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Im > Hepatology Nazary > Flashcards

Hepatology Nazary Flashcards

1
Q

Extra abdominal causes of acute abdominal pain

A
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2
Q

Medical causes of acute abdominal pain

A
  1. Medical causes of Acute Abdominal Pain:
    • Addisonian Crisis
    • Acute pleurisy & Pneumonia
    • Porphyria
    • Pelviureteric Colics
    • Pyelonephritis
    • Severe hypercalcemia
    • SLE & FMF
    • Sickle cell crisis
    • DKA
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3
Q

Most affected area in chirosis

A

Area3 peri central area zone 3

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4
Q

Most active cell in chirosis

A

Cell of ito(fat stellate lipocytes) by tgf1

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5
Q

Mention causes of chirosis and hepatomedga;y

A

Early stage of infection
Cardiac causes

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6
Q

Inherted causes of chirosis

A

Gsd (fasting=syncope)
Galactosemia
Wilson
Hemochrmoatosis
Cf
Alpha 1 anti trypsin deficiency

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7
Q

Hepatotropic virus not causing chirosis

A

A e

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8
Q

Mrntion drugs causing hepatitis

A

Inh rifampicin
Methyl dopa methotrexate
Am iodrone

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9
Q

Immune cause of hepatitis

A

Auto immune hepatitis
Primary biliry chirosis
Sclerosing cholangitis

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10
Q

Mention causes of congestive chirosis

A

Constrictive pericaeditis
Rhf
Tr
Ts
High ivc obstruction
Vod
Budd chairi

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11
Q

Commonest cause of chirosis in egypto

A

Hcv hbv nash

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12
Q

Describe bilharzial hepatitis

A

Fibrosis not chirosis except if mixed infection

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13
Q

Mechanism of fibrosis

A
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14
Q

Liver chirosis consequences

A
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15
Q

Liver chirosis consequences

A
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16
Q

Mention chirosis classification score , factors

A

Child pough
Five factors (مياه ascites
مغ hepatic encephalopathy
3 labs
Bilirubin
Albumin
Pt

Compenstaed —5-6 A

Decompensated ——7-9 b
10-15 c

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17
Q

Nodular classification of liver

A

Micro < 3mm
Macro > 3mm

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18
Q

Sonoelstography findings

A

> 7kpa suggestive
12.5-15 kpa chirosis

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19
Q

How to exclude hcc

A

Us / 6 months
Alpha fetoprotein

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20
Q

Ttt of choice in chirosis

A

Liver transplantation

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21
Q

Durstion for alcholic chirosis

A

> 10 y

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22
Q

Why alcholo damage luver

A

Changed by alcholo dehydrogenase into acetaldeyde which is hepatototxic

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23
Q

Features for chronic alcholism

A
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24
Q

Mention blood in alchohlic chirosis

A

Megaloblastic anemia
Gout

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25
Q

Mention anti body elevated in case of alcholic chirosis

A

Iga

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26
Q

Mention the enzymes of liver in slcholic chirosis

A

Ast/alt >2
Ggt inc
Normal alp

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27
Q

Liver biopsy of alcholic chirosis

A

Fatty infilteration
Esinophilic deposiits. Mallory. Bodeis
Micro nodular

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28
Q

Cardiac chirosis cp

A

Pain
Ascites
Tender liver

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29
Q

Bud chiari most important sign and ttt and comp

A

Rapdily filling ascites
Tipps operation
Fulminant hepatitis

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30
Q

Type of duct affected in primary billiary cholasngitid

A

Intra hepatic ducts

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31
Q

Cause of primary billiary chirosis

A

Auto immune defetc in t suppressor cell so damage to duct

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32
Q

Anti bodies of primary biliary cholangitis

A

Igm
Anti mitochondrail anribodies
AMA

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33
Q

Primary biliary cholangitis associated with

A

Bile duct destruction
Auto immune manifestation
Autoantibodies
AMA igm

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34
Q

Mention incidence of primary billiary cholangitis

A

Female middle age 40 -60

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35
Q

Mention earliest symp of primary biliasss

A

Puritis ——fatigue before jaundice

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36
Q

Mention a cause for hepatic osteodystrophy

A

Primary biliary chirosis

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37
Q

Describe cp of primary cholangitis

A

Female middle age started with puritid snd fstigue before jaundiced
And found skin pigment
Xanthelesma
Clubbing
Steatorhhea
Def of keda
Hepatic osteodystrophyy

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38
Q

Mentio comp of primary billiary chird

A

Liver chiroisis
Metabolic bone dx
Malabsorbtion

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39
Q

Mention the blood chemistry of primary billiary chirosis

A

Alp is very high +- ggt +igm2

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40
Q

Mention the earlist liver abnormality incase of primary biliry chirosis

A

Alp

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41
Q

Mention ttt of primary billiary chirsosi

A
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42
Q

Mention duct affected incase of psc

A

Intra , extra hepatic

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43
Q

Mention etiology of psc

A

Primary with uc
2ry dt stone or strictre

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44
Q

Mention incidence of psc

A

Male in 4 th decade

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45
Q

Earliest abnormality incase of psc

A

Alp and billrubing

46
Q

Mention abs of psc

A

P-anca
Rf
Sma
Ana not ama

47
Q

Mention charactersitic ersp

A

Beading of intra and extra hepatic billiary ducts

48
Q

Mention cancers associated with psc

A

Liver
Gb
Cholingio
Colon

49
Q

Puritis and jaundice flactuating course

50
Q

Mention cp of psc

A

Male in 4th decade with ulcerative colitis
Has jaundice and puritis of fluctusting course
Fatigued
Inc incidence of cholangio carcinoma
With steatrea and hepatic osteodystrophy

51
Q

Most imp inv of hemochromatosis

A

Mri show excess iron in liver and pancreas

52
Q

Mention triad of hemochromatosis

A

Bronzed pigmentstion
Dm
Hepatomegaly

53
Q

Mention y]yhe most important cause of he,ochrmotosis

A

HEF on chromosome 6

54
Q

Mention cause of hemochromatosis

55
Q

Mention first organ affected in hemochromatosis

56
Q

Mention type of chirosis in hemochromatosis

A

Macro nodulsr

57
Q

Frothy urine

A

Ile salt , obstructive jsundice

58
Q

Ast sites

A

Heart kidney muslce liver

59
Q

Alt sites

60
Q

Alt>ast in

A

fulminant hepatitis

61
Q

Explain ratios of liver enzyme in alchol chirosis

62
Q

Ldh inc significant

A

Hepatic necrosis , hepatic ischemia

63
Q

Serum 5 nucleosidase significance

A

inc in biliary obstruction

64
Q

Ggt significance

A

Gggt + alp= billiary obt
Ggt alone alchol

65
Q

Alp signficnace

66
Q

Gamma globulins significance

A

Formed in res inc in infec

67
Q

Gamma globulins produce abs

A

Igm —-primary billiary chirosis
Igg——- chronic hepatitis
Iga ——— alcohol

68
Q

All coagulation factors made in liver except

69
Q

Descrbe amonka cycle

70
Q

Alfa feto protein significance

A

> 400 ng hcc
Inc incidence af indicates neural tube defect of fetus

71
Q

How to differentiate between primary biliary chirosis , sclersing cholangitis , autoimmune hepatitis by immunology

A

Ama in 1ry biliary chirosis
ANCA 1ry sclersiomg cholangitis
Actin liver micrsomal antibodies in auto immune hepatitis

72
Q

Def jaundice

A

Yellowish discoloration of skin mucus membrane , conjuctiva dt inc serum billirubin >2-3 mg bec normal q

73
Q

Causes of hemolytic jaundice

74
Q

Blood picture in hemolytic anemia

A

Inc 5
Dec 3
Inc
Iron ,ferritin , billirubin , reticlocytes , ldh
Dec hb , mcv , haptoglobin
Anemia + iron kyeeer

75
Q

Heptocellular jaundice cause

A

Lcf
Infectin
Nash
Drugs
Toxins
Famillial

76
Q

Isolated hyperbillrubinemia causes

A

Gilbert
Crigler najjar
Dubbin johnson

77
Q

Most common familial hyperbillrubinmeia

A

Gilbert dx

78
Q

Type of billrubin inc in gilbertt

79
Q

Describe gilbert dx ttt cp

A

No ttt
No symp
Normal liver
Lifelomg
Benign.

80
Q

What aggrevate and deaggrevate gilbert dx

A

Fastin , influenza inc.
Phenobarbitone dec

81
Q

What type of inheritance of gilbert and defe t

A

Ad
Defect in uptake

82
Q

Mention defect in criggler najjar and type of billrubin

A

Defect in conjugation enzyme ( glucuronyl transferase )
Indirect

83
Q

Compare between crigller najar types

84
Q

Compare between crigller najar types

85
Q

Difference between rotter and dubin johnson syndrome

A

Absecnce of black or green pigments with liver biopsy in rotter

86
Q

Mention inhertincd of dubin johnson

A

Ar
Chromosome 10

87
Q

Mention defect of dubin or rotter

A

Carrier protein defect

88
Q

Decribe dubin johnson

A

Ar
Chromosome 10
Carrier protein defect
Direct billlrubin inc
Inc melanin like pigment in lyzozymes
Inc preg ocps
Black or green pigments in liver biopsy

89
Q

What aggrevate dubi johnson

90
Q

Causes of isolated elevation of alp

91
Q

Causes of isolated elevation of alp

92
Q

Obstreutive jaundice triad

A

Prolonged jaundice
Pale stool
Hepatomegaly

93
Q

Mention cp of obstructive jaundice

94
Q

Compare between hemolytic obstructive hepatocellular jaundice
Jaundice
Stool
Urine
Features
Serum billirubin
Stercobillongen
Urobillinogen
Liver function
Main. Casues

95
Q

Def acute hepatitis

A

Acute inflammation of liver less than 6 montths

96
Q

Mention non hepatotropic viruses

A

Cyto megalo virus
Epv in ifectious mono nucleousis

97
Q

Hepto tropic virus with no rna

98
Q

Mr]entin heptotropic virus with no vaccine

99
Q

Mention mode of transmission in all hepto tropic viruses

100
Q

Mention clinical presentation of acute hepatitis

101
Q

Prolonged cholestaisi is more common in

102
Q

Idication of hav vaccine hbv and doses and immunity

103
Q

How intestinal bacteria reach general circulation

A

By passing hepatic filter
Porto systemic colletrals

104
Q

Sbp cp

A

Neutrophils >250 cell/mm3
Monobacterial e coli
Defect in gut barrier in chirosis
Ishmeia of res
Porto systemic
Impaired function of liver in detoxification

105
Q

GR fetor hepaticus

A

Due to lack of detoxification of mercaptans

106
Q

What are values of sex hormones in lcf

A

Inc estrogen , sex hormones binding globulin
Dec test dht

107
Q

Why lcf chirosis causes periphral neuroapthy

A

Defciency of thiamine cobalmine folic avid

108
Q

Hepatorenal syndrome

A

Serious complication of cirrhosis
Normal histology

● Functional renal failure with
● Azotemia
● Oliguria
● Intractable ascites

109
Q

Management od ascites

A

Low na
Dirutics
Paracentesis

110
Q

Mangemet of encephalopathy

A

Hold oral protein intake
Sterilization of GI tract with antibiotics (e.g., neomycin)
Lactulose (Cephulac) traps NH3 in gut.
Cathartics/enemas

111
Q

Managemt of esophageal variceal bleeding

A

Stabilize patient
Drug therapy {Proton pump inhibitors, Octreotide (Sandostatin)}
Upper GI endoscopy (band ligation or injection sclerotherapy)

112
Q

Most common cause of chirosis www

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