GI Liver.Pancreas

Question 1

What are the 6 functions of the liver?

Answer 1

1. Carbohydrate metabolism 2. Protein synthesis 3. Lipid metabolism 4. Drug metabolism 5. Hormone metabolism 6. Bile production

Question 2

Where does bilirubin come from?

Answer 2

Breakdown of RBCs and hemoglobin.

Question 3

What is unconjugated bilirubin?

Answer 3

Bilirubin prior to liver processing, without albumin. AKA indirect bilirubin.

Question 4

What happens to bile salts once they are released into the intestine via the liver?

Answer 4

90% are reasborbed in the ileum as urobilinogen. 10% lost in feces as stercobilinogen.

Question 5

What is hemolytic anemia?

Answer 5

excessive destruction of RBCs.

Question 6

Newborns are commonly born jaundiced. What is the cause of this?

Answer 6

Either reduced uptake of circulating bilirubin, OR reduced glucuronyl transferase. **This typically resolves as liver fully develops over the next few weeks.

Question 7

If transaminases are elevated and AST > ALT, what disease is most likely?

Answer 7

Alcoholic liver disease.

Question 8

If transaminases are elevated and ALT > AST, what disease is most likely?

Answer 8

Viral hepatitis.

Question 9

What lab tests demonstrate the health and wellbeing of the hepatocytes specifically?

Answer 9

Transaminases: ALT and AST.

Question 10

What lab tests demonstrate biliary tree disease or abnormalities?

Answer 10

Alkaline phosphatase and GGT.

Question 11

What lab tests can be used to test the severity of liver disease?

Answer 11

Serum albumin and PT. **These are the actual liver FUNCTION tests. This tells you how well the liver is doing its job.

Question 12

What is cholestasis?

Answer 12

Decrease in bile flow through the intrahepatic canaliculi.

Question 13

What abnormalities occur with cholestasis?

Answer 13

Increase in cholesterol, bilirubin, and bile acids in the blood.

Question 14

What are the 2 types of cholestasis can occur? Which bilirubin abnormalities occur with each?

Answer 14

Extrahepatic/obstructive (elevated conjugated bilirubin) and intrahepatic/hepatocellular (elevated unconjugated bilirubin) cholestasis.

Question 15

What is the cause of jaundice? What other symptom is commonly associated with this?

Answer 15

Excess bilirubin in the blood that then builds up in the skin. Itching!

Question 16

This type of jaundice is R/T blood transfusin, hereditary, and in newborn?

Answer 16

1. Hemolytic (prehepatic)

Question 17

Mr. Bil has itcterus, Labs show Elevated liver damage related to drugs, which Jaundice is suspected?

Answer 17

HEpatocellular- DED in bilirubin uptake, thus DEC conjugated bilirbin. UNGONJUGATED dominant

Question 18

If Conjugated bilirubin is INC in labs, what is suspected?

Answer 18

Obstrutive POSThepatic- MC cholelithiasis, congential artresia, Tumors (Cholangiocarcinoma)

Question 19

What are s/s of cholestatis?

Answer 19

Pruritis-plasma bile salts, healed with fluid 2. Jaundice INC conjugated bilirubin 3. Skin Xanthome-hypercholersterolemia 4. INC Alk PHos 5. ADEK definicines, bile obstuctied can’t breakdown fat

Question 20

What are non-viral causes of hepatitis?

Answer 20

• Malaria - Staphylococcal bacteremia - Salmonellosis - Candidiasis - Amebiasis - Miliary TB

Question 21

What viruses can cause hepatitis which will enlarge liver or spleen?

Answer 21

• Hep A, B, C, D, E - Cytolmegalovirus - Epstein-Barr virus - Herpes virus - Yellow fever - Rubella, adenovirus, and enterovirus.

Question 22

What is fulminant hepatitis?

Answer 22

Massive hepatic necrosis.

Question 23

What is the difference between acute and chronic hepatitis?

Answer 23

Acute is self limited and resolves. Chronic is lasting longer than 6 months.

Question 24

Which hepatitis viruses are transmitted via fecal-oral route?

Answer 24

Hep A and E

Question 25

Which hepatitis viruses are transmitted via blood?

Answer 25

B, C, and D.

Question 26

What type of viruses are the hepatitis viruses?

Answer 26

All are RNA except B —> DNA.

Question 27

Who commonly gets Hep A infections?

Answer 27

80% due to travelers. 35% seen with homosexual activity.

Question 28

With what viruses is it most common to develop fulminant hepatitis?

Answer 28

Hep B + D coinfection, and Hep E infection in pregnant women.

Question 29

Which HEP is MC carrier state w/ no clinical dz, but + serum markers?

Answer 29

HEP B

Question 30

Pt is ASY anicteric, but later HBsAB is determined?

Answer 30

Subclinical Infection

Question 31

Which HEP is VC in 50% of us by 50y?

Answer 31

HEP A -INC 2-6 wks. Vacc or not will be seek when gets back

Question 32

What is the only DNA HEP w/ long incubation upt 7mo?

Answer 32

HEP B- most stable/thus long incub. CP- polyarthritis, vasculity, nephritis, urticaria. Uncooked meats

Question 33

Describe HEP C?

Answer 33

MIlder than HEP B. 2. RNA 3. 6-12wk INCub 4. MC in alcoholic liver 5 Repeated bouts of damage with episodic LFTs. 6. Chronic 7. MC Baby boomers

Question 34

Which is poor prognois for pregnant women?

Answer 34

HEP E-rare

Question 35

Which HEP are chroinic hep infx?

Answer 35

HEB B and MC HEP C. Both risk for Liver CA

Question 36

What is requried for HEP A DX?

Answer 36

ANTI HAV IGM-active, ANTI HAV-IGG inactive

Question 37

What is used for HEP C DX?

Answer 37

ELISA and PCER ANTI HCV, prev infectin

Question 38

The Pt ahs the following: POS-HBsAG, HBeAG/HBV DNA, ANTI HBc IgM

Answer 38

Acut HBV infection. IGM and HBsAG first to show

Question 39

What if ONLY ANTI HBc IGm is POS?

Answer 39

Recoving from infection

Question 40

What if ONLY ANTI HBc IGG and ANTI-HBs POS?

Answer 40

Had prev. infx not infectious

Question 41

What means PT is vaccinated?

Answer 41

ANTI HBs POS

Question 42

What is health active carrier?

Answer 42

POS HBSAG and POS ANTI HBc IGM

Question 43

Which serum markers indicate chronic HEP?

Answer 43

HBsAG, ANitBc, ANtiHBE, HBeAG

Question 44

When will jaundice, ALT, and Sx show in HEP B?

Answer 44

Jaundice late-12-28wk, ALT-10-24wks, SX- upt 28wks

Question 45

Pt present with fatigue, malaise, bouts of jaundice, loss of appetite. What is on DDX?

Answer 45

1. Chronic viral hep B 2. Alcholism, 3. TB drugs or RA drugs

Question 46

What would indicate chronic HEP?

Answer 46

1. INC PT 2. Hyperbilli 3. MIld AP 4. INC ALT/AST

Question 47

This conditions is extrahepatic stasis in bile ducts, obstructive jaundice, thus Conjugated Bil is high w/ AP high labs?

Answer 47

Secondary Biliary

Question 48

This autoimmune dz has HIGH conjugaed bilirubin, IGm, where dens lympohcytes block the part tract?

Answer 48

Primary Bilary Cirrosis

Question 49

THis condition has HIHG conjugated bilirubin, AP. IGM and HIHG GAMMA globulins, where periportal tract fibroisis is affected?

Answer 49

Primary sclerosing cholangitis

Question 50

IF a pt has fattly changes in liver, jaundice, TTP, AN, asites and fever, what is suspsected?

Answer 50

Alchoolic induced liver dz

Question 51

These conditions from alcoholism, HEP B,C, Hemochromastosis, and wilson dz cause what?

Answer 51

Cirrhosis- End stage liver dz

Question 52

WHat are some secondary result of cirrhois?

Answer 52

1. Esophageal varices 2. Caput Medusa 3. Hemorroids 4. Arteriovenous shuntin-back of fluid in gut, 5. HSM-anemia, neutropenia, thrompcytopenia 6. Marked ascites-albumin

Question 53

Which sign of liver failure is related to colloid osmotic pressure?

Answer 53

Ascites- less protein made, INC H20 resorbtio in other vessels

Question 54

If a Pt is confused w/ h/o of liver dz. What is the mech?

Answer 54

INC toxins b/c liver not working

Question 55

Duing liver failure, this reduces plasma oncotic pressure, which inc acitis and pitting edema?

Answer 55

HYPOalbuminemia

Question 56

How are hormones affect in Liver failure?

Answer 56

Inability to degrade estrogen-Men gynecomastia, skin changes, testicular atrophy, female hair

Question 57

What can be seen in teh kidney with LIVER failure?

Answer 57

Secondary Hyperaldosterims- INC NA+H2O, cant metabolise aldosterone

Question 58

Which gland make bicarbonate and secretes enzyme to break down all macronutrients?

Answer 58

Pancrease- Acni, langherans- Alpha- Gucoga, Beta Insulin

Question 59

when will pancrease release amylase, lipase, proteas?

Answer 59

Active only when entering small intsting. IF BLOCKED, enzymes can degrade panrease

Question 60

What are CP of pancreatisis?

Answer 60

Alcohol, BAck pain, stabbing epigastric pain. RX, trauma or viral causes

Question 61

What is stimulant of the pancreas the released from duodenum?

Answer 61

CHolecystokinin- stimulated by peptone and FA in chyme

Question 62

What Hormone realease from small intested d/t acid in the chyme is triggers the pacrease to release bicarbonate?

Answer 62

Secretin

Question 63

What phase are the pancreatis secretions?

Answer 63

Intestinal phase- activated by ACH in PNS

Question 64

What is important about Pancreatitis labs?

Answer 64

DX is only if 3x the normal amylase and lipase

Question 65

Which marker is most important in pancreatitis?

Answer 65

LIPASE- 4-8hr early and last longer. Amylase- later, shorter. Also will not rise as high w/ alcoholic and TGs