GI Flashcards
Most abundant plasma protein
Albumin
Synthesized exclusively by the liver
Specific liver function enzyme
ALT, an aminotransferase
AST: not specific to liver, present in extrahepatic tissues
What lab can indicate damage to hepatocyte membranes in bile-salt induced cholestatic disorders
Alkaline phosphate
Gallstone formation is due to
Abnormalities in physicochemical characteristics of various components of bile.
Most gallstones are composed of
cholesterol: high fat and protein intake
They are radiolucent: not seen in xrays
Gallstones are most often in patients with what dz?
Cirrhosis and hemolytic anemia
Procedure of choice for acute cholecystitis
Lap cholecystectomy
Procedure done during lap cholecystitis to clean duct
Cholenagiography with ERCP
Cardio and resp changes in laparoscopic surgery
increased intraabdominal pressure
Decrease in VR, CO increase in SVR and MAP
WHich medication is controversial during surgery of acute cholecystitis
Opioids, they cause spasm of Oddic sphincter
Presence of what causes halothane induced hepatitis
immunoglobulin G antibodies
Most common volatile anesthetic agent to cause hepatitis
Halothane
Which volatile anesthetic does not produce TFA?
Sevoflurane
Most common cause of Chronic Hepatitis is produced by
Alcohol and Hep C
Remaining gallstones are composed of
Calcium bilirubinate; these are radioopaque
Most of the other are composed of cholesterol, high fat and protein intake; radiotranslucent
Inflammation of gallbladder
Cholecystitis
Cholithiasis increased in
women, pregnant, increased age, rapid weight loss and OBESITY
Choliathiasis is
Gallstones in gallbldder
Acute cholecystytis
Obstruction of common bile duct or cystic duct by gallstones
Which pts can not have lap cholescystectomy and what procedure must they undergo
Septic shock, peritonitis, pancreatitis or coagulopathy. Must undergo OPEN cholecystectomy
Inflammation of abdominal cavity by pneumoperitoneum causes in Venous return, CO SVR and MAP
Intrabdominal pressure: increases
CO and VR: decrease
SVR increase
MAP: increase
What may cause opioids if administered during an open cholecystitis and TX?
Spasm of sphincter of Oddi
TX: Glucagon, Nitroglycerin, and Naloxone
Where are gallstones present in choledocholithiasis
Common Bile duct
Acute hepatitis may progress to
Chronic hep, cirrhosis, end stage liver failure and carcinoma
Symptoms of acute hepatitis
May have minimum symptoms, at least malaise and jaundice
Viral hepatitis viruses are
A, B, C, D, Herpes simplex virus, cytomegalovirus, Epstein Barr virus
Most common cause of viral hep
HEP A, not B
Which viruses have high risk of development of cirrhosis and carcinoma
B, C
Which Hepatitis occurs with another
B and D
What is the antidote for drug induced hepatitis in acetaminophen OD
Oral N- Acetylcysteine
Hepatitis caused by acetaminophen OD is cause mainly by
NAPQI, toxic metabolite and decreased stores of glutathione
Tx for autoimmune hepatitis
Dx
No tx: corticosteroids and immunosuppressive drugs
Liver transplant if progression to end stage liver dz
Dx made by serologic and genetic testing
Chronic hepatitis most commonly caused by
Alcohol then Hep C
Most common hereditary hyperbilirubinemia
Gilbert Syndrome
Gilbert Syndrome is caused by
Mutation in glucuronosyl transferase enzyme (this enzyme is responsible of conjugating bilirubin for disposal
In Gilbert Syndrome how much is bilirubin
Does not exceed 5
Normal is 0-1
Crigler Najjar syndrome
Rara unconjugated hyperbilirbenemia
Glucuronosyl transferase is reduced to less than 10%
Peds develop kernicterus
In pts with Crigleer Najjar syndrome, what can be the tzx
Phonobarbital therapy decreases jaundice by stimulating activity of glucuronosyl transferase
Dubin Johnson syndrome
Increase COnjugated hyperbilirubinemia
Not cholestatic
Benign
Postoperative intrahepatic cholestasis
Occurs during prolonged hours of surgery, prolonged hypoxemia, hypovolemia and need for blood transfusion
Which labs are increase in postop intrahepatic cholestaisis
NONE
In Progressive familial Intrahepatic cholestasis, which dz is in infancy and which is in adult
Cholesotasis infancy, End Stage CIRRHOSIS in adulthood
What sign is seen in progressive Familian intrahepatic cholestasis and what is the tx
Pruritus
Tx: Liver transplant
Hepatitis sypmtoms
Minimal.. malaise and jaundice
Halothane hepatitis caues
Immune mediated hepatotoxic reaction: Presence of circulating immunoglobin G antibodies. Antibodies attack the surface of hepatocytes proteins that have been covalently modified by TFA, metabolite of halothane and form neoantigens
Which volatile anesthetic does not produce TFA
Sevoflurane
DM is caused by
Insulin resistance and low insulin production
DM 1a and DM 1b
Type 1 DM
1a, autoimmune, beta cell destruction results in absence or small amounts of insulin
Which dz may mimic ureterolithiasis
Choledocholithiasis
Symptoms of cirrhosis
Spider angiomata, gynecomastia, testicular atrophy and ascites, portal HTN, hepatic encephalopathy, Hepatopulmonary syndrome, hepatorenal syndrome and portopulmonary HTN(most deadly), coagulopathy
Ascites is caused by
Hypoalbinemia, water and sodium retention
Which coagulation factors are VIt K dependent
2,7, 9, 10
Coagulopathy also afected
Protein C, S, ANtithrombin 3, Protein Z
Acute Liver failure is severe failure with
Impaired synthetic capacity and encephalopathy
Dx tool for Acute liver failure
Child PUgh Score, higher the score worst outcome
Pharmakinetics in liver dz
Vd, Cl, Protein binding,
Vd: increased
Cl- decreased
Protein binding, decreased
Organ allocation for End Stage Liver Dz is called
MELD score (40 is highest score)
Liver Dz decreases or increases SVR
Decreases
