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SUMPHYS2 > GI Liver.Pancreas > Flashcards

GI Liver.Pancreas Flashcards

1
Q

What are the 6 functions of the liver?

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

Where does bilirubin come from?

A

Breakdown of RBCs and hemoglobin.

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3
Q

What is unconjugated bilirubin?

A

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

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4
Q

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

A

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

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5
Q

What is hemolytic anemia?

A

excessive destruction of RBCs.

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6
Q

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

A

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

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7
Q

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

A

Alcoholic liver disease.

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8
Q

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

A

Viral hepatitis.

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9
Q

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

A

Transaminases: ALT and AST.

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10
Q

What lab tests demonstrate biliary tree disease or abnormalities?

A

Alkaline phosphatase and GGT.

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11
Q

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

A

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

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12
Q

What is cholestasis?

A

Decrease in bile flow through the intrahepatic canaliculi.

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13
Q

What abnormalities occur with cholestasis?

A

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

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14
Q

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

A

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

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15
Q

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

A

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

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16
Q

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

A
  1. Hemolytic (prehepatic)
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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

What are s/s of cholestatis?

A

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

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20
Q

What are non-viral causes of hepatitis?

A
  • Malaria - Staphylococcal bacteremia - Salmonellosis - Candidiasis - Amebiasis - Miliary TB
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21
Q

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

A
  • Hep A, B, C, D, E - Cytolmegalovirus - Epstein-Barr virus - Herpes virus - Yellow fever - Rubella, adenovirus, and enterovirus.
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22
Q

What is fulminant hepatitis?

A

Massive hepatic necrosis.

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23
Q

What is the difference between acute and chronic hepatitis?

A

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

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24
Q

Which hepatitis viruses are transmitted via fecal-oral route?

A

Hep A and E

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25
Q

Which hepatitis viruses are transmitted via blood?

A

B, C, and D.

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26
Q

What type of viruses are the hepatitis viruses?

A

All are RNA except B —> DNA.

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27
Q

Who commonly gets Hep A infections?

A

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

28
Q

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

A

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

29
Q

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

A

HEP B

30
Q

Pt is ASY anicteric, but later HBsAB is determined?

A

Subclinical Infection

31
Q

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

A

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

32
Q

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

A

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

33
Q

Describe HEP C?

A

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

34
Q

Which is poor prognois for pregnant women?

A

HEP E-rare

35
Q

Which HEP are chroinic hep infx?

A

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

36
Q

What is requried for HEP A DX?

A

ANTI HAV IGM-active, ANTI HAV-IGG inactive

37
Q

What is used for HEP C DX?

A

ELISA and PCER ANTI HCV, prev infectin

38
Q

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

A

Acut HBV infection. IGM and HBsAG first to show

39
Q

What if ONLY ANTI HBc IGm is POS?

A

Recoving from infection

40
Q

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

A

Had prev. infx not infectious

41
Q

What means PT is vaccinated?

A

ANTI HBs POS

42
Q

What is health active carrier?

A

POS HBSAG and POS ANTI HBc IGM

43
Q

Which serum markers indicate chronic HEP?

A

HBsAG, ANitBc, ANtiHBE, HBeAG

44
Q

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

A

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

45
Q

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

A
  1. Chronic viral hep B 2. Alcholism, 3. TB drugs or RA drugs
46
Q

What would indicate chronic HEP?

A
  1. INC PT 2. Hyperbilli 3. MIld AP 4. INC ALT/AST
47
Q

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

A

Secondary Biliary

48
Q

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

A

Primary Bilary Cirrosis

49
Q

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

A

Primary sclerosing cholangitis

50
Q

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

A

Alchoolic induced liver dz

51
Q

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

A

Cirrhosis- End stage liver dz

52
Q

WHat are some secondary result of cirrhois?

A
  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
53
Q

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

A

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

54
Q

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

A

INC toxins b/c liver not working

55
Q

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

A

HYPOalbuminemia

56
Q

How are hormones affect in Liver failure?

A

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

57
Q

What can be seen in teh kidney with LIVER failure?

A

Secondary Hyperaldosterims- INC NA+H2O, cant metabolise aldosterone

58
Q

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

A

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

59
Q

when will pancrease release amylase, lipase, proteas?

A

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

60
Q

What are CP of pancreatisis?

A

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

61
Q

What is stimulant of the pancreas the released from duodenum?

A

CHolecystokinin- stimulated by peptone and FA in chyme

62
Q

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

A

Secretin

63
Q

What phase are the pancreatis secretions?

A

Intestinal phase- activated by ACH in PNS

64
Q

What is important about Pancreatitis labs?

A

DX is only if 3x the normal amylase and lipase

65
Q

Which marker is most important in pancreatitis?

A

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

SUMPHYS2 (27 decks)

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