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Medicine Clerkship > Hepatobilliary Dz > Flashcards

Hepatobilliary Dz Flashcards

1
Q

fibrosis → disruption of liver
architecture → portal HTN +
impaired biosynthetic function
→ multiple complications

How to make Dx?

A

chirrosis

liver biopsy

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2
Q

WHat causes varices

A

portal HTN → dilated
veins in butt (hemorrhoids), gut
(esophageal varices), and caput
(caput medusae)

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3
Q

Ppx against varicies

A

Beta blockers

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4
Q

treatment for bleeding esophageal varicies

A
  1. band the varices
  2. correct coagulopathy
  3. IV octreotide to lower portal pressure
    → if bleeding continues, repeat banding → if bleeding continues, TIPS or gastric balloon tamponade
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5
Q

MC etiologies of chirrosis

A

alcohol > HBC and HCV

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6
Q

What is Childs classifications?

A 
stratifies risk of surgery in pts w/ liver failure:
measure 3 labs (albumin,
bilirubin, PT) and 3 clinical
findings (encephalopathy,
ascites, nutrition)
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7
Q

pathophys of ascities

A

portal HTN + hypoalbuminemia –> fluid collection in abd cavity

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8
Q

how to Dx and treat acites

A

Dx PE (shifting dullness, fluid wave) + paracentesis (to determine cause)

Tx salt restriction + loop diuretic

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9
Q

pathophys of hepatic encephalopathy + s/s

Tx?

A

↓NH4 metabolism → ↑NH4 → CNS toxicity → ∆MS, asterixis,
rigidity, hyperreflexia, fetor
hepaticus

Tx lactulose (prevents NH4 absorption) + neomycin (kills GI flora that make NH4) + low protein diet

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10
Q

pathyphys of hepatorenal syndrome + tx?

A 
end stage liver dz → renal vein vasoconstriction → progressive
renal failure (despite normal
kidneys)

liver txp

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11
Q

acites + abd pain, fever, n/v,
rebound tenderness

how to dx and tx?

A

apontaneous bacterial peritonitis

  • Dx paracentesis (↑WBC)
  • Tx IV abx + repeat paracentesis in 2-3 days
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12
Q

Estrogen inc or dec in chirrosis? What are the consequences of this?

A

elevated E 2/2 to dec E metabolism –> spider angiomas, palmar erythema, gynecomastia,
testicular atrophy

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13
Q

treatment for coagulopathy in cirrhotics?

A

FFP transution (vit K wont work bc they cannot make clotting factors)

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14
Q

consequence of AR ∆ceruloplasmin

A 
wilsons disease = copper
accumulation in liver (cirrhosis),
corneas (Kayser-Fleischer rings),
brain (movement d/o), RBCs
(schistocytes)
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15
Q

how to dx and treat wilsons dz

A

Dx ↓ceruloplasmin, ↑AST/ALT, liver bx

Tx D-penicillamine (copper chelating agent) + zinc (copper uptake competition)

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16
Q

(cirrhosis), heart (restrictive
CM), joints (arthritis), skin
(bronze suntan), pancreas (DM

A

hemachromatosis

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17
Q

how to dx and treat hemachromatosis

A
  • Dx ↑ferritin, ↓TIBC, liver bx

* Tx repeated phlebotomies

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18
Q

etiology of 1/1 vs 2/2 hemachromatosis

A

1° hemochromatosis: AR dz that ↑GI iron absorption
2° hemochromatosis: ↑iron 2/2
multiple transfusions or chronic
hemolytic anemia

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19
Q

anabolic steroids or OCP use + usually asx, can present as hypovolemic shock and distended abdomen if ruptured

A

hepatic adenoma

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20
Q

how is hepatic adenoma dx and treated

A
  • Dx CT scan or U/S

* Tx d/c OCP, if it persists → Tx resection due to possibility of rupture

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21
Q

MC benign liver tumor

A

cavernous hemangioma

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22
Q

what are etiologies od a cavernous hemangioma

A

VAT –
vinyl chloride
aflatoxin
thorotrast

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23
Q

CT scan with central stellate scar or sunburst pattern in liver

tx?

A

focal nodular hyperplasia

reassurance

24
Q

ague RUQ pain and mass +
s/sx of chronic liver dz (portal
HTN, ascites, jaundice)

Dx? Tx?

A

HCC

Dx with CT scan and inc aFP
Tx is resection as long as it has not spread

25
Q

etiologies a/w HCC

A

cirrhosis (MCC), A1AT deficiency, hemochromatosis, Wilson dz, smoking, chemical carcinogens

26
Q

fatty liver in a nonalcoholic pt,

usually asx with mild elevated ALT and AST

A

NASH

27
Q

usually asx, but can present
w/ mild jaundice after fasting

+ pathophys and treatment

A

Gilberts = AD ∆UDP-glucuronyltransferase
–> elevated unconjugated/indirect bili bc there is dec enzyme that conjegates bili

reassurance

28
Q

What is hemobilia

how is it dz and tx?

A

injury to liver or biliary tract →
blood drains into duodenum via
CBD → UGIB, jaundice, RUQ
pain

  • Dx arteriogram (gold std); EGD shows bleeding from ampulla of Vater
  • Tx supportive care, stop bleeding if severe
29
Q

What can cause hemobilia?

A

trauma (MCC), surgery (CBD exploration), tumors, infx

30
Q

cyst in liver, what is on differential

A
  1. ADPKD
  2. hydatid cysts (Echinococcus
    granulosus (dog tapeworm) →
    multilocular cyst w/ calcified
    walls)
31
Q

treatment for hydatid cyst

A

Tx inject hypertonic saline inside cyst and

• carefully excise it + post-op mebendazole

32
Q

how do liver abcess prsent?

tx?

A

fever, RUQ pain, jaundice

multiple/small bacterial abscesses → Tx IV abx

single/large bacterial abscess → Tx perc drain

amebic abscess (in Mexicans) → Tx Flagyl

33
Q

What is budd chiari syndrome?

tx? etiology?

A

occlusion of hepatic vein
outflow → hepatic congestion +
portal HTN → hepatomegaly,
RUQ pain, ascites, jaundice

Tx TIPS as a “bridge to liver txp”

Etiology: polycythemia vera
(MCC), OCPs (#2)

34
Q

↑AST/ALT (ALT>AST): ?
↑AST/ALT (AST>ALT): ?
↑↑AST/ALT: ?
↑↑↑AST/ALT: ?

↑AΦ + GGT nl: ?
↑AΦ + ↑GGT: ?

A

↑AST/ALT (ALT>AST): chronic viral hepatitis (virALT)

↑AST/ALT (AST>ALT): acute alcoholic hepatitis (toAST)

↑↑AST/ALT: acute viral hepatitis

↑↑↑AST/ALT: severe hepatic necrosis

↑AΦ + GGT nl: pregnancy or bone dz (e.g. Paget’s)

↑AΦ + ↑GGT: biliary obstruction

35
Q

↑bilirubin (conjugated 50%): ?

A

↑bilirubin (conjugated 50%): obstructive jaundice (cancer, choledocholithiasis)

36
Q

↓albumin: ?

A

chronic liver dz, nephrotic syndrome, malnutrition, inflammatory states

37
Q

How are gallstones worked up?

A

US then get HIDA if inconclusive

ERCP if choledocholithiasis/acute cholangitis

38
Q

What is Boas sign?

A

referred right scapular pain of biliary colic

39
Q

What is charcot triad?

A

RUQ pain
Fever
Jaundice

40
Q

What is reynold’s pentad

A

RUQ pain
Fever
Jaundice

change in MS
hypotension

41
Q

what is acute cholangitis

A

stone in CBD + infection

42
Q

what is gallstone pancreatitis

tx

A

impacted stone in pancreatic duct –> reflux of pancreatic enzymes –> mid epigastric pain

if amylase returns to normal → Tx lap chole
if amylase elevated → ERCP to remove stone

43
Q

what is billiary colic?

tx?

A

cholelithiasis →
RUQ pain after fatty meals ± n/v

elective lap chole

44
Q

tx for choledocholithiasis

A

Tx NPO, IVF, ±abx → ERCP to remove stone

45
Q

where is stone in acute cholecystitis?

tx?

A

cystic duct

Tx NPO, IVF, abx → lap chole within 24 hrs

46
Q

who usually gets acalculous cholecystitis

tx?

A

ICU pts

Tx NPO, IVF, abx → lap chole within 24 hrs; perc drain w/ cholecystostomy if nonsurgical candidate

47
Q

what is porcelin GB? Why is it significant?

A

dystrophic calcification of GB has 50% risk of adenocarcinoma, take it out

48
Q

What is gallstone ileus

A

gallstone enters bowel through cholecystenteric fistula → gets stuck in terminal ileum → SBO

49
Q

thickening of bile duct walls →
narrowed lumens → gradual
jaundice and pruritus → liver
failure, cirrhosis, portal HTN

How is it Dx? Tx? Etiology?

A

1° sclerosing cholangitis (PSC)

• Dx ERCP (beading of bile ducts)
• Tx cholestyramine (helps w/ pruritus), liver txp (definitive)
• Etiology: idiopathic, but highly
associated w/ UC

50
Q

destruction of intra-hepatic bile ducts → gradual jaundice and pruritus → liver failure, cirrhosis, portal HTN

Dx? Tx?

A

1° biliary cirrhosis (PBC)

Dx screen w/ AMA (anti-mitochondrial ab), confirm w/ liver bx

Tx ursodeoxycholic acid

51
Q

what can cause 2° biliary cirrhosis?

A

(progressive cirrhosis 2/2 to biliary obst)

sclerosing cholangitis, cystic fibrosis, biliary atresia

52
Q

tumor of bile ducts → s/sx of
obstructive jaundice (dark
urine, clay stools, pruritus)

how to make dx? tx? etiologies?

A

cholangiocarcinoma

dx with ERCP
Tx whipple if resectable

etiologies: PSC (MCC US), Chlonorchis sinensis (MCC China)

53
Q

What is Klatskin tumor?

A

tumor of proximal 1/3 of CBD, poor px since it’s not resectable

54
Q

What are choledocal cysts and how do they present? How are they Dx and tx?

A

cystic dilation of biliary tree →
RUQ mass/pain, jaundice, fever

dx with ERCP
Tx with resection

55
Q

iatrogenic injury → s/sx of
obstructive jaundice (dark
urine, clay stools, pruritus)

Dx? Tx? complications?

A

billiary stricture

Dx with ERCP
Tx endoscopic stent > surgical bypass

complications = 2° biliary cirrhosis, acute cholangitis, liver abscess

56
Q

pathophys and presentaion of billiary dyskinesia

dx? tx?

A

motor dysfxn of sphincter of
Oddi → recurrent biliary colic
w/o stones

HIDA scan (fill up GB w/ contrast and give CCK to determine ejection fraction)

lap chole

Medicine Clerkship (20 decks)

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