GI V Flashcards
cirrhosis
bridging fibrosis and nodular regeneration via stellate cells
risk of hepatocellular carcinoma
alk phos
biliary marker
AST and ALT
hepatocyte damage marker
alcohol - AST > ALT
viral hepatitis - ALT > AST
amylase
acute pancreatitis and mumps
ceruloplasmin
decreased wilson disease
GGT
biliary marker
also up with alcohol use
most specific for acute pancreatitis
lipase
reye syndrome
hepatic encephalopathy
microvesicular fatty change
with viral infection tx with aspirin
aspirin metabolite - decrease B-ox by reversible inhibition mito enzymes
avoid ASA in children
mallory bodies
intracytoplasm eosinophil inclusion of damaged keratin
with alcoholic hepatitis
alcoholic cirrhosis
sclerosis around zone III -central vein
non-alcoholic fatty liver disease
ALT > AST
ballooning and necrosis
hepatic encephalopathy
cirrhosis - portosystemic shunt
-NH3 to brain
tx - lactulose and rifaximin
hepatocellular carcinoma
hep B and C autoimmune disease a1-antitrypsi deficiency wilson disease hemochromatosis aflatoxin
diagnosis - increased AFP
angiosarcoma
vinyl chloride, arsenic - malignant liver tumor
budd chiari syndrome
thrombosis hepat vein
centrilobular congestion and necrosis
liver disease
nutmeg liver - mottled
a1 anti trypsin deficiency
misfolded protein stay in liver - PAS positive
lungs - uninhibited elastase - panacinar emphysema
unconjugated hyperbilirubin
physioogic of newborn
hemolytic
crigler najjar
gilbert
conjugated hyperbilirubin
biliary tract obstruction
biliary tract disease
dubin johnson, rotor
physiologic neonatal jaundice
immature UDP glucuronosyl transferase
unconjugated hyperbilirubin
tx - phototherapy - tran to cis (in yo piss)
gilbert
mild low UDP glucuronsyl transferase
jaundice with stress
unconjugated hyperbilirubin
crigler najjar type I
absent UDP glucoronsyl transferase
dies within few years
increased indirect bilirubin
tx - plasmapharesis
crigler najjar type II
less severe - respond to phenobarbitol
dubin johnson
conjugated hyperbilirubin
defective liver excretion
black liver
rotor
mild dubin johnson
conjugated hyperbilirubin
wilson disease
hepatolenticular degeneration
copper - in brain, cornea, kidney, joint
fanconi - copper in kidney
wilson genetic
auto rec - CH 13
ATP7B gene
tx of wilson disease
chelation of copper
penicillamine
trientine
oral zinc
hemochromatosis
deposition hemosiderin - iron
micronodular cirrhosis
DM
skin pigmentation (bronze)
labs with hemochromatosis
increased ferritin
increased iron
decreased TIBC
increased transferrin saturation
prussian blue stain
hemochromatosis genetic
primar - C282Y and H63D mutation
HFE gene
tx hemochromatosis
chelation - deferasirox
deferoxamine
deferiprone
phlebotomy
primary biliary cirrhosis
autoimmune
see granuloma
middle aged women
anti-mito Abs - IgM
with other autoimmune conditions
primary sclerosing cholangitis
onion skin bile duct fibrosis
beading of ducts
in young men with IBD
hyper IgAM
MPO-ANCA - pANCA
with ulcerative colitis
gallstones
forty
fat
female
flatulent
cholelithiasis
tx - cholecystectomy
cholesterol stones
80% gallstones
obesity, crohns, age, estrogen, weight loss
pigment stones
black - Ca, bilirubin, hemolysis - radiopaque
brown - infection - radiolucent
cholecystitis
inflammation of gallbaldder
MC - block cystic duct
positive murphy sign
cholangitis
inflammation biliary tree
