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SUMMED2 > GI-LFT, Biliary DZ > Flashcards

GI-LFT, Biliary DZ Flashcards

1
Q

What 3 categories define liver function?

A
  1. Hepatocellular – Transaminase AST/ ALT
    ratio determine etiology
  2. Cholestatic – Alkaline Phosphatase. Biliary Tree
  3. Bilirubin:
  4. total
  5. indirect-uncongugated,
  6. direct bilirubin:
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2
Q

What other metoblic panels are made by liver?

A

GGT- alcholism
Albumin- DM
Clotting factors

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3
Q

Mr. Pepsi has inc LFT with AST predominant AST/ALT >1. What are DDX?

AST/ALT- N 40
Ideally- 14-20

A

Alcoholism-**AST rarely >300 AST= alcohol

IF INC ALT >500

  1. viral HEP C/B
  2. acetaminophen, TB drugs, antifungal, methotrexate, NSAIDs, herbals, occupation
  3. Hepatocellular damage
  4. Autoimmune Hepatitis- inc
  5. Fatty liver
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4
Q

What are non hepatic causes of inc AST/ALT

A 
MSK injury
Adrenal insuff
MI
Celiac
AN
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5
Q

Name steps for evaluation of INC AST, ALT

A
  1. confirm >3m, recheck
  2. Ask habits alcohol, RX, illness
  3. Rx meds drug toxicitys
  4. Ratios- AST/ALT
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6
Q

Mr pepsy has h/o of IVDA. Which further test would be used?

A

Hepatitis panel (A, B, C)

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7
Q

Mr. pepsy CBC came back ABN, what addn test are needed?

A

Ferritin, Fe/TIBC
hemochromatosis (high iron levels)

Copper /ceruloplasmin- in young patient- Wilson’s dz

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8
Q

Mr. Pepsy has HSM during PE. What is next workup?

A

US: fatty liver, splenomegaly

tumor

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9
Q

IF nothing is identifiable for the cause of INC AST/ALT, what is next?

A

Referral

Liver biopsy- liver regenerates, major blood supply

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10
Q

What could be causes of Mr. Boney’s mild elevation of Alk Phos and mild elevation of transaminases?

A

ALK PHOS-MC Biliary tract
Metastatic or biliary Ca

  • PBC primary biliary cirrhosis
  • *Fatty liver
  • Biliary stones
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11
Q

What is DDx when Alk Phos is dominant and GGT is INC?

A

Hepatobiliary dz
US RUQ- dilated Bile ducts?

Kids normal high Alk Phos levels- growing, 400s

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12
Q

Mr. Boney has INC Alk phos and has NORMAL GGT gamma-glutamyl transpetidases, isoenzyme detects origin?

A

Bone origin

bone cancer= INC Alk

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13
Q

What type of bilirubin if INC may come from hemolysis, heart failure, hyperthyroidism?

A

Unconjugated bilirubin
fat soluble BBB, W/IN plasma, attached to albumin. 1st process of hemolysis of RBC

Spilling of bilirubin in the blood
Reticulocyte count INC = immature new red blood cells
Serum haptoglobin = RBC are split open, you also get low levels of haptoglobin

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14
Q

What type of bilirubin if INC came from gallbladder and liver?

A

Conjugated bilirubin WATER soluble, NO BBB, W/in BILE, NO albumin, EXcreted in URINE

DDX-Choledocholistasis
Biliary Obstruction
Cholangiocarcinoma
AIDS
PSC
HEPABC
Pregnancy
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15
Q

What two congential d/o relate to hyperbilirubinemia?

A

Gilbert’s- MC * indirect/uncong bilirubin. All LFTs are normal, asymptomatic. Just a little bit higher than normal.

Dubin Johnson

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16
Q

MC ETOH or choledocholithiasis (gallstone) cause inflammation here which result in n/v, dyfx digestion.

A 
Pancreatitis:
Meds
Trauma, structural
Chronic- ETOH
FH
malnutrition
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17
Q

Mr. KFC finishes his 3piece meal and c/c n/v, indigestion. PMH DM. What can result from this eating?

A

Pancreatitis d/t Hypertriglyceridemia- INC TGs 4-500 ABN

FH genetic

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18
Q

Vacuoles are formed d/t blockage. Trypsin release lead to what of the pancreas?

A

AUTODIGESTION from Digestive enzymes
cell death
enzymes released in blood

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19
Q

What are causes of HYPOtension, ARDS, DEC clotting factors, hypocalcemia?

A

Pancreatic enzymes released into circulation

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20
Q

Mr. KFC c/c ABD pain, stabbing thru back. Constant pain radiating to back, flank, shoulder. He states leaning forward and fasting helps?

A

Clinical symptoms of Pancreatic- retroperitineal

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21
Q

Mr. KFC has abdominal rigidity on PE. What other signs are expected with pancreatitis?

A

Abdominal guarding
Fever
Tachycardia
Shock- when severe

22
Q

Mr. KFC should get what diagnostic studies for is suspected pancreatis?

A

MC-CT w/ Contast

Abdominal XR, US-stones

23
Q

Mr. KFC labs show INC BUN. Why and what are other findings in labs?

A

DX-INC amylase and lipase***

BUN- dehydration
Hypocalcemia- d/t enzymes
Leukocytosis- INC WBC infx
Hyperglycemia- pancreas not working to release insulin
INC LFT- biliry obstruction Alk phos
24
Q

What are the complication of pancreatiis?

A 
GI bleed- MC
Shock-ED
Hypoxia- pleural effusion RDS
Pseudocysts- damaged pancreas
Abscess
25
Q

What are complication of alcholism on prancreas?

A 
Bile duct obstruction
Ascites- leakage
Pancreatic pseudocyst
Recurrent epigastric pain
Amylase inc
Emaciation
Edema
Brusises
DM
Jaundice
Gi bleeds
Polyarteriis- small jt of hand and feet
26
Q

What is complication of stool with chronic pancreatisis?

A

Steatorrhea- white stool

greasy, floaty;

27
Q 
Mr. Vodka labs show the following
INC amylase, lipase
Hyperglycemia: 
INC bilirubin
hypoproteinemia, 
Why are these present?
A

Chronic Pancreatitis findings
Hyperglycemia: advanced parenchymal damage

bilirubin, alk phos due to extrahepatic, biliary obstruction

Malabsorption: hypoproteinemia, d/t deficiency of fat soluble vitamins

Stool analysis for fat content

Ascites- INC protein/amylase

28
Q 
The following complication that pose rare risk of death are related to;?
GI bleed- esophageal varices, cirrhosis
Biliary tract infection
Liver failure
Malabsorption
Electrolyte abnormalities
A

Chronic pancreatitis

Death rare from pancreatitis associated

29
Q

What is 1st line of treatment for pancreatisis?

A

NO ETOH
Pancreatic ensyme w/ meals
Analgesics
Small meal

30
Q

What is MCC of Cholelithiasis/ gallstones?

A 
Most are cholesterol related
50% symptoms
P
obese
DM
Statins
GI d/o
Estrogen-F
Hemolysis
Billary infx- INC unconjugated bili
ETOH
31
Q

What are the 4 F related to risk of Cholethiasis?

A

FAT
FORTY
FEMALE
FERTILE

32
Q

Mrs. Jasper 40yo cc/ RUQ and mid epigastric pain, that is intermittent for 1 wk. Pain often sharp and severe after eating KFC meals. What is DDX and other findings?

A

Cholelithiasis: Biliary colic- intermittent pain
Pain- radiate to back and R shoulder wrap around

DX- NEG Murphy sign w/ US
NORMAL LFTs

33
Q

What labs are necessary for gallstones?

A

LFT- If no obstruction w/ gallstone, then LFT normal
If obstruction w/ gallstone, then Alk Phos will be elevated

CBC
Chem7

DX- Retroperitoneal ABdomen US- stone have acoustic shadow

34
Q

Why is elective cholecystectomy important?

A

IF sx, very important
LOW Risk of CA If gallbladder is calcified
50% recurrence rate- no surgery

35
Q

What are non surgical treatment?

A

Oral bile salts slowly dissolves stones
Lithotripsy
ERCP- last

36
Q

Are severity of symptoms related to prognosis of gallstones?

A

NO

ONLY Length of time w/ symptoms inc risk

37
Q

These risk are assoc with what concern

a. Acute cholecystitis
b. Cholangitis with liver abscess
c. Necrotizing pancreatitis
d. Gallstone ileus with SBO
e. Gallbladder CA

A

MORBIDITY People who elect NOT to have cholecystectomy
(cholecy-gallbadder, bile, fat)

Tell PT go to ED for RUQ severe pain that doesn’t go away w. FEVER

38
Q

*Mr. Bile c/c of severe RUQ pain w fever. Pain moves to around to R shoulder, 1-2hr after meals. Fever for 2 day 100.4.

A 
Acute cholecystitis
SEVERE CONSTANT RUQ PAIN
R UPPER SHOULDER
LAB- LFTS, CBC, CHEM
**DX- US- RUQ distended gallbladder fluid
39
Q

What is on PE w/ Pt of acute cholecystitis?

A
  • Fever
  • RUQ tenderness
  • Involuntary guarding
  • (+) Murphy’s sign. KEY

BUT WITH CHOLECYSTITIS **AND CHOLECLITHTISAS = NEG. MURPHYS

40
Q

Mr. Bile came in today because of RUQ, SHAKING CHILLs; FEVER. His daughter notice yellow JAUNDICE of skin. What is the triad called?

A

CHARCOTS TRIAD-Indicates ASCENDING CHOLANGITIS- stasis infection in bilary tract.
cholecystitis moved from biliary tract to common bile duct.

**GRAM NEG BACTERIA TRAVEL UP TO BILE DUCT OR HEPATIC DUCT RESULT OF OBSTRUCTION

41
Q

What occurs if the infection moves into common bile duct?

A

CHOLANGITIS
Gallbladder will stop working L/T infection and abscess

TX- ABX GRAM - /ANAEROBES
IF acsending to common hepatic EMERGENCY SURGERY

42
Q

Mr. Bile labs are as follows: What is this condition?
• *Leukocytosis w/ left shift
• *Elevated Alk Phos, Total (direct) bili, GGT
• Variable elevations in ALT, AST

A

ACUTE CHOLANGITIS

immature neutrophils-bands- INFECTION

43
Q

Ms. KFC labs are as follow: What is this condition
• Leukocytosis
• Elevated Amylase, mild
• Elevated ALT/AST, mild
• Total bilirubin and Alk Phos not elevated
• Order US

A

ACUTE CHOLECYSTISIS

44
Q

What are main difference btwn ACUTE Cholecystitis vs Cholangitis

A
  1. CHOLANGITIS- JAUNDICE, COMMON BILE DUCT SURGERY, INC ALK PHOS, LEFT SHIFT
  2. CHOLECYSTITS- ELEVATED AMYLASE, ALT/AST
45
Q

*Mr. Bile c/c of severe RUQ pain w fever. Pain moves to around to R shoulder. Fever for 2 day 100.4. What is treatment?

A
  1. Cholecystectomy definitive treatment
  2. IV, ABX GRAM -
  3. Analgesics
  4. NPO-
46
Q

Ms. Frost has PHM of IBD, what are some complications?

A

Primary Scleroising cholangitis- inflammation, fibrosis, and stricturing of medium
and large ducts in the intrahepatic and/or extrahepatic biliary tree

MC w/ IBD with ABNormal LFT
MC do have UC, NOT Crohn

CP- ASY, Itching**, fatigue, nt sweats, jaundice

LABS- INC Alk Phon, bilirube, Mild AST/ALT

DX- MRI, US

Prognosis- CA, biliary strdictus, bone dz, ADEK defiicent

47
Q

What is a Rare T-lymphocyte-mediated attack on small intralobular bile ducts;
MC W 30-65

A

Primary Biliary cholangitis (primary biliary cirrhosis)

48
Q

What is Intrabiliary pigment stone formation, resulting in strictures of the biliary tree and biliary obstruction with recurrent bouts of cholangitis?

MC Southeast Asia

A

Recurrent pyogenic cholangitis

49
Q

Ms. Harris had painless jaundice, cough, no hempotosis RUQ pain, edema and weight loss.

A

Cholangiocarcinoma

Rare bile duct cancer, often associated with PSC,

50
Q

Any pt with itching and pain or painless jaundice, what should be workup?

A

Check their LFT
SrC and BUN- kidney fxn.
Very concerning for biliary tract cancer

SUMMED2 (38 decks)

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