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Meds 2 > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Liver makes what clotting factors

A

5,7,9,10
Prothrombin
Fibrinogen

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2
Q

Portal htn causes what?

A

thrombocytopenia

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3
Q

Tests for hepatocellular injury

A

AST & ALT

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4
Q

Tests for cholestatic injury

A

alk phos & total bilirubin

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5
Q

tests for biosynthesis

A

Glucose
INR
Albumin
Cholesterol

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6
Q

Bilirubin soluble when? How much in this form?

A

Conjugated, 30%

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7
Q

Unconjugated bilirubinemia caused by?

A

Gilbert’s syndrome - impaired uptake/conjugation
Intravascular hemolysis
Newborns

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8
Q

Conjugated Hyperbilirubinemia due to?

A

Liver disease
Obstructive
Sepsis
Conjenital

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9
Q

AST/ALT normal serum levels?

A

30-40 U/L

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10
Q

Correlated AST/ALT and liver cell dmg?

A

POOR

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11
Q

AST or ALT found more in live? Which more specific for liver dmg?

A

ALT

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12
Q

If Alkaline Phosphatase is high, check what next?

A

Check GGT, GGT high = liver source

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13
Q

Cholestatic liver diseases?

A

Bile duct obstruction
Biliary cirrhosis
Sclerosing cholangitis

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14
Q

Albumin synthesized?

A

exclusively in liver

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15
Q

Albumin half life?

A

20 days

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16
Q

Albumin levels in liver disease/cirrhosis?

A

normal in acute, lower in cirrhosis

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17
Q

Albumin levels specific for liver disease?

A

noo

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18
Q

Most liver clotting factors are what dependent?

A

vit K

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19
Q

> 1000 elevation of LFT can mean (big 5)

A
  1. Drug/toxin
  2. Ischemic
  3. Acute viral Infection
  4. autoimmune hepatitis
  5. Wilson’s disease
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20
Q

250-1000 elevation LFT can mean?

A
  1. Drug - NSAIDS
  2. alpha antitrypsin
  3. Viral EBV/HSV
  4. Autoimmune Hepatitis
  5. Wilsons disease
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21
Q

Mild elevation

A

many things
steatosis
alcohol

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22
Q

Pattern of LFT abnormalities

A

Cholestasis Hallmark elevated AP and bilirubin

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23
Q

Acute liver failure defined as?

A

Previously normal liver, develops within 6mo

Impaired synthetic function and encephelopathy

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24
Q

Most important prognostic factor of Acute LIver Failure

A

INR

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25
AST can be found in where else besides liver?
skeletal and cardiac muscle
26
Patients with preexisting liver disease/drink max dose of acetaminophen?
2g
27
Hepatotoxicity from converting Acetaminophen to what?
NAPQI
28
Acetaminophen overdose treatment?
GI decontamination with charcoal | Antidote: N-Acetylcysteine
29
Tylenol > NSAIDS in liver failure b/c
NSAIDS worsen underlying coagulopathy | Can interact with diuretics used to treat ascites
30
Transmission of HBV?
vertical | blood - mucosal, blood, c7uts
31
HBV incubation period?
2-6mo
32
What % adults exposed to HBV resolve infection?
90%
33
% of people who get persistent infection get chronic?
1-3%
34
7 Markers for HBV infection?
``` sAg - present infection sAB immunity Core IgM - acute infection Core IgG - current or previous infection HBV Viral DNA - active infection e antigen - no replication e antibody - replication ```
35
HBV treatment?
tenofovir | entecavir
36
HCV tests?
Hep C antibody, then RNA viral load
37
HCV highest path of transmission?
parenteral - hemophiliacs, dialysis patients, IV drug users
38
HCV incubation
3 mo
39
% patients with HCV develop chronic hepatitis
85%
40
HCV chronic liver disease symptoms?
cryoglobulinemia Porphyria cutanea tarda Oral: Lichen Planus, Sjogrens, Xerostomia Peripheral neuropathy'
41
HCV stable at room temp for?
5 days
42
Needle stick % for HIV, HBV, HCV?
30% HBV 3% HCV 0.3% HIV
43
3 Pathological stages of alcoholic liver disease?
fatty liver alcoholic hepatitis alcoholic fibrosis/cirrhosis
44
Treatment for alcoholic liver disease?
abstinence
45
Alcoholic hepatitis clinical findings?
``` Fever hepatomegaly leukocytosis GLossitis, angular chielitis, gingivitis, sialadenosis AST:ALT greater than 2:1 ```
46
% people progressing ot each stage of alcoholic liver disease?
90 to fatty 20 to hepatitis 40 to cirrhosis
47
Instead of progressing through alcoholic hepatitis, fatty liver can do what?
pericentral fibrosis then straight to cirrhosis
48
Non-alcoholic steatohepatitis is what?
Subset of non-alcoholic fatty liver disease with inflammation
49
Hepatic steatosis is?
fatty accumulation without fibrosis or inflammation
50
Two hits of fatty liver disease?
INsulin resistance | Oxidative injury
51
Most common cause of abnormal LFTs in US?
NAFLD
52
Risk factors for NAFLD?
obesity diabetes hyperlipidemia
53
Primary biliary cirrhosis most common symptoms?
fatigue, pruritis
54
diagnosis of primary biliary cirrhosis?
positive anti-mitochondrial Ab | liver biopsy
55
Primary biliary cirrhosis vs Primary Sclerosing Cholangitis?
Biliary - intrahepatic bile ducts destroyed | Cholangitis - medium/large bile ducts, MRCP/ERCP
56
Autoimmune hepatitis distinguishing diagnostic factor?
positive ANA and anti-smooth muscle Ab | female
57
Wilson's disease leads to?
Accumulation of copper in liver, brain, kidney,s cornea
58
Key diagnosis in Wilson's disease?
Kayser-Fleisher cornea rings Decreased ceruloplasmin High urinary copper
59
Treatment for Wilson's?
Copper binding medications (Penicillamine)
60
Clinical signs of Cirrhosis Early Portal Htn Impaired Liver Function
Early - thrombocytopenia portal htn - splenomegaly, ascites, varices impaired liver fcn - decreased albumin, elevated INR
61
Decompensated Cirrhosis 3 manifestations?
jaundice ascites encephalopathy
62
Cirrhosis consideration for giving drugs?
tylenol
63
Most common complication of cirrhosis?
ascites
64
5 things to order for diagnosing ascites?
Paracentesis: ``` gram stain culture cell count albumin total protein ```
65
Serum-Ascite Albumin Gradient (SAAG) cutoff?
1.1g/dl
66
If SAAG >1.1g/dL...
portal Htn | Cirrhosis
67
Management of Ascites
Decrease Na intake
68
TIPS is?
a shunt across liver
69
Spontaneous Bacterial peritonitis - diagnosis?
``` paracentesis gram stain cell count (if >250, abx and albumin) culture albumin Tprotein ```
70
Variceal bleeding prognosis?
30% mortality with first b leed | 60% rebleed in 1 year
71
Variceal bleeding treatment?
esophageal banding blakemore tube emergent TIPS Octreotide
72
Hepatic encephalopathy substances from gut into brain?
ammonia get into astrocytes
73
Ammonia comes from?
Highest in hepatic portal vein, normally converted to urea in urea cycle and excreted, reduced in acute/chronic liver disease.
74
Ammonia mainly acts on what in brain?
agonizing GABA --> cerebral failure
75
Diagnosis for HE?
NO ammonia levels | Rule out precipitating factors - dehydration, constipation, primary CNS event
76
Treatment for HE?
underlying cause | lactulose rifaximin
77
Hepatocellular carcinoma risk factors?
Cirrhosis Non-Cirrhotic Hep B NASH

Meds 2 (7 decks)

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