Hep/Bili/Panc Disease Flashcards
What causes gallbladder diseases?
Anything that slows or prevents outflow of bile from the gallbladder
Cholelithiasis is composed of what?
cholesterol, secreted by the liver into the gallbladder
Etiology of Cholelithiasis?
- Fair
- Fat
- Female
- 40’s (age)
Etiology of biliary colic?
spasm of the cystic duct
- usually forms obstruction from a stone
- can be stenosis from cancer
Clinical presentation of biliary colic?
- 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
PE of biliary colic?
afebrile and RUQ pain
Diagnostic of biliary colic?
- LFTs WNL
- elevated WBC
Imaging for biliary colic?
US
What causes chronic cholecystitis?
gallbladder wall thickening, scaring, and shrinking of the gallbladder
Etiology of acute cholecystitis?
- blockage of cystic duct usually cholelithiasis stuck in the cystic duct
Clinical presentation acute cholecystitis?
+ murphy sign: deep palpitation of RUQ, pain will prevent deep inspiration.
What is Choledocholithiasis?
a stone in the common bile duct, pt becomes symptomatic when stone obstructs
Clinical presentation of Choledocholithiasis?
- anorexia
- jaundice
- n/v
- light-colored stool
- Pruritis: 2 degree elevated bilirubin
- RUQ pain
Gold standard diagnostic testing for Choledocholithiasis?
ERCP
Etiology of Cholangitis?
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.
Clinical presentation of Cholangitis, charcot’s triad?
- Fever/chills
- RUQ pain
- Jaundice
Cholangitis managment “pus under pressure” means?
- pus near the liver unable to get out d/t obstruction of stone
- surgical emergency!!!!
What cells produce insulin?
Beta cells located in islet of Langerhans
Glucagon stimulates what?
The liver to metabolize glycogen into glucose and release it into the blood
What is acute pancreatitis?
Inflammatory disease characterized by autodigestion of the pancreas by proteolytic enzymes, activated and produced from within the pancreas
Etiology of acute pancreatitis?
- alcohol
- biliary tract disease (stones MC)
- ERCP
- hypertriglyceridemia >500
- trauma
- drugs (thiazides, estrogen, sulfonamides, salicylates)
Where is the pain of acute pancreatitis felt and what type of pain?
- midepigastric pain —> back
- a constant, boring, dull ache
Uncommon signs of severe necrotizing pancreatitis?
Cullen sign and Gray turner sign
Diagnostic test for acute pancreatitis?
elevated lipase (test of choice)
Acute pancreatitis complications?
- pseudocyst (collection of fluid and debris on epithelial lining)
- pancreatic abscess
- ascites from leaking duct of pseudocyst
What is chronic pancreatitis?
repeated episodes of acute inflammation leading to chronic damage and ductal obstruction.
The gradual loss of pancreatic function results in?
Exo and endocrine insufficiency
Exocrine insufficiency is a deficiency in?
amylase, lipase and protease
Endocrine insufficiency is an abnormality of?
glucagon and insulin
Etiology of chronic pancreatitis?
Alcohol, CF, or idiopathic
Classic triad of chronic pancreatitis?
- Diabetes: loss of endocrine function
- Steatorrhea: loss of exocrine function
- Pancreatic calcification: chronic inflammation
Chronic pancreatitis “3 polys”?
- polydipsia
- polyurea
- polyphagia
Pancreatic carcinoma arises from?
exocrine portion (adenocarcinoma)
Pancreatic carcinoma occurs where in the pancreas?
head and neck of the pancreas
Clinical presentation of Pancreatic carcinoma?
- Courvoisiers sign
- early satiety/anorexia
- weight loss
What is Courvoisier’s sign found in pancreatic carcinoma?
enlarged palpable nontender gallbladder in patients w/obstructive jaundice caused by tumors of the biliary tree or pancreatic head tumor
Diagnostic test for Pancreatic carcinoma?
CT scan and ERCP
Liver function test measures what?
the amount of enzymes in the blood
- enzymes are released into the blood when hepatocytes are damaged or destroyed
Liver function test: AST
Liver, heart, muscle, kidney, brain
- elevated in alcoholics
Liver function test: ALT
Liver (more specific than AST) and kidney
- elevated with hepatitis
What are TRUE liver function tests?
PT/INR and Albumin
What test do you order for hepatocellular damage?
ALT and AST
What is NASH (nonalcoholic steatohepatitis)?
fat infiltrates of the liver causing inflammation
NASH can progress to?
- Steatosis —> steatohepatitis
- cirrhosis
Alcoholic liver disease progression?
- alcoholic steatosis –> steatohepatitis —> cirrhosis —> hepatocellular carcinoma
Clinical presentation of alcoholic hepatitis?
- jaundice
- palmar erythema
- spider angiomata
- hepatomegaly
Diagnostic for alcoholic hepatitis liver bx finding?
- “mallory bodies”
- neutrophil infiltration
- fatty changes
What is hereditary hemochromatosis?
- an autosomal recessive disorder of iron metabolism
- results in an increase of GI iron absorption leading to iron accumulation in organs, esp. the liver.
Hereditary hemochromatosis can cause what very common medical condition?
Diabetes!
Hereditary hemochromatosis treatment?
- weekly phlebotomy (until ferritin <50)
- control diet
- genetic testing for all 1st egress relatives
Autoimmune hepatitis type 1 antibodies?
ANA, ASMA, and AMA
Autoimmune hepatitis type 2 antibodies?
anti-LKM-1 and anti-LC1
Autoimmune hepatitis is associated with what medical condition?
SLE
Autoimmune hepatitis diagnostic bx is used to?
R/o viral hepatitis
What is alpha 1 antitrypsin?
serine protease inhibitor primarily produced in the liver, the role is performed primarily in the lungs where it regulates neutrophil elastase production.
What is alpha 1 antitrypsin disease?
- autosomal- codominant geneic diorder,
- caused by lack of alpha 1 antitrypsin resulting in break down of elastic in alveoli —> COPD.
Diagnostic test for alpha 1 antitrypsin disease?
Screen w/ SPEP = absent of a-1 peak.
Hepatitis A virus transmitted via?
fecal-oral route
Hepatitis B virus transmitted via?
- blood
- sexual contact
- parenteral contact
Hepatitis B virus is the leading cause of?
cirrhosis and HCC worldwide
Name the 3 antigens/”proteins” in Hepatitis B virus?
- surface antigen
- e antigen
- core antigen
HBsAg (Hep B surface antigen) positive lab test indicates?
- virus is present
HBsAb or Anti-HBs positive lab test indicates?
- immunity and end of acute phase
- vaccinated and pts who cleared the virus
HBV DNA used to quantitatively measure?
viral load
Hepatitis C is transmitted via?
- blood transfusions
- IVDU
- tattoos
- piercings
- cocaine use
- healthcare workers
- Vietnam veterans
- high-risk sexual behavior (most risky MSM)
HCV Ab or Anti-HCV positive lab test indicates?
- past exposure or ongoing infection
- if positive order HCV RNA
HCV RNA lab test determines?
- genotype
- presence of the virus
Hepatitis D virus you have to be coinfected with?
HBV
Hepatitis E (echo) is transmitted by?
Fecal-oral
Clinical presentation of Cirrhosis?
- Caput medusa
- fluid retention
- depuytrens contractures (4-5 fingers contracted)
- abd vein dilation
- ascities
Cirrhosis lab results?
- thrombocytopenia
- hypoalbuminemia
- elevated PT/INR
List some cirrhosis complications?
- hepatic encephalopathy
- esophageal varices
- hepatorenal syndrome
- spontaneous bacterial peritonitis
Hepatocellular carcinoma arises from what cells?
Parenchymal cells
Hepatocellular carcinoma MCC?
- cirrhosis causes 80% of HCC
- higher incidence in HCV/HBV
Management of cirrhosis?
- Abd US every 6 mos to screen for HCC
- EGD surveillance for varices
Hepatocellular carcinoma diagnostics?
- elevated alpha-fetoprotein
- liver bx
