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Old DOOS > Liver > Flashcards

Liver Flashcards

1
Q

how big is the liver?

A

Size of a football

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2
Q

what is one of the primary products of the liver?

A

Bile (80% or > cholesterol)

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3
Q

2 forms of bile

A

conjugated and unconjugated

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4
Q

What are the LFTs?

A

Transamin (SGOT/AST, SGPT/ ALT)

Alkaline phosphatase

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5
Q

What are 2 serum proteins to measure?

A

albumin

prealbumin

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6
Q

what is a coagulation indicator?

A

Prothrombin

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7
Q

what is a good measure of someones nutritional status. Can show if they need artificial nutrition.

A

Prealbumin

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8
Q

Ways to look at the liver

A

Plain films
US (good for hallow vs. solid)
CT of RUQ and abdomen

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9
Q

What is percutaneous transhepatic cholangiograph? (PTC)

A

Puncture through the liver to one of the major vessels and put dye in there to show biliary drainage system.

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10
Q

What is an MRI choloangiopancreatography

A

High resolution, close-up of the main junctions where the cystic ducts and common bile duct join into the ampulla

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11
Q

Invasive tests for liver issues.

A

Needle biopsy
open biopsy
ERCP
surgical exploration & excision

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12
Q

a yellow green coloration of the skin, sclera & mucous membranes. May be associated w/ pruritis

A

Jaundice

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13
Q

Jaundice is detected when bilirubin levels are above what?

A

2.5 mg/100 mL

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14
Q

Mechanisms that can cause jaundice. 6 causes

A

Excessive bilirubin production (pre conjugation)
Decreased hepatic uptake (pre conjugation)
Impaired conjugation
Intrahepatic cholestasis
Extra-hepatic obstruction
Hepatocellular injury

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15
Q

What does indirect bilirubin mean?

A

Unconjugated

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16
Q

if bilirubin is unconjugated will be in the urine?

A

No, urine will be free of bilirubin

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17
Q

What are ways to get excess unconjugated bilirubin (bilirubinemia)?

A

RBC destruction, decreased uptake, concurrent illness

impaired conjugation, hereditary

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18
Q

what can cause conjugated (direct) bilirubinemia?

A

Intracellular, canalicular, ductule, septal, intralobular problems

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19
Q

What is the onset with direct bilirubinemia?

A

Gradual with pruritis

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20
Q

what symptoms will you have with conjugated bilirubinemia?

A

pale stools
dark urine
steatorrhea (odor, float) from lack of fat absorption

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21
Q

What will labs look like with conjugated bilirubinemia?

A

^ Alk phos
mild LFT
normal albumin
coagulopathy

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22
Q

what are symptoms of indirect bilirubinemia

A

anemia on CBC due to RBC destruction

jaundice

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23
Q

How do you revere the coagulopathy found with conjugated bilirubinemia.

A

Vitamin K

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24
Q

what causes extrahepatic obstruction?

A

Stone, stricture, tumor block biliary tree

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25
Q

Signs of extrahepatic obstruction.

A

GB may be palpable, painless

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26
Q

What is a sudden onset of extrahepatic obstruction often associated w/

A

Colangitis

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27
Q

What does extrahepatic obstruction look similar to?

A

intrahepatic cholestasis

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28
Q

What do you see on labs for extrahepatic obstruction

A

High direct biliruin
High alk phos
moderate high LFTs

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29
Q

What symptoms will someone with extrahepatic obstruction have?

A

Dark urine
pale stools
possible coagulopathy

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30
Q

Hepatitis picture with prodromal anorexia, nausea, abd pain, malaise. Hepatomegaly, ecchymoses, tender

A

Hepatocellular dz

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31
Q

what will labs look like with hepatocellular dz?

A

alk phos 2-4x upper limit of normal

LFTs >5x (ULN) (except with Hep C or alcoholism)

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32
Q

After 7 days of hepatocellcular dz what will happen?

A

Coagulopathy due to decreased clotting factors

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33
Q

What will happen after 10-14 days of hepatocellular dz?

A

hypoalbuminemia

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34
Q

What can you see with chronic hepatocellular dz.

A 
chronic fibrosis
portal HTN
ascites
gynecomastia
atrophy of the testes
encephalopathy
35
Q

Why do you get encephalopathy with hepatocellular dz?

A

unconjugaeted bilirubin is lipophilic so it can cross the BBB

36
Q

How much of alcoholic cirrhosis is silent?

A

Up to 40%

37
Q

what do the majority of people with cirrhosis have?

A

portal HTN

38
Q

what is a codition with excessive levels of iron in blood and body than can damage liver, testes, ovaries, heart.

A

hemochromatosis

39
Q

What are heredity and metabolic cuases of cirrhosis

A

Wilson’s, Gaucher’s
Primary biliary cirrhosis (PBC)
Faconi’s
Cardiac

40
Q

what is an inflammatory biliary dz common in women. Need a liver tranplant.

A

Primary biliary cirrhosis (PBC)

41
Q

signs of chronic viral and alcoholic hepatitis

A 
Varices
Ascities
Hypersplenism
peripheral edema
encephalopathy
42
Q

why is there peripheral edema with chronic hepatitis?

A

such low protein in blood, so fluid part of blood isn’t held in by osmotic pressure and seeps into soft tissue

43
Q

what is the leading cause of death with chronic viral and alcoholic hepatitis

A

bleed- esophageal varcieal or gastric
infection
encephalopathy

44
Q

What is there a chronic morality risk of with chronic viral and alcoholic hepatitis?

A

hepatocellular carcinoma

45
Q

Progressive fibrotic liver disease
Associated with other autoimmune disorders
Cholestatic and fibrotic manifestations

A

primary biliary cirrhosis

46
Q

Labs to get with primary biliary cirrhosis

A

Alk Phos
SED/ CRP
Anti-Mitochondrial Ab
IgM (high)

47
Q

what is the key finding with primary biliary cirrhosis

A

positive anti-mitro Ab

48
Q

Patient presents with dypnea, arthritis, skin discoloration, fatigue.

A

hemochromatosis

49
Q

what is a TIPS

A

Trans hepatic intraperiotoneal shunt

artificial connection b/w portal circulation and systemic circulation to take pressure off portal system

50
Q

how do you treat wilson’s

A

d-penicillamine (chelator)

51
Q

Txs for primary biliary cirrhosis

A 
ursodiol
colchicine
MTX
Vit ADK
cholestyramine
zinc
transplant
diet
52
Q

treatment for hemochromatosis

A

phlebotomy

53
Q

what are signs of alcoholic liver dz

A

caput medusa

parotid gland enlargement

54
Q

what is a chemical toxin that farm workers may encounter. causes tumors of the liver

A

aflatoxin

55
Q

drugs that can cause tumors of the liver

A

Estrogens
anabolic steroids
alcohol

56
Q

what type cancer is almost always in someone with hep c

A

hepatocellcular carincoma

57
Q

what lab is diagnostic for a hepatocellcular carcinoma

A

alpha fetoprotein

58
Q

How do you get HAV (hepatitis A virus)?

A

Fecal-oral
child care
NICU
men having sex with men

59
Q

How do you get HAB?

A

percutaneous
perinatal
sexual

60
Q

How do you get HCV?

A

Percutaneous

primarily IVDA

61
Q

What is HDV like?

A

HBV

62
Q

What is HEV like?

A

HAV

63
Q

how many binge drinkers develop fatty liver?

A

90% of binge drinkers

64
Q

who are more susceptible to liver injury with less intake.

A

women

65
Q

what type hepatitis has a 4-24 week incubation is has an insidious/acute onset

A

HBV

66
Q

what type hepatitis has a 2-6 week incubation and onset is acute

A

HAV

67
Q

What type of hepatitis has a 5-10 weeks incubation on insidious onset

A

HCV

68
Q

do the hepatitis viruses actually kill cells?

A

No, the body’s rxn to the viruses actually do harm

69
Q

what is the pathologic picture of hepatitis

A

monocyte infiltration
cell necrosis
hyperplasia & cholestasis

70
Q

Patient presents with Fever, spider angioma, hepatomegaly, splenomegaly, ascites, caput medusa,
malnutrition, ecchymoses, parotid enlarge-ment, jaundice, nausea

what do you suspect

A

alcohol harm to the liver

71
Q

what ratio is elevated in alcoholic hepatitis?

A

ALT/AST >1

72
Q

what will be elevated with chronic alcoholic hepatitis.

A

MCV (mean corpuscular volume)

cell size is large

73
Q

what drugs can cause cholestatic liver problems?

A

OCP
Erythromycin
Tegretol
Chloropro

74
Q

What can outdated tetracycline lead to?

A

Problem with liver

75
Q

what drugs can give you fatty liver

A

methotrexate

protease inhibitor

76
Q

what drugs can lead to hepatitis

A

halothane
INH
keocon
verapmail

77
Q

what can you get miex hepatitis/ cholesterol from

A

azathi
niacin
statins

78
Q

what drugs can lead to necrosis of liver cells

A 
Acetaminophen
Carbon Tetetrachloride 
Amanita (mushrooms) 
DMF
Yellow phosphorus
79
Q

What drugs can cause granulomas in the liver?

A

Sulfonamide
allopruinol
quinidine (off market)

80
Q

how much time do you have to give antidote for acetamenophen OD?

A

17 hours

81
Q

treatment for hep b and D

A

Interferon, Lamuvidine

82
Q

treatment for hep c

A

Interferon, Ribavirin

83
Q

treatment for hep A and E

A

supportive

84
Q

ABCDEF pneumonic for fulminant hepatitis

A

Acetaminophen Hep A autimmune hept
Het B
Hep C cryptogenic
Hep D, drugs
Esoteric causes- wilson’s Budd-Chiar syndrome
Fatty infiltration- acute fatty liver preggo, Reye’s

Old DOOS (21 decks)

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