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HPIM 19th Gastro > Hepatobiloary > Flashcards

Hepatobiloary Flashcards

1
Q

MC and most characteristic symptom of liver disease

A

Fatigue

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2
Q

Hallmark symptom of liver disease, the most reliable marker of severity

A

Jaundice

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3
Q

Jaundice is detectable in what bilirubin levels

A

> 25 mg/dL (>43 umol/L)

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4
Q

Clinically helpful approach to diagnosis of alcohol dependence and abuse

A

CAGE questionnaire

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5
Q

Suggestive of chronic alcoholism and chronic alcoholic disease

A

Dupuytren contracture

Parotid enlargement

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6
Q

Kaysher-Fleischer rings

A

Wilson’s Disease

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7
Q

pANCA

A

Primary sclerosing cholangitis

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8
Q

Mitochondrial antibody

A

Primary biliary cirrhosis

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9
Q

Useful assessment of the severity and stage of liver damage, prediction of prognosis and monitoring and respinse to treatment

A

Liver biopsy

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10
Q

Evaluation of liver transplantation candidates

A

MELD

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11
Q

Clinical staging of cirrhosis

A

Chikd-Pugh

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12
Q

MELD components

A

bilirubin
crea
protime

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13
Q

More specific transaminase indicator of liver injury

A

SGPT/ALT

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14
Q

Albumin levels suggesting chronic liver diseases

A

<3 g/dL

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15
Q

Inactivates HAV

A

Boiling for 1 min
Contact with formaldehyde and chlorine
UV irradiation

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16
Q

First virologic marker detectable in the serum

A

HBs

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17
Q

May be the only serologic evidence of current or recent HBV infection during the gap or window period

A

Anti HBc

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18
Q

Qualitative marker of early chronic HBV infection

A

HBe

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19
Q

Quantitative marker of early chronic HBV infection

A

HBV DNA

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20
Q

Major route of transmission of HBV

A

percutaneous inoculation

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21
Q

Account for most casesnof transfusion-transmitted hepatitis

A

HCV

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22
Q

Greatest impact on transmission in HBV

A

Perinatal transmission

Intimate sexual contact

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23
Q

Pathogenesis of Chronic HBV infection

A

Defective Cellular Immunity

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24
Q

Requires HBV for its replication and expression

A

HDV

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25
Q

MC genotype of HCV

A

Genotype 1

26
Q

Associated with essential mixed cryoglobinemia

A

HCV

27
Q

Severe histologic findings in Acute Viral Hepatitis

A

Bridging hepatic necrosis

may be seen in methyldopa toxicity

28
Q

Fulminant Hepatitis

A

B
E
D

(with massive hepatic necrosis)

29
Q

False-positive IgM Anti-HAV is seen

A

Presence of Rheumatoid Factor

30
Q

Gold standard to establish diagnosis of HCV

A

HCV RNA assay

31
Q

More sensitive test for HBV replication

A

HBV DNA

32
Q

May produce serum-sickness like syndrome

A

Acute HBV

33
Q

Likelihood of chronicity after acute infection

A

HCV

34
Q

Treatment of Acute Hep C

A

PEG + Ribavirin

35
Q

MCC of acute liver failure

A

Drug-induced liver injury

36
Q

May cause centrilobular zonal necrosis

A

Carbon tetrachloride

Trichloroethylene

37
Q

May cause periportal injury

A

Yellow phosphorus poisoning

38
Q

May cause massive hepatic necrosis

A

Octapeptides of Amanita phalloides

39
Q

May cause hepatocellular injury indistinguishable from that of viral hepatitis

A

Isoniazid

Ciprofloxacin

40
Q

MC form of hepatocellular injury

A

Spotty necrosis in the liver lobule with predominantly lymphocytic infiltrate

41
Q

Most frequently implicated antibiotic among cases of drug-induced liver injury

A

Amoxicillin-Clavulanic

42
Q

“Ductopenic” cholestasis

A

Carbamazepine

Levofloxacin

43
Q

Hepatocellular vs cholestatic reaction

A

R value > 5: hepatocellular injury
R value < 2: cholestatic

2-5 mixed

44
Q

Gastric lavage in Acetaminophen ingestion

A

Should be done within 30 mins otherwise ineffective

45
Q

Blood levels of acetaminophen predictive of development of severe damage

A

> 300 ug/mL 4 hours after ingestion

46
Q

Treatment for sodium valproate toxicity

A

IV carnitine

47
Q

Causative agent in TMP-SMX hepatotoxicity

A

Sulfamethoxazole component

48
Q

Causes chronic viral hepatitis

A

B
C
D (superimposed on chronic hep B)

49
Q

Three major forms of ALD

A

Fatty Liver
Alcoholic Hepatitis
Cirrhosis

50
Q

Quantity of ethanol in men produces fatty liver

A

40-80 g/day

1 beer = 12 g of alcohol

51
Q

Quantity of ethanol in men produces hepatitis or cirrhosis

A

160 g/day x 10-20 years

52
Q

Initial and MC histologic response to increased alcohol ingestion

A

Fatty Liver

53
Q

Hallmark of Alcoholic hepatitis

A

Injured hepatocyte with ballooning degeneration, spotty necrosis, PMN infiltration and fibrosis in the perivenulae and perisinusoidal space of Disse

54
Q

Heralds severe alcoholic hepatitis

A 
PT >5s
Anemia
Alb <2.5 mg/dL
Bil >8 mg/dL
renal failure
ascites
55
Q

MELD score with significant mortality

A

> /= 21

56
Q

Cornerstone of Alcoholic hepititis

A

Complete abstinence from alcohol

57
Q

Preferred treatment for Alcoholic Hep with Discriminant function >/= 32 or MELD = 21 without comorbids

A

Prednisolone x 4 weeks then taper for 4 weeks

Alternative: Pentoxyfylline x 4 weeks

58
Q

MC chronic liver disease in many parts of the world

A

NAFLD

59
Q

Highest risk of advanced liver fibrosis

A

NASH in >45-50 years old + overweight/obese or with T2DM

60
Q

Gold standard for establishing the severity of liver injury and fibrosis

A

Liver biopsy

HPIM 19th Gastro (3 decks)

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