GI2b Flashcards
What are 4 signs that point towards peritonitis?
a. BS-
b. Murphy Sign +
c. Rebound +
d. Guarding +
What are 4 things that predispose people to cholesterol gall stones?
a. DM2
b. hydrochlorothiazide (BP med)
c. estrogen
d. hyperlipidemia
What are 5 things cholesterol stones associated with?
a. obesity
b. Crohn’s
c. CF
d. age
e. Native American ancestry
Who can get pigment stones? What are the two types of pigment stones? Must you have a gall bladder to get pigment stones?
Seen in pts with chronic hemolysis, alcoholic cirrhosis and old age.
a. dark: hemolysis
b. brown: infection
Don’t have to have a gall bladder.
What are the 4 F’s that increase risk for gall stones?
a. Fat
b. Fertile
c. Female
d. Forty
What are the “REAL” liver functions?
a. INR
b. Albumin
c. Globulins
What turn unconjugated bilirubin into conjugated bilirubin?
Glucuronic Acid
What is Charcot’s Triad of cholangitis?
a. jaundice
b. fever
c. RUQ pain
What is Reynold’s pentad?
a. jaundice
b. fever
c. RUQ pain
d. confusion
e. hypotension
What does “CD-ROM” and “Use CNG” stand for?
CD-ROM: Conjugated = Dubin-johnson and ROtor
Use CNG: Unconjugated = Crigler-Najjar and Gilbert
What is the histological sign of PSC?
Starry Night
What does “beads on a string” refer to?
PSC
What are 4 characteristics of primary biliary cirrhosis?
a. Autoimmune
b. lymphocytic infiltration
c. granulomas
d. destruction of the small intralobular bile ducts.
What is asterixis a sign of?
hepatic encephalopathy
What are 5 cause of acute liver failure?
a. viruses (Hep A, B, C, D, E)
b. Drugs (Tylenol)
c. Toxins (amanita mushroom)
d. metabolic disease (Wilson’s)
e. Ischemia (Budd-Chiari)
When does hepatic encephalopathy happen? How do you calculate cerebral perfusion pressure (CPP)?
hepatic encephalopathy is a sign of ALF.
CPP = Intracranial Pressure [ICP] - [MAP]
What two conditions do you use NAC to treat?
a. Tylenol overdose
b. Amatoxin (mushroooms)
What lobular zone does Tylenol overdose cause the most damage to? Why? What is the role of glutothione?
Zone 3.
CYP2E1 is in zone 3, and that is the enzyme that makes the toxic metabolite. Glutothione reacts with the metabolite and helps it to be excreted harmlessly. But when you overwhelm the system, you run out of enough glutothione to deal with the toxic metabolite.
What percent of ALF pts get infections? What should you do?
80%.
Treat broadly with Abx.
What are two bile acid synthesis defects?
a. 3B-Hydroxy-C27 (most common)
b. Cerebrotendinous Xanthomatosis (CTX) (leads to xanthomas)
How does bile acid get from sinusoid to canaliculus? What are the (transporters)?
Sinusoid > (NTCP or OATP) > Hepatocyte > (BSEP) > Canaliculus
What transporter helps the colon reabsorb bile acids?
Apical Sodium Bile Transporter (ASBT).
