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Goljan > Hepatobiliary/Pancreatic > Flashcards

Hepatobiliary/Pancreatic Flashcards

1
Q

Do the trasaminases peak before or after the onset of acute hepatitis?

A

before

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2
Q

What is almost the only way to observe a mixed hyperbilirubinemia?

A

viral hepatitis

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3
Q

What type of drug can cause jaundice?

A

OCPs

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4
Q

Other than LDH, what enzyme can increase in the blood during intravascular hemolysis?

A

AST

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5
Q

Other than an obstruction, what else could elevate GGT?

A

induction of cytochrome enzymes

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6
Q

Which immunoglobulin is increased during Primary Biliary Cirrhosis?

A

IgM

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7
Q

What auto-antibody is present during Primary Biliary Cirrhosis?

A

anti-mitochondrial

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8
Q

Which two auto-antibodies are present during Autoimmune Hepatitis?

A

anti-nuclear

anti-smooth muscle

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9
Q

Is HAV spread by the blood?

A

NO

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10
Q

Does HAV produce a carrier state?

A

no

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11
Q

Is HAV an RNA or DNA virus?

A

RNA

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12
Q

Is HBV an RNA or DNA virus?

A

DNA

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13
Q

Is HBV carried by the blood?

A

yes

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14
Q

Which hepatitis virus is known to produce Immune complex disease?

A

HBV

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15
Q

Is HCV an RNA or DNA virus?

A

RNA

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16
Q

Which specific kidney pathology does HCV cause?

A

Type I MPGN

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17
Q

What two drugs are used to treat HBV?

A

Lamivudine

entecavir

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18
Q

What two drugs are used to treat HCV?

A

ribavarin

Telaprevir

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19
Q

Is HDV an RNA or DNA virus?

A

RNA

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20
Q

Is HEV an RNA or DNA virus?

A

RNA

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21
Q

Which specific part of HBV does HDV require to replicate?

A

HBsAg

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22
Q

What causes fulminant hepatitis in pregnant women?

A

HBV and HDV superinfection

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23
Q

What are the two hepatitis viruses not carried by the blood?

A

HAV

HEV

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24
Q

What is the first marker for HBV infection?

A

appearance of HBsAg

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25
Q

How does the presence of HBsAg define chronic hepatitis?

A

longer than 6 months = chronic

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26
Q

What are the two markers for Hepatitis B infectivity?

A

HBeAG and HBV-DNA

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27
Q

Do HBeAG and HBV-DNA occur before or after HBsAg?

A

after

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28
Q

Do HBeAG and HBV-DNA disappear before or after HBsAg?

A

before

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29
Q

What is the marker for acute immune response against HBV?

A

anti-HBc IgM

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30
Q

Is anti-HBc IgM protective?

A

no

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31
Q

What are the only two markers of HBV infection during the window period?

A

IgM core

IgG core

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32
Q

What is the marker for HBV protection?

A

anti-HBs

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33
Q

What is the gold standard for detecting HCV?

A

HCV RNA

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34
Q

What is the hepatitis virus where IgG is not protective?

A

HDV

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35
Q

Mixed hyperbilirubinemia is indicative of what disease?

A

hepatitis

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36
Q

Which haplotypes are associated with Autoimmune Hepatitis?

A

HLA DR3 and DR4

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37
Q

Autoimmune hepatitis is associated with what two other autoimmune diseases?

A

Hashimoto and Graves

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38
Q

Other than the liver diseases, what virus can cause neonatal hepatitis?

A

CMV

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39
Q

What are the three symptoms of Reye Syndrome?

A

Encephalopathy

Microvascular Fatty change

increased transaminases

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40
Q

What two metabolic processes are mos likely to happen during Reye Syndrome?

A

urea cycle

β-oxidation

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41
Q

What defines Microvascular Fatty steatosis?

A

no displacement of nucleus

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42
Q

What is the metabolic abnormality present in Reye Syndrome?

A

hypoglycemia

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43
Q

What drug is used to treat Reye Syndrome?

A

Mannitol

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44
Q

What zone of the liver is affected during Pre-eclampsia?

A

zone 1

45
Q

What is HELLP Syndrome?

A

Hemoltic anemia

Elevated liver enzymes

Low platelets

46
Q

What is Pelios hepatis?

A

sinusodial dilation do to blood

47
Q

What are the two causes of Pelios Hepatis?

A

B. henselae and anabolic steroids

48
Q

What damages the hepatocyte during Alcoholic Hepatitis?

A

acetylaldehyde

49
Q

What invades the cell during alcoholic hepatitis?

A

Neutrophils

50
Q

Which is more elevated during Alcoholic Hepatitis, AST or GGT?

A

AST

51
Q

Where is thorium dioxide found?

A

radiographic contrast

52
Q

What molecule causes pruritis?

A

bile salt

53
Q

What type of amino acids are increased during liver cirrhosis?

A

aromatic

54
Q

Do loops and thiazides produce a metabolic acidosis or alkalosis?

A

alkalosis

55
Q

Liver failure can produce an excess of what hormone?

A

aldosterone

56
Q

What is the difference between serum albumin and ascites albumin during liver ascites or peritoneal ascites?

A

liver = > 1.1 g/dL

peritoneal =

57
Q

What happens to the kidney during hepatorenal syndrome?

A

intense vasoconstriction

58
Q

What type of drug is used to treat HRS?

A

vasopressors

59
Q

Why does liver failure induced hyperestrogenism produce impotence?

A

increased synthesis of sex hormone binding protein binds free testosterone

60
Q

What gets destroyed during Primary Biliary Cirrhosis? Where?

A

bile ducts

portal triads

61
Q

What disease other than Wilsons disease can produce copper accumulation in the cornea?

A

Primary Biliary Cirrhosis

62
Q

What are the two treatments for Primary Biliary Cirrhosis?

A

Ursodeoxycholic acid

Budesonide

63
Q

Why does the skin get dark during hemochromatosis?

A

iron activates melanin

64
Q

Transferrin saturation over what value requires investigation for hemochromatosis?

A

> 45%

65
Q

Destruction of what gland can occur during hemochromatosis? Which two values would go down?

A

anterior pituitary

LH and FSH

66
Q

What is defective during Wilson disease?

A

defective transport of copper into bile

67
Q

What protein carries copper in the absence of ceruloplasmin?

A

albumin

68
Q

Where in the cornea does copper deposit during Wilson disease?

A

Descemet membrane

69
Q

What other disease can produce copper in the cornea?

A

Primary Biliary Cirrhosis

70
Q

What two specific structures of the brain does copper accumulate?

A

putamen

subthalamic nucleus

71
Q

What type of movement does deposition of copper in the subthalamic nucleus produce?

A

hemiballismus

72
Q

What specific kidney disease does excess copper produce?

A

fanconi syndrome

73
Q

What type of emphysema does α1 anti-trypsin deficiency produce?

A

panacinar

74
Q

What is the most common cause of cirrhosis in children?

A

α1 anti-trypsin deficiency

75
Q

What does liver cirrhosis do to fasting glucose levels?

A

fasting hypoglycemia

76
Q

What does liver failure do to breathing?

A

chronic pulmonary alkalosis

77
Q

What type of blood pH abnormality do patients with liver failure clasically produce?

A

lactic acidosis

78
Q

Do liver failure pt’s present with hypernatremia or hyponatremia?

A

hyponatremia

poor CO leads to

79
Q

Do liver failure pt’s present with hyperkalemia or hypokalemia? Why?

A

hypokalemia

excess aldosterone secretion do to poor kidney perfusion

80
Q

Hypoalbuminemia will produce what electrolyte disturbance?

A

hypocalcemia

81
Q

Which hydroxylation reaction of vitamin D takes place in the liver?

A

25

82
Q

What are the three causes of a liver adenoma?

A

OCPs

anabolic steroids

Von Gierke glycogenolysis

83
Q

What amino acid disease can cause HCC?

A

tyrosinemia

84
Q

Where can bile be found during HCC?

A

neoplastic cells

85
Q

What three hormones can HCC secrete?

A

insulin-like factor

EPO

PTHrp

86
Q

What type of cyst is the most common to find in children under the age of 10 in their liver?

A

Choledochal

87
Q

Which liver cancer does Clonorchis sinesis cause?

A

Cholangiocarcinoma

88
Q

What are the three mechanisms by which estrogen may contribute to formation of cholesterol stones?

A

increase HDL synthesis

upregulates LDL receptor

activates HMG-CoA reductase

89
Q

Which virus can cause cholecystitis?

A

CMV

90
Q

What is used for pain for a gall stone?

A

Meperidine

91
Q

Why is morphine not used to treat a gall stone?

A

contracts sphincter of Oddi

92
Q

What patient population most often develops gall bladder adenocarcinoma?

A

elderly women

93
Q

What activates the pancreatic enzymes during a bile duct obstruction?

A

bile

94
Q

Why can Acute Pancreatitis cause ARDS?

A

circulating pancreatic phosphoLipase can cleave surfactant

95
Q

Why can acute pancreatitis cause DIC?

A

activate of prothrombin by trypsin

96
Q

Why can acute pancreatitis cause tetany?

A

consumption of calcium during peripancreatic fet necrosis

97
Q

Isolated increases in amylase are indicative of what?

A

pancreatic pseudocyst

98
Q

What is secreted in the urine, amylase or liapse?

A

lipase

99
Q

Which enzyme is increased during pancreatitis?

A

trypsin

100
Q

What is the most sensitive marker for Acute Pancreatitis?

A

Serum Immunoreactive Trypsin

101
Q

Does Serum Immunoreactive Trypsin increase or decrease during Acute Pancreatitis?

A

increase

102
Q

Does Serum Immunoreactive Trypsin increase or decrease during Chronic Pancreatitis?

A

decrease

103
Q

What does Bentiromide get converted into?

A

PABA

104
Q

Where is PABA found?

A

urine

105
Q

What is PABA in the urine indicative of?

A

Chronic Pancreatitis

106
Q

Which gene is associated with Pancreatic Adenocarcinoma?

A

KRAF

107
Q

Which two tumor suppressors are often mutated during Pancreatic Adenocarcinoma?

A

p16 and p53

108
Q

What is the gold standard marker for pancreatic cancer?

A

CA 19-9

109
Q

Which two cancers can produce a Sister Mary Joseph Nodule?

A

gastric and pancreatic

Goljan (2 decks)

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