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clin med > hepatic > Flashcards

hepatic Flashcards

1
Q

GGT (gamma glutamyl transferase), ALP, and TBIL → tell us about

A

bile ductal cells

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2
Q

ast and alt detect

A

injury to hepatocytes

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3
Q

Best test for measuring day to day synthetic function of the liver:

A

prothrombin time/INR

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4
Q

ercp?

A

allows you to treat and dx probs of the liver, GB, bile ducts, and pancreas

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5
Q

ercp procedure

A

Endoscope goes into the duodenum, dye is injected into CBD, and can see by fluoroscopy

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6
Q

portal htn back up

A

Blood backs up in the stomach, intestines, spleen, pancreas, when portal venous system is backed up

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7
Q

portal htn leads to

A

esophageal varices and hemorrhoids

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8
Q

cirrhosis?

A

Fibrosis and nodules in liver

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9
Q

dx ascites

A

Dx with US or CT… hard to dx on PE

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10
Q

ascites trmt

A

Trmt- Na restriction, diuretics

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11
Q

Kayser fleischer rings

A

corneal copper deposition in wilson’s disease

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12
Q

Fetor hepaticus?

A

(bad odor of breath and urine)

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13
Q

guaiac + stools are a sx in this disease

A

cirrhosis

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14
Q

Asterixis ?

A

flappy tremor of arms

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15
Q

choreoathetosis ?

A

dancing extremities

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16
Q

common causes of cirrhosis

A

Common: Hep B and C, alcoholic liver disease, hemochromatosis, NASH (nonalcoholic steatohepatitis)

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17
Q

Extrahepatic cholestasis?

A

Bile flow from liver is reduced bc of an obstruction outside the liver

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18
Q

Intrahepatic cholestasis?

A

Bile flow from liver is reduced bc of an obstruction inside the liver

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19
Q

Primary sclerosing cholangitis (PSC)?

A

Chronic progressive inflammation, fibrosis, and stricturing of medium and large ducts in intra and extra hepatic biliary tree that leads to fatigue

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20
Q

Primary sclerosing cholangitis (PSC)

cause

A

unknown

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21
Q

Primary sclerosing cholangitis (PSC) sx

A

Asymptomatic

Fatigue, pruritus (from hyperbilirubinemia), RUQ pain, arthropathy

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22
Q

Primary sclerosing cholangitis (PSC)

pe

A

May be normal
Hypopigmentation, excoriation (from itching), jaundice
Late stage: ascites, clubbing, edema

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23
Q

Primary sclerosing cholangitis (PSC)

dx

A 
\+ antimitochondrial antibodies (AMA)
Inc LFT esp. Alk phos
Histology shows Asymmetric destruction of bile ducts
Do liver biopsy, MRCP, ERCP
Need all 3 to dx
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24
Q

Associated with UC

A

Primary sclerosing cholangitis (PSC)

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25
Q

“Beading of bile ducts”

A

Primary sclerosing cholangitis (PSC)

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26
Q

Primary sclerosing cholangitis (PSC)

2 trmt goals

A

Slow and reverse disease progression- many drugs dont succeed
Manage disease and complications

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27
Q

Primary sclerosing cholangitis (PSC)

trmt

A

Ursodeoxycholic acid (UDCA)/Ursodiol is best
Endoscopic therapy to dilate or stent the stricture
No widely acceptable trmt
Treat underlying sx: itching, bone disease, hyperlipidemia
Ursodeoxycholic acid (UDCA)/Ursodiol- good if trmt starts early bc it thins the bile duct
Cholestyrene resin reduces pruritis
Liver transplant if they think you’ll die within a year

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28
Q

Acute Hepatitis A

cause

A

Hep A virus (HAV)

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29
Q

Acute Hepatitis A

sx

A

Nausea, vomiting, fatigue, diarrhea, fever, jaundice

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30
Q

Acute Hepatitis A

prevention?

A

yes, Vaccine

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31
Q

Acute Hepatitis A

transmission

A

Fecal oral route

No bloodborne transmission

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32
Q

Hepatitis B

cause

A

Hepatitis B virus (HBV)- DNA virus

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33
Q

Hepatitis B

transmission

A

Transmitted by blood, sex
Present in saliva, semen, or vaginal secretions
HBsAg + mothers can transmit HBV when delivering baby

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34
Q

Hepatitis B

sx

A

Anorexia, NV, malaise

Fever, enlarged liver and tender, jaundice

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35
Q

Hepatitis B

dx

A

High aminotransferases (ALT and AST)
Liver biopsy: hepatocellular necrosis
Chronic hep B will have high aminotransferase levels for over 6 mo

36
Q

Hepatitis B

prevention?

A

yes 3 series vaccine

37
Q

Hepatitis B

trmt

A

No trmt bc it resolves on its own

For chronic hep B give immune modulators (INF) and antiviral agents in nucleoside analogues (lamivudine)

38
Q

Hepatitis B

complications

A

Cirrhosis in pts with chronic hep B and HBV or HCV

Pts with cirrhosis at risk for hepatocellular carcinoma

39
Q

skin sx cirrhosis

A

Jaundice, palmar erythema, Spider angioma, Ecchymosis, Dilated abdominal wall veins, Xerotic eczema, Caput medusae, Hemochromatosis- inc pigmentation, Xanthomas- primary biliary cirrhosis, Needle tracts- viral hepatitis

40
Q

MCC portal hypertension

A

ascites

41
Q

MC blood borne infection

A

Acute Hepatitis C

42
Q

Leading cause of chronic liver failure

A

Acute Hepatitis C

43
Q

MC indication for liver transplant

A

Acute Hepatitis C

44
Q

Acute Hepatitis C

cause

A

HCV- RNA virus

45
Q

Acute Hepatitis C

transmission

A

Bloodborne

Transmitted by IV drug use (MC), transfusion, sexual activity, and tattoos previously (think needles)

46
Q

Acute Hepatitis C

sx

A

Mostly asymptomatic

Jaundice, abd pain, anorexia, malaise… nonspecific

47
Q

Acute Hepatitis C

dx

A 
Enzyme immunoassay (EIA) to look for anti-HCV antibody- dont do often
Then do Recombinant immunoassay (RIBA) to confirm if this is +
HCV RNA PCR- we do this now
High AST/ALT and bilirubin
48
Q

Acute Hepatitis C

trmt

A

INF + any -vir drug

49
Q

in hep C:
Genotype 1 and 4 have ____ response to trmt
Genotype 2 and 3 have ____ response to trmt
____ less likely to respond to trmt

A

poor
better
AA/males

50
Q

Important historical breakthrough… over 95% of pts show response in this disease but…
Expensive… 50-90K

A

Acute Hepatitis C

51
Q

Acute Hepatitis C

trmt goals

A

Get rid of infection
Slow disease progression
Improve QOL
Sustained virological response: aviremia 12-24 wks after antiviral therapy

52
Q

MCC of cirrhosis

A

Alcoholic cirrhosis

53
Q

Alcoholic cirrhosis

cause

A

4 beers a day for ten yrs

Malnourished and anemic bc ppl drink more than they eat

54
Q

Alcoholic cirrhosis

dx

A

AST>ALT

High bilirubin

55
Q

Alcoholic cirrhosis

trmt

A

Stop drinking

Transplant

56
Q

Nonalcoholic steatohepatitis/fatty liver (NASH)

sx

A

Most asymptomatic

Fullness in RUQ, fatigue, malaise, hepatomegaly

57
Q

Nonalcoholic steatohepatitis/fatty liver (NASH)

dx

A 
High ALT and AST
No infectious hepatitis
HLD
Inc PTT and bilirubin, hypoalbuminemia
US/CT/MR shows fatty liver
Biopsy makes dx
58
Q

dx for Nonalcoholic steatohepatitis/fatty liver (NASH)

is based on

A

histological findings

59
Q

criteria for NASH

A

Based on histological findings
Low alcohol consumption
No serological evidence of other disease
Biopsy: macrovesicular steatosis or steatohepatitis

60
Q

NASH can lead to

A

Can lead to insulin resistance

61
Q

Nonalcoholic steatohepatitis/fatty liver (NASH)

trmt

A

Lose weight, control HLD and hyperglycemia, liver transplant

62
Q

MC metastatic CA

A

Hepatocellular neoplasms

63
Q

Hepatocellular neoplasms

come from

A

lung, colon, breast, prostate

64
Q

Hepatocellular carcinoma aka

A

hepatoma

65
Q

Hepatocellular carcinoma cause

A

Hep B and C

66
Q

Hepatocellular carcinoma sx

A

Weight loss

Signs of cirrhosis

67
Q

Hepatocellular carcinoma dx

A

US MC

AFP (alpha fetoprotein) tumor marker present

68
Q

Hepatocellular carcinoma trmt

A

Transplant or resection

69
Q

Hemochromatosis inheritance

A

autosomal recessive

70
Q

Hemochromatosis?

A

Inc iron in various organs

71
Q

Hemochromatosis sx

A

Arthralgias, hepatomegaly, gray skin, DM, ED

72
Q

Hemochromatosis dx

A

Hallmark: inc % transferrin saturation and high serum transferrin

73
Q

Hemochromatosis trmt

A

Weekly phlebotomy

74
Q

Wilson’s disease?

A

Disorder of copper transport and copper accumulates in liver, brain, kidneys and cornea

75
Q

Wilson’s disease

sx

A

Looks like acute or chronic liver disease (malaise, high LFT)
hallmark: Kayser- fleischer gold ring in iris periphery
Low serum ceruloplasmin
Diagnostic: urine copper

76
Q

Wilson’s disease

trmt

A

Penicillamine

77
Q

Autoimmune hepatitis?

A

Chronic inflammation of the liver dt circulating autoantibodies

78
Q

Autoimmune hepatitis

sx

A

Jaundice, fatigue, anorexia, nausea, abd pain, pruritus, arthralgia

79
Q

Autoimmune hepatitis

dx

A 
Antinuclear Ab (ANA), anti smooth mc Ab (ASMA)
Liver biopsy shows inflammation
80
Q

Autoimmune hepatitis

trmt

A 
Transplant
No hepatotoxins (in meds)
81
Q

Acetaminophen poisoning?

A

7.5-10g APAP over 24 hrs

82
Q

Acetaminophen poisoning

sx

A

0-24 hrs nausea vomiting, anorexia
24-72 hrs RUQ pain, inc AST and ALT
72-96 hrs ast and alt peak
Over 5 days revolution or death

83
Q

Acetaminophen poisoning

dx

A

APAP in blood

84
Q

Acetaminophen poisoning

trmt

A

N-acetylcysteine

Liver transplant

85
Q

MELD- model for end stage liver disease?

A

Predicts disease severity and mortality in pts with hepatic dysfunction
Helps us give priority too liver transplant pts

86
Q

MELD- model for end stage liver disease calculation?

A

Calculated using bilirubin, creatinine, and INR

clin med (35 decks)

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