A
  • Acute constant pain in the upper part of abdomen
  • Obstructive Jaundice
  • Murphy’s sign is NEGATIVE
150
Q

What is the major sign and symptom with Choledocholithiasis ?

A

The CHARCOT triad (indicates the ASCENDING CHOLANGITIS

151
Q

What is Charcot triad?

A

URQ pain, Jaundice, and Fever

152
Q

When diagnosis Cholelithiasis, what will be elevated in the blood?

A
  • Increased WBC
  • Increased common bilirubin content
  • Increased alkaline phosphatase
153
Q

Alkaline Phosphatase is in what organs?

A
  • Liver
  • Bile duct
  • Kidneys
  • Bones
  • Placenta
154
Q

What can high Alkaline Phosphatase show?

A
  • Bile duct obstruction
  • Presence of Paget’s disease w/ osteoblastic activity, or Mets prostate cancer
  • Presence of pregnancy
  • Presence of Celiac disease
155
Q

What is the gold standard examination for diagnosis of gallbladder stones and stones in cystic duct?

A

Ultrasound

156
Q

In regard to Cholelithiasis, the CT scan is used for diagnosis of:

A

Distal common bile duct stones, “Porcelain Gallbladder”

157
Q

What is MRI used for w/Cholelithiasis?

A

Diagnosis of stones at any level of bile tree and gallbladder

158
Q

What is the black sheep of diagnosing for Cholelithiasis ?

A

ERCP

Endoscopic Retrograde Cholangiopancreatography

159
Q

What is X ray sensitive to?

A

For diagnosis of “Porcelain Gallbladder”

160
Q

What is Porcelain Gallbladder characterized by?

A

Calcification of gallbladder wall, developing usually in Cholelithiasis complicated by chronic cholecystitis

161
Q

On x ray, where would gallstones be?

A

In FRONT of lumbar spine

162
Q

What are the complications of Cholelithiasis?

A
  1. Acute Cholecystitis
  2. Chronic Cholecystitis
  3. Gallbladder Gangrene
  4. Perforation or rupture
  5. Cholangitis
  6. Acute Pancreatitis
163
Q

When would you get Acute Cholecystitis (complication of Cholelithiasis )?

A

When the CYSTIC DUCT is obstructed

164
Q

How do you develop Chronic Cholecystitis (complication of CHolelithiasis)?

A

When long term presence of gallstones (Silent stones) leads to fibrosis of the gallbladder wall, will further its calcification (Porcelain Gallbladder)

165
Q

How do you get “Porcelain Gallbladder?”

A

Chronic Cholecystitis

166
Q

What will happen if there is perforation or rupture of the gallbladder?

A

Development of Bile Peritonitis and high level of mortality

167
Q

When will you develop Cholangitis?

A

When the common bile duct is obstructed before joining the pancreatic duct

168
Q

How would you develop Acute Pancreatitis?

A

When the hepatopancreatic duct or pancreatic duct is obstructed

169
Q

What is Cholecystitis defined as?

A

Inflammation of gallbladder wall

170
Q

What are the 2 forms of Cholecystitis ?

A
  1. Calculous

2. Acalcolous

171
Q

What is Calculous Cholecystitis?

A

When stones in the gallbladder are formed - 90%

172
Q

Cholecystitis is divided into what 2 categories ?

A
  1. Acute

2. Chronic

173
Q

What are the first 4 risk factors for Calculous Cholecystitis ?

A
  • Female sex
  • Obesity
  • Rapid Weight loss
  • Pregnancy
174
Q

What are the last 3 risk factors for Calculous Cholecystitis?

A
  • Increasing age
  • ethnic groups (Hispanic, Scandinavia)
  • drugs (especially hormonal therapy in women)
175
Q

What are the first 3 etiologies of Acalculous?

A
  1. Critical illness (HIV, diabetes mellitus, myocardial infarction)
  2. Major surgery or severe trauma/burns
  3. Sepsis
176
Q

What are the last 3 etiologies of Acalculous Cholecystitis ?

A
  1. Long term parenteral nutrition
  2. Prolonged Fasting
  3. Salmonella Infection
177
Q

What is the Pathogenesis of Chronic Cholecystitis ?

A

Chronic Cholecystitis occurs after repetitive mild exacerbations of acute cholecystitis, and is characterized by mucosal atrophy and fibrosis of gallbladder wall

178
Q

What are the first 3 signs and symptoms of Acute Cholecystitis ?

A
  1. Acute pain in RUA that is severe and constant, may last for days
  2. Pain increases w/breathing
  3. Pain radiates to right shoulder, or right scapula, or right mid back (T8-T9)
179
Q

What are signs and symptoms 4-6 of acute Cholecystitis ?

A
  1. Changing position and passing gas do NOT relieve the pain
  2. Large amount of meal or fat meal can trigger the pain
  3. Pain occurs several hours after eating and awakens the patient during the night
180
Q

What are the symptoms 7-9 of Acute Cholecystitis ?

A
  • Fever and chills
  • Nausea and vomiting
  • vomiting does NOT relieve the pain (unlike peptic ulcer)
181
Q

What are the first 3 signs and symptoms of Chronic Cholecystitis?

A
  1. The first symptoms are bitter taste and taste of metal in the mouth in the mornings
  2. Abdominal discomfort after meals
  3. Complaints of gas accumulation
182
Q

What are the last 3 signs of Chronic Cholecystitis ?

A
  1. Nausea
  2. Chronic diarrhea
  3. Xanthomas
183
Q

What do Xanthomas represent?

A

Focal accumulation of cholesterol, result from cholestasis or/and hyperlipidemia

184
Q

What signs are present with Cholecystitis?

A
  • Ortner’s
  • Georgievskiy-Myussi
  • Murphy’s
  • Boas
185
Q

What is Ortner’s sign?

A

Tenderness when hand taps the end of right costal arch

186
Q

What is Georgievskiy-Myussi sign?

A

Phrenic Nerve sign

  • Pain when pressing between edges of RIGHT SCM
187
Q

What is Murphy’s sign?

A

Specific for cholecystitis but is non-sensitive especially in geriatric patients

188
Q

What is Boas’s sign?

A

Increased sensitivity below the right scapula (also due to phrenic nerve irritation)

189
Q

When would elevated WBC be present?

A

With Acute Cholecystitis

190
Q

When is Alkaline Phosphatase elevated?

A

Acute Cholecystitis (indicates inflammation of the gallbladder wall due to bile duct obstruction)

191
Q

When would you see elevated C reactive protein?

A

Acute Cholecystitis

192
Q

Blood test for Chronic Cholecystitis frequently show ____ values

193
Q

What do you use to diagnose Chronic Cholecystitis ?

A
  • Ultrasound sonography
  • MRI
  • CT scan
  • HBS
194
Q

What is the CT scan good for with Chronic Cholecystitis ?

A

More sensitive that ultrasound sonography in diagnosis of pericholecystic inflammation

195
Q

What is HBS associated with Chronic Cholecystitis ?

A

Hepatobiliary Scintigraphy - used for differential diagnosis between acute and chronic Cholecystitis

196
Q

What is the DDX for ACUTE Cholecystitis ?

A
  • Acute peptic ulcer
  • Perforated peptic ulcer
  • Acute pancreatitis
  • Ureteral colic
197
Q

What is the DDX for CHRONIC Cholecystitis ?

A
  • Peptic ulcer
  • Hiatal hernia
  • Colitis
  • Chronic pancreatitis
198
Q

What are the complications of Cholecystitis ?

A
  • Perforation or rupture of gallbladder
  • Ascending cholangitis
  • Local abscess
  • Peritonitis
199
Q

What is the management of Acute Cholecystitis ?

A

Cholecystectomy

200
Q

What is the management of Chronic Cholecystitis ?

A

Diet modification, antibiotics, restriction of physical activity

201
Q

What is Pancreatitis?

A

Inflammation of the pancreas when certain enzymes that normally do not become active until they reach the small intestine, become active in the pancreas “digesting” this gland itself

202
Q

What enzyme plays the most important role with Pancreatitis?

203
Q

What are the 2 types of Pancreatitis?

A

Acute and chronic

204
Q

Is acute pancreatitis reversible?

205
Q

What is chronic pancreatitis characterized by?

A

Atrophy, fibrosis, and calcification of pancreatic parenchyma (IRREVERSIBLE)

206
Q

What are the first 3 etiologies for acute pancreatitis?

A
  1. Alcohol use
  2. Gallstones
  3. Trauma of the abdomen (blunt abdominal trauma)
207
Q

What are the last 3 etiologies of acute pancreatitis?

A
  1. Viral infections (mumps)
  2. Pseudocysts
  3. Medications (corticosteroids, estrogen, statins)
208
Q

What is the etiology for chronic pancreatitis?

A
  • Alcoholism
  • Cystic fibrosis
  • Pseudocysts
  • Idiopathic
209
Q

Does Acute Pancreatitis resolve?

A

Severe pain in upper abdomen and resolves itself

210
Q

When does acute pancreatitis pain worsen?

A

After food eating

211
Q

Where does the pain localize with acute pancreatitis?

A

T8-L1 “Band like pain”

212
Q

Where can pain radiate with acute pancreatitis?

A

Umbilical, both flanks, left shoulder

213
Q

In what position does the pain become worse with acute pancreatitis?

A

Lying flat on back

214
Q

When does pain decrease with acute pancreatitis?

A

Sitting and flexion forward (unlike pain in Cholelithiasis and acute Cholecystitis )

215
Q

What is acute pancreatitis pain ALWAYS accompanied by?

A

High BP and tachycardia

216
Q

What sign is positive with Acute pancreatitis?

A

Positive Cullen’s sign

217
Q

What is Cullen’s sign?

A

Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus

218
Q

What is the 2nd positive sign with Acute Pancreatitis?

A

Grey Turner’s sign

219
Q

What is Grey Turner’s sign?

A

Ecchymosis of flanks - bruising of the flank, which may be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding

220
Q

What are the 3 signs and symptoms of Acute Pancreatitis?

A

Nausea, Vomiting, and Fever

221
Q

What are the 2 big things with Chronic Pancreatitis?

A

Acute pain is NOT resolved itself

Change of position does NOT relieve pain

222
Q

What are the signs and symptoms of Chronic Pancreatitis?

A
  • Severe vomiting,
  • fatty stool,
  • signs of diabetes mellitus: thirst, polyruia
  • Weight loss
223
Q

What is 4-6 times higher in the blood with Chronic Pancreatitis?

A

Blood amylase and lipase

LIPASE IS BETTER INDICATOR

224
Q

What is significantly increased with the diagnosis of Pancreatitis?

A

Urine amylase and blood glucose level

225
Q

What are the 2 complications for Acute pancreatitis ?

A

Pancreonecrosis and Pancreatic abscess

226
Q

Due to adjacent organs, what can happen due to Acute pancreatitis?

A

Acute gastritis and Duodenitis

227
Q

What is a serious condition that can arise from acute pancreatitis?

A

Internal bleeding w/ development of hypovolemic shock

228
Q

Can the lungs be affected with acute pancreatitis?

A

YES, (enzymes may affect the lung tissue causing its inflammation)

229
Q

What are the 4 complications for Chronic Pancreatitis?

A
  1. Diabetes Mellitus
  2. Pancreatic Cancer
  3. Calcification of Pancreas
  4. Multiple Cysts
230
Q

What is MC type of Pancreatic cancer?

A

Adenocarcinoma , arising from EXOCRINE component

231
Q

What is a Non-specific sign and symptom of Pancreatic cancer?

A

Clinical depression (sometimes before cancer is diagnosed)

232
Q

What sign is Present with Pancreatic cancer?

A

Unexplained Thrombophlebitis (Trousseau sign)

233
Q

What is Endocrine Pancreatic Tumor?

A

Insulinoma (beta cell)

  • Overproduction of insulin = Results in hypoglycemia
234
Q

What does Zollinger Ellison syndrome cause?

A

It causes multiple peptic ulceration

10 GE (6 decks)

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