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Differential > Hepatic/Biliary > Flashcards

Hepatic/Biliary Flashcards

1
Q

what bilirubin level causes jaundice in the sclera?

A

2-3 mg/dL

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2
Q

what bilirubin level causes jaundiced skin?

A

5-6 mg/dL

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3
Q

you should be concerned if you see more than ___ spider angiomas on the chest

A

5

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4
Q

what is leukonychia?

A

white bands in nail beds

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5
Q

what is koilonychia?

A

spooning of nails (convex to concave)

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6
Q

where can you see referred pain for liver disease (abscess, cirrhosis, tumors, hepatitis)?

A

-Thoracic spine (T7-T10; midline to R)
-R UT and shoulder

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7
Q

where can you see referred pain for the gallbladder?

A

-R UT and shoulder
-R interscapular area (T4 or T5-8)
-R subscapular area

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8
Q

pts with liver problems are at greater risk of OA at what 2 joints?

A

wrist and ankle

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9
Q

mild to moderate cases of hepatitis require ____ with later progression

A

liver transplant

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10
Q

what are 3 reasons for urgent referral of someone with hepatitis?

A

-Joint or muscle pain that is disproportionate to the physical findings
-Presence of palmar tendinitis in someone with RA
-Positive risk factors for hepatitis

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11
Q

being a liver transplant recipient puts you at increased risk for which type of hepatitis?

A

B

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12
Q

HepA S/S (“FEL CAR JAD HAPI”)

A

-Fever (low-grade)
-Extreme fatigue
-Loss of desire to smoke cigarettes or drink alcohol
-Clay-colored stools
-Anorexia
-R upper abdominal pain
-Jaundice
-Arthralgia and myalgia (transient)
-Dark urine
-HA
-Alteration of taste and smell
-Pharyngitis
-Indigestion

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13
Q

HepB S/S (“F DAP JAR”)

A

-Fever
-Dark urine
-Anorexia, nausea
-Painful abdominal bloating
-Jaundice
-Arthralgia
-Rash (over entire body, itchy)

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14
Q

Chronic Persistent Hepatitis S&S (“RAMM”)

A

-RUQ pain
-Anorexia
-Mild fatigue
-Malaise

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15
Q

what is Wilson’s disease?

A

-Metabolic disease that causes chronic hepatitis
-Biliary excretion of copper is impaired
-Darkish brown on periphery of iris
-Commonly see proximal weakness (shoulders, hips, trunk)

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16
Q

what is hemochromatosis?

A

-Defect in iron aborption
-Causes liver failure
-Fibrosis of parenchymal organs
-Arthralgia/arthropathy may develop (often confused with RA and OA)

17
Q

what joints are commonly involved in hemochromatosis?

A

-2nd and 3rd MCP joints commonly involved first
-Then knees/hips/shoulders/low back

18
Q

what can happen at the knees with hemochromatosis?

A

pseudo-gout

19
Q

what are the most common hepatotoxic agents?

A

-Acetaminophen (#1 most common)
-Aspirin

20
Q

what 4 items should put toxic/drug-induced hepatitis on your radar? (“FARR”)

A

-Fever
-Arthralgias
-Rash
-RUQ or epigastric pain

21
Q

If you feel nodules with liver palpation, what should be on your radar?

A

cirrhosis

22
Q

what is a big thing we need to consider when working with a pt who has cirrhosis?

A

Rest periods during exercise according to level of fatigue experienced by pt during exercise (d/t diminished hepatic BF with moderate exercise)

23
Q

what is portal HTN?

A

Dilated veins of lower esophagus
Result from portal vein HTN
Thin-walled
Can rupture, causing severe hemorrhage and sometimes death

24
Q

what 3 items are in the cluster for cirrhosis?

A

-Ease of fatigue (with mild exertion)
-RUQ pain
-Fever

25
Q

what is kernicterus?

A

type of brain damage from toxic levels of bilirubin in blood that occurs if jaundice is left untreated for too long

26
Q

what can kernicterus cause? (“Vic And Harry Itch”)

A

-Vision and teeth abnormalities
-Athetoid CP
-Hearing loss
-Intellectual disabilities

27
Q

what is the most common cause of liver abscess?

A

biliary tract disease

28
Q

liver = primary metastatic site for which cancers? (“Pan and Ed Stall while Collin Looks for his Beats”)

A

Pancreas
Esophagus
Stomach
Colorectal
Lung
Breast

29
Q

biliary colic = stone lodged where?

A

neck of the gallbladder (cystic duct)

30
Q

what is the classic symptom of biliary colic?

A

R upper abdominal pain that comes and goes in waves

31
Q

cholecystitis = stone blocking what?

A

cystic duct

32
Q

cholangitis = stones lodged where?

A

further down in the common bile duct (after bile duct joins pancreas)

33
Q

exposure to radon is a risk factor for what condition?

A

glallbladder cancer

Differential (3 decks)

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