GI V

Question 1

cirrhosis

Answer 1

bridging fibrosis and nodular regeneration via stellate cells

risk of hepatocellular carcinoma

Question 2

alk phos

Answer 2

biliary marker

Question 3

AST and ALT

Answer 3

hepatocyte damage marker

alcohol - AST > ALT
viral hepatitis - ALT > AST

Question 4

amylase

Answer 4

acute pancreatitis and mumps

Question 5

ceruloplasmin

Answer 5

decreased wilson disease

Question 6

GGT

Answer 6

biliary marker

also up with alcohol use

Question 7

most specific for acute pancreatitis

Answer 7

lipase

Question 8

reye syndrome

Answer 8

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

Question 9

mallory bodies

Answer 9

intracytoplasm eosinophil inclusion of damaged keratin

with alcoholic hepatitis

Question 10

alcoholic cirrhosis

Answer 10

sclerosis around zone III -central vein

Question 11

non-alcoholic fatty liver disease

Answer 11

ALT > AST

ballooning and necrosis

Question 12

hepatic encephalopathy

Answer 12

cirrhosis - portosystemic shunt
-NH3 to brain

tx - lactulose and rifaximin

Question 13

hepatocellular carcinoma

Answer 13

hep B and C
autoimmune disease
a1-antitrypsi deficiency
wilson disease
hemochromatosis
aflatoxin

diagnosis - increased AFP

Question 14

angiosarcoma

Answer 14

vinyl chloride, arsenic - malignant liver tumor

Question 15

budd chiari syndrome

Answer 15

thrombosis hepat vein

centrilobular congestion and necrosis

liver disease

nutmeg liver - mottled

Question 16

a1 anti trypsin deficiency

Answer 16

misfolded protein stay in liver - PAS positive

lungs - uninhibited elastase - panacinar emphysema

Question 17

unconjugated hyperbilirubin

Answer 17

physioogic of newborn
hemolytic
crigler najjar
gilbert

Question 18

conjugated hyperbilirubin

Answer 18

biliary tract obstruction
biliary tract disease
dubin johnson, rotor

Question 19

physiologic neonatal jaundice

Answer 19

immature UDP glucuronosyl transferase

unconjugated hyperbilirubin

tx - phototherapy - tran to cis (in yo piss)

Question 20

gilbert

Answer 20

mild low UDP glucuronsyl transferase

jaundice with stress

unconjugated hyperbilirubin

Question 21

crigler najjar type I

Answer 21

absent UDP glucoronsyl transferase

dies within few years

increased indirect bilirubin

tx - plasmapharesis

Question 22

crigler najjar type II

Answer 22

less severe - respond to phenobarbitol

Question 23

dubin johnson

Answer 23

conjugated hyperbilirubin

defective liver excretion

black liver

Question 24

rotor

Answer 24

mild dubin johnson

conjugated hyperbilirubin

Question 25

wilson disease

Answer 25

hepatolenticular degeneration

copper - in brain, cornea, kidney, joint

fanconi - copper in kidney

Question 26

wilson genetic

Answer 26

auto rec - CH 13

ATP7B gene

Question 27

tx of wilson disease

Answer 27

chelation of copper

penicillamine
trientine
oral zinc

Question 28

hemochromatosis

Answer 28

deposition hemosiderin - iron

micronodular cirrhosis
DM
skin pigmentation (bronze)

Question 29

labs with hemochromatosis

Answer 29

increased ferritin
increased iron
decreased TIBC
increased transferrin saturation

prussian blue stain

Question 30

hemochromatosis genetic

Answer 30

primar - C282Y and H63D mutation

HFE gene

Question 31

tx hemochromatosis

Answer 31

chelation - deferasirox
deferoxamine
deferiprone

phlebotomy

Question 32

primary biliary cirrhosis

Answer 32

autoimmune

see granuloma

middle aged women

anti-mito Abs - IgM

with other autoimmune conditions

Question 33

primary sclerosing cholangitis

Answer 33

onion skin bile duct fibrosis

beading of ducts

in young men with IBD

hyper IgAM

MPO-ANCA - pANCA

with ulcerative colitis

Question 34

gallstones

Answer 34

forty
fat
female
flatulent

cholelithiasis

tx - cholecystectomy

Question 35

cholesterol stones

Answer 35

80% gallstones

obesity, crohns, age, estrogen, weight loss

Question 36

pigment stones

Answer 36

black - Ca, bilirubin, hemolysis - radiopaque

brown - infection - radiolucent

Question 37

cholecystitis

Answer 37

inflammation of gallbaldder

MC - block cystic duct

positive murphy sign

Question 38

cholangitis

Answer 38

inflammation biliary tree