GASTRO Flashcards
1
Q
Storage function, relaxes to accomodate the meal
A
Proximal stomach
2
Q
Phasic contractions, propels food residue against the pylorus
A
Distal stomach
3
Q
secretes intrinsic Factor for Vitamin B12 absorption
A
Stomach
4
Q
Suited For absorption of vit B 12 and bile acids
A
Ileum
5
Q
GI diseases with impaired digestion and Absorption
A
ZE, lactase deficiency, Biliary obstruction, other intestinal enzyme deficiencies
6
Q
most common intestinal maldigestion syndrome involving dairy products ( lactose content)
A
L actase deficiency
7
Q
GI diseases with altered secretion
A
Gastric acid hypersecretion: ZE, G-cell hyperplasia, retained antrum Syndrome, some with DU
Gastric acid hyposecretion: Atrophic gastritis, pernicious anemia
Inflammation and infection
8
Q
GI diseases with altered Gut Transit
A
mechanical Obstruction
Disordered Gut motor Function: impaired propulsion/ rapidpropulsion disorders
9
Q
GI diseases associated with immune dysregulation
A
Celiac disease, Eosinophilic gastritis, Ulcerative colitis and Chron’s disease
10
Q
GI diseases with Impaired Gut Blood flow
A
Thromboembolic causes: arterial embolus or thrombosis, venous thrombosis
Hypoperfusion causes: dehydration, sepsis, hemorrhage or decreased CO
Radiation enterocolitis
Gastroparesis due to blockage of the celias and SMA
11
Q
GI disease typically presenting at after age 50
A
Colorectal CA
12
Q
may be due to chronic acid reflux or with extensive Alcohol and tobacco use
A
Esophageal cancer
13
Q
Abdominal pain:generally midline in location and vague in character
A
visceraL pain
14
Q
Abdominal pain that can be localized and precisely described
A
Parietal pain
15
Q
Most common causes of abdominaL pain
A
IBS and Functional dyspepsia
16
Q
Initial procedure to evaluate dysphagia to exclude subtle rings or strictures and assess for achalasia
A
Barium swallow
17
Q
Performed when colonoscopy is unsuccessful or contraindicated
A
Contrast enema
18
Q
Alternative for colonoscopy For colon cancer screening
A
CT and MR Colongraphy
19
Q
Diagnostic modality used to exclude mesenteric ischemia and determines Spread of malignancy
A
Angiography
20
Q
Userful in searching for Intraabdominal abscesses not visualized on CT
A
Radio labeled leukocyte scans
21
Q
Esophageal manometry is a functional test used for patient’s suspected Of
A
Achalasia
22
Q
GOld standard for imaging of colonic mucosa
A
Colonoscopy
23
Q
More accurate for evaluation of diverticula and measurement of colonic strictures
A
Barium enema
24
Q
Procedure used to visualize the rectum and a variable portion of the left colon
used for colorectal cancer screening primarily used for evaluation of diarrhea and rectal outlet bleeding
A
Flexible Sigmoidoscopy
25
Used as both diagnostic and therapeutic procedure
open sphincter of Oddi: endoscopic sphincterotomy
Retrieval of stones from the ducts
Biopsy, dilation and stenting of duct strictures, stenting of ductal leaks
Di agnosis: sphincter of Oddi dysfunction
ERCP
26
Most accurate pre - op local staging of Cancers
EUS
27
Risks of Bleeding and GI perforation
Low risk: Diagnostic Upper endoscopy, Colonoscopy, diagnostic Eus
Increased risk: Therapeutic procedures such as EMR and ESD, control of bleeding, or Stricture
Rare with flexible sigmoidoscopy
28
Recommended to Start Antibiotic prophylaxis For Endoscopic procedure
Bile duct obstruction (-) Cholangitis: ERCP with anticipated incomplete drainage: prevention of Cholangitis
Sterile Pancreatic fluid collection (pseudooyst, necrosis) which communicates with pancreatic duCt: ERCP: cyst infection
Sterile pancreatic Fluid collection: Transmural drainage: cyst infection
cystic lesions along GI tract: EUS- FNA: cyst infection
percutaneous Endoscopic feeding tube placement: periostomal infection
Cirrhosis with acute GI bleeding: All patients regardless of endoscopic procedure
29
LR endoscopic procedures for the management of Antithrombotic Drugs before Endoscopy
EGD or colonoscopy with/ without Biopsy, EUS without FNA, ERCP with stent exchange
30
HR endoscopic procedures for the management of Antithrombotic Drugs before Endoscopy
E G D or colonoscopy with dilation, Polypectomy or thermal ablation, PEG, Eus with FNA, ERCP with sphincterotony or psendocyst drainage
31
Antithrombotic drug that does not increase the risk of bleeding during endoscopic procedures
Aspirin monotherapy
32
Risk of developing Pancreatitis during ERCP
5% with increased risk in young anicteric patients with normal ducts
33
Most common complication in Percutaneous gastrostomy tube placement during EGD
Wound infection
34
Increases likelihood of rebleeding from endoscopy
R/R-A-C/C
Respi/Renal Failure
Age> 70 y 0.
Cirrhosis/ Coagulopathy
35
Indications for urgent endoscopy
Resting hypotension, repeated hematemesis, Ngt aspirate that does not clear with large volume lavage, orthostatic change in vital signs, or requirement for BT
36
PUD risk of rebleeding: clean- based ulcer
low risk (3-5 %)
37
PUD risk of rebleeding:
Flat red or purple spots in the ulcer base
Large adherent CLots covering the ulcer base
Intermediate risk
| 10% and 20%
38
PUD risk of rebleeding: sentinel clot ( platelet plug protruding from a vessel wall in the base of an ulcer) or visible vessel; often requires local endoscopic therapy to decrease the bleeding rate
High Risk: approximately 40%
39
Reduces Rebleeding rate and improves patient outcome
proton Pump Inhibitor
40
Indicated for primary prophylaxis from large esophageal varices when BBS are. contraindicated or not tolerated preferred last therapy For bleeding esophageal varices and eradication of varices
Endoscopic Variceal Ligation
41
Used as salvage therapy when EVL Fails as it has higher complication rates
Endoscopic variceal sclerotherapy
42
Persistent caliber artery
| Large caliber arteriole that runs immediately beneath the GI mucosa and bleeds through a pinpoint mucosal erosion
Dieulafoy's Lesion
43
Most common location Of the Dieulafoy's lesion
Lesser curvature of the proximal stomach
44
Linear mucosal rent near or across the GE junction often associated with retching or vomiting
Mallory- Weiss tear
45
Watermelon stomach
Gastric antral Vascular Ecasias (GAVE)
46
Flat mucosal anomalies diagnosed by endoscopy
vascular Ectasias
47
Etiology of bleeding: nutrient arteries penatrating the muscular wall of the colon en route to the colonic mucosa
Characterized by painless and impressive hermatOchezia
Colonic Diverticula
48
Common Causes of G00
malignancy and Chronic peptic ulceration with stenosis of the by pylorus
49
Risk of cecal perforation
> 12 cm
50
More accurate disqustic modality for Bile buct imaging
Mrcp and Eus >90 % accuracy
51
Procedure of choice if a bile duct stone is highly likely and urgent treatment is required(jaundice and biliary sepsis)
ERCP
52
Procedure of choice if a bile duct stone is highly likely and urgent treatment is required(jaundice and biliary sepsis)
ERCP
53
Charcot 's triad
Jaundice, fever, RUQ pain
54
Reynold's Pentad
Charcot 's triad+ confusion and shock
55
Most sensitive test for diagnosis Of GERD
24 H ambulatory pH monitoring
56
Indications For endoscopy in GERD
Resistant reflux symptoms
Recurrent dyspepsia
Reflux and dysphagia to look for a stricture or malignancy
Long standing (more than or equal to 10 years) Frequent heartburn due to 6x increase risk of Barrett's esophagus(periodic endoscopy with biopsy) to detect dysplasia or early carcinoma
57
Most sensitive diagnostic test For Peptic ulcer
Endoscopy
58
Alarm symptoms for endoscopy in Peptic ulcer
Weight loss, Anemia, Bleeding
59
progressive dysphagia, solids then liquids
Esophageal strictures
60
Intermittent dysphagia For both solids and liquids
Motor disorders
61
Episodic dysphagia For solids, typically at the beginning of a meal
Schatzki's ring
62
Difficultly initiating deglutition ( transfer dysphagia) and nasal reflux with swallowing
pharyngeal motor disorders
63
Nocturnal regurgitation of undigested Food
Achalasia
64
Best initial test if motor disorder is suspected in dysphagia
Esophageal radiography and or a video Swallow study
65
Procedure done For resection of early-stage malignancies limited to the superficial layers of the GI mucosa
EMR or ESD
66
Colorectal Cancer screening strategies:
| Asymptomatic individuals more than Or equal to 50 y. 0.
FOBT annually
CT colonography/ Flexible sigmoidoscopy /Double contrast barium enema every 5 years
Colonoscopy every 10 years
67
Chronic diarrhea ( Duration)
4 weeks
68
Behavior in which recently swallowed Food is regurgitated and then re swallowed repetitively for up to an hour
Rumination
69
Globus sensation is attributable to What disease
GERD
70
Useful test for diagnosing motility disorders. achalasia, diffuse esophageal spasm
Esophageal manometery
71
Outpouchings Of the esophagus wall, associated with increased intraluminal pressure associated with a distal obstruction
Diverticula
72
Seen in natural zone of weakness in the posterior hypopharyngeal wall (Killian's triangle) and causes halitosis and regurgitation of saliva and food that may have been consumed several days earlier
Zenker's diverticulum
73
Due to traction from adjacent inflammation ( tuberculosis) or by propulsion associated with esopageal motor abnormalities
midesophageal diverticulum
74
Thin membranous narrowing at the squamocolumnar mucosal junction Of the esophagus, seen in 10-15% of the population usually asymptomatic
B-ring
75
Similar to B - ring but with a lumen diameter of 13 mm and associated with episodic solid food dysphagia
Schatzki's ring
76
Steakhouse Syndrome
Schatzki's ring
77
Symptomatic hypopharyngeal webs and iron- deficiency anemia in middle -aged women
plummer - Vinson syndrome
78
Herniation of part of the stomach into the thoracic Cavity through the esophageal hiatus in the diaphragm
Hiatal hernia
79
Type of hiatal hernia which is associated with GERD
Type I sliding hiatal hernia (95% cases)
80
Esophageal CA with predilection to the distql esophagus
Adenocarcinoma
81
Esophageal cancer with predilection to the proximal esophagus
SCC
82
Rare motor disorder of the esophageal smooth muscle in which the LES does not relax normally with swallowing and the esophageal body undergoes non-peristaltic contractions
Achalasia
83
Loss of ganglion cells within the esophageal myenteric plexus involving both excitatory ( Cholinergic) and inhibitory(nitric oxide) ganglionic neurons
Achalasia
84
ManOmeric finding of the esophageal LES in patients with Achalasia
Normal or elevated pressure
85
Barium swallow xray Finding of patients with Achalasia
Dilated esophagus with poor emptying, air fluid level, tapering at the LES beak like appearance
86
Pharmacologic therapy For patients with Achalasia
Nitrates or CCB before meals
| Botulinum toxin
87
Manifests as episodes of dysphagia with chest pain attributable to abnormal esophageal contractions with normal deglutitive LES relaxation
Diffuse Esophageal Spasm
88
Corkscrew esophagus
Rosary bead esophagus
psendo diverticula or curling
DES
89
Treatment shown to be efficacious For DES
Anxiolytics
90
Exacerbating Factors for GERD
Abd obesity, pregnancy, gastric hypersecretion states, delayed gastric emptying, disruption of esophageal peristalsis and gluttonY
91
Accounts for 90% Of reflux in normal Subjects or GERD patients without hiatal hernia
Transient LES relaxation
92
Involves proximal esophagus, Ulcerations appear punctuate and diffuse
Infectious esophagitis
93
multiple esophageal rings, linear Furrows or white punctate exudate
Eosinophilic Esophagitis
94
Singular and deep at points of luminal narrowing especially near the carina, distal sparing
pill esophagitis
95
Most severe histologic consequence of GERD
Barrett's metaplasia
96
Dominant mechanism Of Esophagogastric junction incompetence GERD
Transient LES relaxation(90% Of reflux in normal subjects or GERD patients who histal hernia)
LES hypotension
97
Extra - esophageal Syndromes with established association with GERD
Chronic cough, laryngitis, asthma, dental erosions
98
Characterised by tongues of reddish mucosa extending proximally from the GEJ with specialized columnar metaplasia
Barrett's metaplasia
99
Gold standard treatment Of high - grade dysplasia in GERD in a healthy patient with minimal surgical risk
Esophagectomy
100
Adverse Effect of PPI
Malabsorption of vit B12 and Iron, increase susceptibility to enteric infections especially C- difficile colitis, slight increase risk of bone fracture
101
Diagnosis of eosinophilic esophagitis
Symptoms + esophageal mucosal biopsies showing squamous epithelial eosinophil predominant inflammation
102
Patient presenting with atypical chest pain heartburn that is refractory to ppi with note of peripheral eosinophilia and with history of atopy
Eosinophilic esophagitis
103
Infectious esophagitis in immunocompromised hosts is due to
CMV, HSV, Candida
104
Infectious esophagitis is more common in AIDS patients with CD4 count of
<100
105
Most common organisms causing infectious esophagitis in immunocompetent hosts
HSV, Candida
106
Risk factors for candida esophagitis
Immunocompromised state, esophageal stasis
107
Treatment for candida esophagitis
Oral fluconazole for 14-21 days but if refractory may give itra, vori, posaconazole
108
Endoscopic finding of vesicles, small punched out ulcerations with biopsy findings of ground glass nuclei with eosinophilic cowdry type A intranuclear inclusions, giant cell formation
Herpetic esophagitis
109
Endoscopic appearance of serpiginous ulcers that coalesce to form giant ulcers, particularly in the distal esophagus with pathognomonic large nuclear or cytoplasmic inclusion bodies on biopsy
CMV esophagitis
110
Treatment of choice for cmv esophagitis
Ganciclovir iv or foscarnet iv until healing occurs (3-6wks)
111
Usual site of injury with endoscopy or ngt placement
Hypopharynx or GEJ
112
Increased intraesophageal pressure associates with forceful vomiting and retching causing spontaneous esophageal rupture
Boerhaave's syndrome
113
Most sensitive in detecting mediastinal air
Chest ct
| confirmed with contrast swallow with gastrografin followed by thin barium
114
Patient presenting with vomiting retching vigorous coughing with associated UGIB with note of nontransmural tear at the GEJ
Mallory weiss syndrome
115
Caused by ingestion of caustic agents more commonly strong alkali
Corrosive esophagitis
116
Most common location for pill to lodge in patients with pill esophagitis
Mid esophagus near the crossing of the aorta or carina
117
Play a central role in gastric epithelial defense/repair, regulate release of mucosal HCO3 and mucus, inhibit parietal cell secretion and maintains mucosal blood flow and epithelial cell restitution
Prostaglandin
118
2 principal gastric secretory products capable of inducing mucosal injury
Hcl and pepsinogen
119
Principal contributors to acid secretion
Cholinergic via vagus
| Histaminergic via local gastric sources
120
Breaks in the mucosal surface >5mm in size with depth to the submucosa
Ulcers
121
Most common location of DU
1st portion of the duodenum (>95%) with ~90% located within 3cm of the pylorus
122
Ulcer associated with malignancy
Gastric ulcer
123
Majority of DU cases are associated with
H. Pylori or nsaid induced
124
Incidence of h. Pylori causing ulcer
10-15% develop frank peptic ulcer
30-60% in GU
50-70% In DU
125
Antral predominant gastritis
DU
126
Corpus dominant gastritis
GU, gastric atrophy, gastric carcinoma
127
Ulcer caused by interuption of prostaglandin synthesis impairing mucosal defense and repair
NSAID-induced
128
Blood group associated with ulcer due to preferential binding of h pylori
Blood group O
129
Chronic disorders with strong association with ulcer
```
Systemic mastocytosis
Chronic pulmo disease
Chronic renal failure
Cirrhosis
Nephrolith
Alpha 1 antitrypsin deficiency
```
130
Chronic disorders with possible association with ulcer
Hyperparathyroidism
CAD
PV
chronic pancreatitis
131
Most discriminating symptom of DU
Pain that wakes patient from sleep (md-3am)
132
Pain occurs 90mins to 3h after a meal, relieved by antacids or food
DU
133
Ulcer pain that may be precipitated by meals
GU
134
Succussion splash is seen in
Gastric outlet obstruction
135
Most frequent finding in ulcer patients
Epigastric tenderness
136
Most common complication in PUD
Gi bleeding
137
Hypercalcemia, hyperphosphatemia with renal calcinosis and progression to renal insufficiency
Milk-alkali syndrome
138
Inhibits basal and stimulated acid secretion
H2 receptor antagonist
139
Inhibits all phases of gastric acid secretion by irreversibly inhibiting H-K-ATPase
PPI
140
Most potent acid inhibitory agent
PPI
141
Due to high incidence of malignancy in GU (especially body, fundus) if biopsy negative a repeat endoscopy should be done when
8-12wks to document healing, if still with ulcer biopsy
142
GU that fails to heal after 12wks and a DU that does not heal after 8 wks of therapy
Refractory ulcer
143
Can decrease ulcer re bleeding in patients who undergone endoscopic therapy
Parenteral and orally administered PPI
144
Bacterial overgrowth in the afferent limb secondary to stasis causing postprandial abdominal pain, bloating, diarrhea with malabsorption of fats and vit b12
Afferent loop syndrome
145
Series of vasomotor and GI signs and symptoms and occurs in patients who have undergone vagotomy and drainage (billroth)
Dumping syndrome
146
Phase of dumping syndrome which is due to rapid emptying of hyperosmolar gastric contentd into the small intestine causing fluid shift into gut lumen with plasma volume contraction, acute intestinal distention, release of vasoactive GI hormones
Early dumping (15-30mins after meals)
147
Phase of dumping syndrome secondary to hypoglycemia fron excessive insulin release
Late phase (90mins to 3h)
148
Gastric acid hypersecretion due to a unregulated gastrin release from a non-cell endocrine tumor (gastrinoma)
Zollinger-Ellison syndrome
149
In ZE >60% of the tumors are
Malignant
150
Most common non pancreatic lesion (gastrinoma) occuring in 50-75% of patients with ZE
Duodenal tumors
151
Most common clinical manifestation seen in >90% of gastrinoma patients
Peptic ulcer
152
Ulcer features that should raise suspicion of ZES
Unusual location (2nd part of duodenum and beyond)
Refractory to standard med therapy
Recurrence after acid reducing surgery
Frank complications(bleeding, obstruction, perforation)
Absence of h pylori/nsaids ingestion
153
Most frequent condition that can elevate fasting gastrin level
Gastric hypochlorhydia or achlorhydria
154
Used to differentiate between causes of hypergastrinemia, useful in patients with indeterminate acid secretory studies
Gastrin provocative test
155
Most sensitive and specific provocative test for diagnosis of gastrinoma
Secretin stimulation test
156
Treatment of choice for ZE
PPI
157
Elevated gastric acid secretion after head trauma causing ulcer
Cushings ulcer
158
Ulcer associated with severe burns
Curlings ulcer
159
Treatment of choice for stress induced ulcer prophylaxis
PPI
160
Most common cause of acute gastritis
Infectious
161
More common rype of chronic gastritis
Type B
162
Type B chronic gastritis involves predominantly what site of the stomach and is associated with what infection
Antral predominant
| H pylori
163
Type A gastritis predominantly involves
Fundus and body, with antral sparing
164
Autoimmune type of chronic gastritis, traditionally associated with PERNICIOUS ANEMIA
Type A
165
Rare disease characterized by large, tortuous gastric mucosal folds
Menetriers disease
166
Functional disorder characterized by altered bowel habits + abdominal pain with NO detectable structural abnormalities
Irritable Bowel Sundrome
167
Criteria for Diagnosis of IBS
Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months with 2 or more of the Following
Improvement with defecation
Onset associated with a change in the frequency of stool
Onset associated with a change in the form of stool
168
Prerequisite Clinical feature in IBS
Abdominal pain
169
most consistent Clinical feature of IBS
Altered bowel habits
170
Constipation alternating with diarrhea with one predominating which can switch in l year is seen in
IBS
171
Initial therapy of choice for IBS_ D
peripherally acting opiates
172
Smoking reduces the risk for developing what type of IBD
Ulcerative colitis
173
protective effect on patients with Ulcerative Colitis
Appendectomy
174
OCP use increases the risk Of developing what types of IBD
Chron's disease
175
Interventions that alter microbiota and can improve CD
metro, Cipro, elemental diets
| Fecal diversion
176
Other distinguishing Feature of CD vs UC
Rectal sparing
Segmental involvement with skip areas in the midst of diseased intestine
Possible involvement of liver and the pancreas
177
IBD with transmural involvement
CD
178
Cobblestone appearance
CD
179
Pathognomonic Feature Of CD
nonCaseating granulomas in all layers of the bowel
180
IBD Often presenting with diarrhea, rectal bleeding teneSmus, passage of mucus, crampy abdOminal pain ANCA. positive
uc
181
most common site of inflammation in CD
Terminal ileum
182
Circumferential inflammation and fibrosis_ String sign is seen in what type of IBD
CD
183
First line test for evaluation of Suspected CD and its Complications
CT/ MR enterography
184
Mainstay Of therapy For mild- moderate uc
sulfasalaZine and other 5- ASA agents
185
Protrusion Of mucosa through the muscularis propia of the colon
False or pseudodiverticulum
186
common location of diverticular disease
```
sigmoid colon (5 %)
Asian population: 70 %. in the right colon and rectum
```
187
Inflammation due to retention Of Particulate material within diverticular Sac and Formation of a fecalith
Diverticulitis
188
Most common cause of hematochezia in patients >60 years
Colonic diverticulum hemorrhage
189
Best diagnostic modality for localization Of massive bleeding from diverticular disease in an Otherwise stable patient
Angiography
190
Patient presenting with fever, anorexia, LLQ Abdominal pain, Obstipation
Uncomplicated diverticulitis
191
Diverticular disease associated with abscess or perforation or Fistula
complicated diverticular disease
192
Best management For diverticular disease
Diet alteration: fiber rich ( 30g/d)
193
Antibiotic therapy for patients with diverticulitis
co- tri or cipro + metro
| addition of Ampicillin to cover for enterococci for non responders
194
Circumferential/ Full- thickness profusion Of the rectal wall through the anal orifice
Rectal prolapse
195
Most common cause of Fecal incontinence
Obstetric injury to the pelvic floor
196
GOLD standard for treatment OF Faecal Incontinence
Overlapping sphincteroplasty
197
Sclerotherapy is part of the management in what stage of hemorrhoidS
Stage I
198
Banding is part of the management in What stage of Hemorrhoids?
stage Ill
199
Operative hemorrhoidectomy
Stage III and IV
200
Most common site of Anorectal Abscess
Perianal (40-50 %)
201
AnOrectal Abscess have higher prevalence in What group of patients
Immunocompromised, Dm, hematologic disorders, IBD, HIv
202
Communication of an abscess cavity with an identifiable internal opening within the anal canal
Fistula in Ano
203
On Anal manonetry, pathognomonic for anal Fissure
Increased anal resting pressure and sawtooth deformity with paradoxical contractions of the sphincter muscles
204
Risk Factors For AOMI
AF, recent AMI, VHD, recent cardiac or vascular cath
205
Most often seen in the aging population affected by atherosclerotic disease
cardiogenic/ septic shock on high dose vasopressor infusions, cocaine overdose
most prevalent GI disease complicating cardiOvascular surgery
NOMI
206
Most common locations in GI ischemia
```
watershed areas
Splenic Flexure ( Griffith's point)
Descending/ sigmoid colon ( Sudeck's point)
```
207
Origin of emboli in mesenteric ischemia
> 75% From the heart
208
Gold standard for diagnosis or acute arterial occlusive disease
Angiography
209
most common and most characteristic symptom of liver disease
Fatigue
210
Often the presenting symptom in PBS and Sclerosing cholangitis
Itching
211
Most reliable marker of severity
Jaundice
212
Alcohol consumption associated with an increased risk of alcoholic liver disease
22-30 g/ day for women
| 33-45g/ daY for men
213
Clinically helpful approach to diagnosis of alcohol dependence and abuse
CAGE questionnaire
214
ANA or SMA, elevated IgG levels and compatible histology
Autoimmune hepatitis
215
mitochondrial antibody, elevated Igm levels, and compatible histology
Primary biliary cirrhosis
216
Decreased serum cerulo plasmin and increased urinary copper increased hepatic copper level
wilson's disease
217
Elevated iron Saturation and serum ferritin; genetic testing for HFE gene mutations
Hemochromatosis
218
Elevated arterial ammonia levels have been shown to correlate with outcome in
Fulminant hepatic Failure
219
More specific indicator Of liver injury
ALT
220
Most common cause of acute liver Failure
Drug induced liver injury
