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GI > Hep/Bili/Panc Disease > Flashcards

Hep/Bili/Panc Disease Flashcards

1
Q

What causes gallbladder diseases?

A

Anything that slows or prevents outflow of bile from the gallbladder

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2
Q

Cholelithiasis is composed of what?

A

cholesterol, secreted by the liver into the gallbladder

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3
Q

Etiology of Cholelithiasis?

A
  • Fair
  • Fat
  • Female
  • 40’s (age)
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4
Q

Etiology of biliary colic?

A

spasm of the cystic duct

  • usually forms obstruction from a stone
  • can be stenosis from cancer
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5
Q

Clinical presentation of biliary colic?

A
  • sudden onset of pain (1-5 hrs)
  • RUQ or mid epi severe pain, may radiate to the shoulder
  • Dull or boring pain
  • pain w/ fatty meals
  • n/v
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6
Q

PE of biliary colic?

A

afebrile and RUQ pain

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7
Q

Diagnostic of biliary colic?

A
  • LFTs WNL

- elevated WBC

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8
Q

Imaging for biliary colic?

A

US

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9
Q

What causes chronic cholecystitis?

A

gallbladder wall thickening, scaring, and shrinking of the gallbladder

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10
Q

Etiology of acute cholecystitis?

A
  • blockage of cystic duct usually cholelithiasis stuck in the cystic duct
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11
Q

Clinical presentation acute cholecystitis?

A

+ murphy sign: deep palpitation of RUQ, pain will prevent deep inspiration.

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12
Q

What is Choledocholithiasis?

A

a stone in the common bile duct, pt becomes symptomatic when stone obstructs

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13
Q

Clinical presentation of Choledocholithiasis?

A
  • anorexia
  • jaundice
  • n/v
  • light-colored stool
  • Pruritis: 2 degree elevated bilirubin
  • RUQ pain
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14
Q

Gold standard diagnostic testing for Choledocholithiasis?

A

ERCP

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15
Q

Etiology of Cholangitis?

A

infection of the biliary tree caused by statsis of the common bile duct. Stasis is usually d/t some obstruction CBD or inflation post manipulation.

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16
Q

Clinical presentation of Cholangitis, charcot’s triad?

A
  • Fever/chills
  • RUQ pain
  • Jaundice
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17
Q

Cholangitis managment “pus under pressure” means?

A
  • pus near the liver unable to get out d/t obstruction of stone
  • surgical emergency!!!!
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18
Q

What cells produce insulin?

A

Beta cells located in islet of Langerhans

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19
Q

Glucagon stimulates what?

A

The liver to metabolize glycogen into glucose and release it into the blood

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20
Q

What is acute pancreatitis?

A

Inflammatory disease characterized by autodigestion of the pancreas by proteolytic enzymes, activated and produced from within the pancreas

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21
Q

Etiology of acute pancreatitis?

A
  • alcohol
  • biliary tract disease (stones MC)
  • ERCP
  • hypertriglyceridemia >500
  • trauma
  • drugs (thiazides, estrogen, sulfonamides, salicylates)
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22
Q

Where is the pain of acute pancreatitis felt and what type of pain?

A
  • midepigastric pain —> back

- a constant, boring, dull ache

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23
Q

Uncommon signs of severe necrotizing pancreatitis?

A

Cullen sign and Gray turner sign

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24
Q

Diagnostic test for acute pancreatitis?

A

elevated lipase (test of choice)

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25
Q

Acute pancreatitis complications?

A
  • pseudocyst (collection of fluid and debris on epithelial lining)
  • pancreatic abscess
  • ascites from leaking duct of pseudocyst
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26
Q

What is chronic pancreatitis?

A

repeated episodes of acute inflammation leading to chronic damage and ductal obstruction.

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27
Q

The gradual loss of pancreatic function results in?

A

Exo and endocrine insufficiency

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28
Q

Exocrine insufficiency is a deficiency in?

A

amylase, lipase and protease

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29
Q

Endocrine insufficiency is an abnormality of?

A

glucagon and insulin

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30
Q

Etiology of chronic pancreatitis?

A

Alcohol, CF, or idiopathic

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31
Q

Classic triad of chronic pancreatitis?

A
  • Diabetes: loss of endocrine function
  • Steatorrhea: loss of exocrine function
  • Pancreatic calcification: chronic inflammation
32
Q

Chronic pancreatitis “3 polys”?

A
  • polydipsia
  • polyurea
  • polyphagia
33
Q

Pancreatic carcinoma arises from?

A

exocrine portion (adenocarcinoma)

34
Q

Pancreatic carcinoma occurs where in the pancreas?

A

head and neck of the pancreas

35
Q

Clinical presentation of Pancreatic carcinoma?

A
  • Courvoisiers sign
  • early satiety/anorexia
  • weight loss
36
Q

What is Courvoisier’s sign found in pancreatic carcinoma?

A

enlarged palpable nontender gallbladder in patients w/obstructive jaundice caused by tumors of the biliary tree or pancreatic head tumor

37
Q

Diagnostic test for Pancreatic carcinoma?

A

CT scan and ERCP

38
Q

Liver function test measures what?

A

the amount of enzymes in the blood

- enzymes are released into the blood when hepatocytes are damaged or destroyed

39
Q

Liver function test: AST

A

Liver, heart, muscle, kidney, brain

- elevated in alcoholics

40
Q

Liver function test: ALT

A

Liver (more specific than AST) and kidney

- elevated with hepatitis

41
Q

What are TRUE liver function tests?

A

PT/INR and Albumin

42
Q

What test do you order for hepatocellular damage?

A

ALT and AST

43
Q

What is NASH (nonalcoholic steatohepatitis)?

A

fat infiltrates of the liver causing inflammation

44
Q

NASH can progress to?

A
  • Steatosis —> steatohepatitis

- cirrhosis

45
Q

Alcoholic liver disease progression?

A
  • alcoholic steatosis –> steatohepatitis —> cirrhosis —> hepatocellular carcinoma
46
Q

Clinical presentation of alcoholic hepatitis?

A
  • jaundice
  • palmar erythema
  • spider angiomata
  • hepatomegaly
47
Q

Diagnostic for alcoholic hepatitis liver bx finding?

A
  • “mallory bodies”
  • neutrophil infiltration
  • fatty changes
48
Q

What is hereditary hemochromatosis?

A
  • an autosomal recessive disorder of iron metabolism

- results in an increase of GI iron absorption leading to iron accumulation in organs, esp. the liver.

49
Q

Hereditary hemochromatosis can cause what very common medical condition?

A

Diabetes!

50
Q

Hereditary hemochromatosis treatment?

A
  • weekly phlebotomy (until ferritin <50)
  • control diet
  • genetic testing for all 1st egress relatives
51
Q

Autoimmune hepatitis type 1 antibodies?

A

ANA, ASMA, and AMA

52
Q

Autoimmune hepatitis type 2 antibodies?

A

anti-LKM-1 and anti-LC1

53
Q

Autoimmune hepatitis is associated with what medical condition?

A

SLE

54
Q

Autoimmune hepatitis diagnostic bx is used to?

A

R/o viral hepatitis

55
Q

What is alpha 1 antitrypsin?

A

serine protease inhibitor primarily produced in the liver, the role is performed primarily in the lungs where it regulates neutrophil elastase production.

56
Q

What is alpha 1 antitrypsin disease?

A
  • autosomal- codominant geneic diorder,

- caused by lack of alpha 1 antitrypsin resulting in break down of elastic in alveoli —> COPD.

57
Q

Diagnostic test for alpha 1 antitrypsin disease?

A

Screen w/ SPEP = absent of a-1 peak.

58
Q

Hepatitis A virus transmitted via?

A

fecal-oral route

59
Q

Hepatitis B virus transmitted via?

A
  • blood
  • sexual contact
  • parenteral contact
60
Q

Hepatitis B virus is the leading cause of?

A

cirrhosis and HCC worldwide

61
Q

Name the 3 antigens/”proteins” in Hepatitis B virus?

A
  • surface antigen
  • e antigen
  • core antigen
62
Q

HBsAg (Hep B surface antigen) positive lab test indicates?

A
  • virus is present
63
Q

HBsAb or Anti-HBs positive lab test indicates?

A
  • immunity and end of acute phase

- vaccinated and pts who cleared the virus

64
Q

HBV DNA used to quantitatively measure?

A

viral load

65
Q

Hepatitis C is transmitted via?

A
  • blood transfusions
  • IVDU
  • tattoos
  • piercings
  • cocaine use
  • healthcare workers
  • Vietnam veterans
  • high-risk sexual behavior (most risky MSM)
66
Q

HCV Ab or Anti-HCV positive lab test indicates?

A
  • past exposure or ongoing infection

- if positive order HCV RNA

67
Q

HCV RNA lab test determines?

A
  • genotype

- presence of the virus

68
Q

Hepatitis D virus you have to be coinfected with?

A

HBV

69
Q

Hepatitis E (echo) is transmitted by?

A

Fecal-oral

70
Q

Clinical presentation of Cirrhosis?

A
  • Caput medusa
  • fluid retention
  • depuytrens contractures (4-5 fingers contracted)
  • abd vein dilation
  • ascities
71
Q

Cirrhosis lab results?

A
  • thrombocytopenia
  • hypoalbuminemia
  • elevated PT/INR
72
Q

List some cirrhosis complications?

A
  • hepatic encephalopathy
  • esophageal varices
  • hepatorenal syndrome
  • spontaneous bacterial peritonitis
73
Q

Hepatocellular carcinoma arises from what cells?

A

Parenchymal cells

74
Q

Hepatocellular carcinoma MCC?

A
  • cirrhosis causes 80% of HCC

- higher incidence in HCV/HBV

75
Q

Management of cirrhosis?

A
  • Abd US every 6 mos to screen for HCC

- EGD surveillance for varices

76
Q

Hepatocellular carcinoma diagnostics?

A
  • elevated alpha-fetoprotein

- liver bx

GI (16 decks)

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