GI

Question 1

term for increased liver fat
no inflammation

Answer 1

steatosis

Question 2

What does NASH stand for

Answer 2

non-alcoholic steatohepatitis

Question 3

increased liver fat
with inflammation

Answer 3

Steatohepatitis

Question 4

Nash leads to

Answer 4

Fibrosis, cirrhosis and liver failure

Question 5

risk factors for NASH

Answer 5

obesity
metabolic syndrome
-abd fat
-insulin resistance
-DM
-Dyslipidemia
-HTN
-PCOS
-obstructive sleep apnea

Question 6

signs of end stage liver disease

Answer 6

palmar erythema
spider angioma
muscle wasting
jaundice
encephalopathy

Question 7

what should you do with elevated ALT and symptoms of infection

Answer 7

reevaluate ALT 2-4 weeks after resolution of symptoms

Question 8

for asymptomatic patients with elevated liver enzymes…when do you repeat

Answer 8

2 weeks

Question 9

what viruses can elevate liver enzymes

Answer 9

influenza
EBV
CMV
SARS

Question 10

elevated enzymes
things to rule out

Answer 10

viral hepatitis
-anti hep c AB
Hep B SA
-Anti Hep A AB

Celiac - tissue transglutaminase and total IgA

Hypothyroidism

Autoimmune hepatitis
-ANA
-Anti-liver/kidneyAB
-Anti-smooth muscle AB
-Total protein and IgG levels

Question 11

tests for viral hepatitis

Answer 11

-anti hep c AB
Hep B SA
-Anti Hep A AB

Question 12

tests for celiac

Answer 12

tissue transglutaminase and total IgA

Question 13

tests for autoimmune hepatitis

Answer 13

ANA
-Anti-liver/kidneyAB
-Anti-smooth muscle AB
-Total protein and IgG levels

Question 14

Wilson disease tests

Answer 14

Serum ceruloplasmin levels (low)
24 hour urine copper (elevated)
copper in liver biopsy
Kayser-Fleischer rings seen with slit lamp (Optho)

Question 15

Kayser-Fleischer rings

Answer 15

wilson disease

Question 16

what are things that elevate ALT

Answer 16

viral causes
NASH
NAFLD
Genetic - Wilson disease

Question 17

treatment for Wilson disease

Answer 17

oral chelation (Triatine)
also d-penicillamine
(more side effects - n/v, leukocytosis, rash)

Zinc can also be a chelator
(75-150mg TID)

Question 18

symptoms Gilbert syndrome

Answer 18

malaise
abd discomfort
fatigue
+/- jaundice

Question 19

labs for Gilbert

Answer 19

total bili
retic
CBC
Periph smear

Genetic UGT1A1

Question 20

genetic
UGT1A1

Answer 20

Gilbert

Question 21

elevated CK can be from _____ _______ esp if AST >ALT

Answer 21

muscular dystrophies

Question 22

AST is specific to ____
ALT is specific to ____

Answer 22

AST - Body
ALT - liver

Question 23

Alpha 1 antitrypsin deficiency causes

Answer 23

liver and lung disease

in younger pt -> liver disease and cirrhosis
In adults it progresses to lung issues (emphysema)

Question 24

what type of US looks for fibrosis of liver

Answer 24

RUQ US with elastography

Question 25

symptoms for celiac

Answer 25

constipation weight loss bulky/foul smelling stools floating stool flatulence abd distension abd pain oral lesions

Question 26

liver tumor marker (lab)

Answer 26

Alpha fetoprotein (AFP)

Question 27

GGT looks at

Answer 27

intrahepatic and gallbladder

Question 28

platelets - what causes increase and what causes low

Answer 28

Infection - up liver problems will cause lower

Question 29

What does DILI stand for

Answer 29

Drug induced liver injury

Question 30

biologics that can lead to DILI

Answer 30

chemotherapy Accutane adhd/psych meds

Question 31

endocrine worries bout elevated liver enzymes on metformin, elaborate

Answer 31

Leave on metformin and trend liver enzymes...more likely metabolic ..may help due to weight loss