GI2b

Question 0

What are 4 signs that point towards peritonitis?

Answer 0

a. BS-
b. Murphy Sign +
c. Rebound +
d. Guarding +

Question 1

What are 4 things that predispose people to cholesterol gall stones?

Answer 1

a. DM2
b. hydrochlorothiazide (BP med)
c. estrogen
d. hyperlipidemia

Question 2

What are 5 things cholesterol stones associated with?

Answer 2

a. obesity
b. Crohn’s
c. CF
d. age
e. Native American ancestry

Question 3

Who can get pigment stones? What are the two types of pigment stones? Must you have a gall bladder to get pigment stones?

Answer 3

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.

Question 4

What are the 4 F’s that increase risk for gall stones?

Answer 4

a. Fat
b. Fertile
c. Female
d. Forty

Question 5

What are the “REAL” liver functions?

Answer 5

a. INR
b. Albumin
c. Globulins

Question 6

What turn unconjugated bilirubin into conjugated bilirubin?

Answer 6

Glucuronic Acid

Question 7

What is Charcot’s Triad of cholangitis?

Answer 7

a. jaundice
b. fever
c. RUQ pain

Question 8

What is Reynold’s pentad?

Answer 8

a. jaundice
b. fever
c. RUQ pain
d. confusion
e. hypotension

Question 9

What does “CD-ROM” and “Use CNG” stand for?

Answer 9

CD-ROM: Conjugated = Dubin-johnson and ROtor

Use CNG: Unconjugated = Crigler-Najjar and Gilbert

Question 10

What is the histological sign of PSC?

Answer 10

Starry Night

Question 11

What does “beads on a string” refer to?

Answer 11

PSC

Question 12

What are 4 characteristics of primary biliary cirrhosis?

Answer 12

a. Autoimmune
b. lymphocytic infiltration
c. granulomas
d. destruction of the small intralobular bile ducts.

Question 13

What is asterixis a sign of?

Answer 13

hepatic encephalopathy

Question 14

What are 5 cause of acute liver failure?

Answer 14

a. viruses (Hep A, B, C, D, E)
b. Drugs (Tylenol)
c. Toxins (amanita mushroom)
d. metabolic disease (Wilson’s)
e. Ischemia (Budd-Chiari)

Question 15

When does hepatic encephalopathy happen? How do you calculate cerebral perfusion pressure (CPP)?

Answer 15

hepatic encephalopathy is a sign of ALF.

CPP = Intracranial Pressure [ICP] - [MAP]

Question 16

What two conditions do you use NAC to treat?

Answer 16

a. Tylenol overdose

b. Amatoxin (mushroooms)

Question 17

What lobular zone does Tylenol overdose cause the most damage to? Why? What is the role of glutothione?

Answer 17

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.

Question 18

What percent of ALF pts get infections? What should you do?

Answer 18

80%.

Treat broadly with Abx.

Question 19

What are two bile acid synthesis defects?

Answer 19

a. 3B-Hydroxy-C27 (most common)

b. Cerebrotendinous Xanthomatosis (CTX) (leads to xanthomas)

Question 20

How does bile acid get from sinusoid to canaliculus? What are the (transporters)?

Answer 20

Sinusoid > (NTCP or OATP) > Hepatocyte > (BSEP) > Canaliculus

Question 21

What transporter helps the colon reabsorb bile acids?

Answer 21

Apical Sodium Bile Transporter (ASBT).