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Internal Medicine > Liver Diseases > Flashcards

Liver Diseases Flashcards

1
Q

[Approach to Jaundice]

ALP&raquo_space;> AST/ALT

A

Cholestatic pattern, do UTZ

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2
Q

[Approach to Jaundice]

AST/ALT&raquo_space;» ALT

A

Hepatocellular pattern

  1. Viral
  2. Drug-induced
  3. Ceruloplasmin
  4. ANA, SMA, SPEP
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3
Q

Inherited disorders that can cause indirect hyperbilirubinemia

A
  1. Gilbert

2. Crigler-Najjar

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4
Q

Inherited disorder that can cause direct hyperbilirubinemmia

A
  1. Dubin-Johnson
  2. Rotor

Remember: Direct: Dubin,

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5
Q

Entities that could elevate AST and ALT up to thousands

A
  1. Viral hepatitis
  2. Drug-induced
  3. ischemic hepatitis
  4. Transient blocking of CBD by a choledocholith
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6
Q

Drug toxicity that can cause Pure cholestasis resulting to jaundice

A
  1. Anabolic steroid

2. Contraceptive steroids

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7
Q

Drug toxicity that can cause cholestatic hepatitis resulting to jaundice

A
  1. Chlorpromazine

2. Erythromycin estolate

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8
Q

Drug toxicity that can cause cholestatic cholestasis resulting to jaundice

A
  1. Chlorpromazine

2. Prochlorpromazine

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9
Q

Most common and most characteristic symptom of liver disease

A

fatigue

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10
Q

Hallmark symptom of liver disease

A

jaundice

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11
Q

Single most common risk factor for Hep C

A

injection drug use

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12
Q

[Blood test in liver disease]

AST:ALT >2

A

alcoholic liver disease

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13
Q

[Blood test in liver disease]

AST:ALT < 1

A

chronic viral hepatitis, NAFLD

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14
Q

Procedure of choice for visualization of biliary tree

A

ERCP, MRCP

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15
Q

Gold standard in diagnosing most liver diseases

A

liver biopsy

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16
Q

This replaced liver biopsy in evaluating cirrhosis

A

liver elastography

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17
Q

Most important serologic test to check for acute Hep A and Hep B

A

Anti HAV Igm
HBsAg
Anti-HBc IgM

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18
Q

How many percent of patients infected with HCV will recover spontaneously?

A

15%

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19
Q

[Interpret the serology]

HBsAg: +
Anti-HBs: -
Anti-HBc: IgM
HBe: +
Anti-HBe: -
A

Acute, Hep B high infectivity

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20
Q

[Interpret the serology]

HBsAg: +
Anti-HBs: -
Anti-HBc: IgG
HBe: +
Anti-HBe: -
A

Chronic, Hep B, high infectivity

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21
Q

[Interpret the serology]

HBsAg: +
Anti-HBs: -
Anti-HBc: IgG
HBe: -
Anti-HBe: +
A

Late acute or chronic,

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22
Q

[Interpret the serology]

HBsAg: -
Anti-HBs: -
Anti-HBc: IgM
HBe: -
Anti-HBe: -
A

Anti HBc window

Acute Hepatitis B

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23
Q

[Interpret the serology]

HBsAg: -
Anti-HBs: -
Anti-HBc: IgG
HBe: -
Anti-HBe: -
A
  1. Low-level Hep B carrier

2. Hepatitis B in remote past

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24
Q

[Interpret the serology]

HBsAg: -
Anti-HBs: +
Anti-HBc: IgG
HBe: -
Anti-HBe: -
A

Recover

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25
Q

[Interpret the serology]

HBsAg: -
Anti-HBs: +
Anti-HBc: -
HBe: -
Anti-HBe: -
A

Immunization

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26
Q

What is the marker for hepatitis A during acute illness?

A

IgM Anti-HAV

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27
Q

What is the marker that predominates during the first 6 months after acute infection. Present eve at the window period

A

IgM Anti-HBc

28
Q

What is the marker to diagnose Hep C

A

Anti-HCV

29
Q

[Diagnose]

palmar erythema, gynecomastia, testicular atrophy

HBsAg: +
Anti-HBs: -
Anti-HBc: IgG
HBe: -
Anti-HBe: +
A

Chronic active Hep B, high infectivity

30
Q

Scleral icterus is seen when the TB is ___

A

> 2.5 to 3 mg/dL

31
Q

Derangement of this liver enzyme indicates worse prognosis

A

PT

32
Q

The only serologic marker present during the window period

A

Anti HBc

33
Q

Hepatitis A vaccine is given ___ doses, ___ month apart

A

2 doses

6 months apart

34
Q

Hepatitis B vaccine is given ___ doses

A

three doses, over 6 months

35
Q

What is the mainstay treatment for hepatic encephalopathy?

A

lactulose

36
Q

Cut off value for portal hypertension

A

> 5mmHg

37
Q

Significant alcohol intake means an alcohol level of ____ grams per day

A

30g or more

3 pilsen cans per day

38
Q

[Type of hepatorenal syndrome]

AKI in less than 2 week with oliguria. More serious

A

Type 1

39
Q

[Type of hepatorenal syndrome]

Renal impairment less severe, ascites refractory to diuretics

A

Type 2

40
Q

___ syndrome seen i cirrhotic patients mainly due to nitric oxide in the splanchnic circulation causing peripheral vascular resistance

A

Hepatorenal syndrome

41
Q

dyspnea in the upright position is called ___

A

platypnea

42
Q

____ refers to cirrhotic patients desaturation greater than 4mmHg or 5% sats from supine to upright

A

Orthodeoxia

43
Q

What are the stigmata of cirrhosis

A
  1. Palmar erythema
  2. Spider angiomata
  3. Testicular atrophy
  4. Dupuytren’s contracture
  5. caput medusae
44
Q

[Cirrhosis]

beta blocker lower ___

A

portal pressure

45
Q

What is an alternative to surgery for patients who fail endoscopic and medical treatment?

A

Transjugular intrahepatic portosystemic shunt (TIPS)

46
Q

___ are potent splanchnic vasoconstrictor, decreases HR and CO resulting to decreased portal blood flow

A
  1. Propranolol

2. Nadolol

47
Q

___ is added to propranolol since it further decreases the hepatic vascular tone thereby decreasing hepatic resistance

A

Carvedilol

48
Q

What is the next step after confirming that a patient has ascites via UTZ?

A

Paracentesis (LLQ)

49
Q

What is the most common cause of ascites?

A

Liver cirrhosis

50
Q

What is the initial treatment of cirrhotic ascites?

A

restrict sodium

next: spironolactone + furosemide

51
Q

[Causes of SAAG}

< 1.1 g/dL

A

NONPORTAL HPN

  1. Biliary leak
  2. Nephrotic Syndrome
  3. Pancreatitis
  4. Peritoneal carcinomatosis
  5. TB
52
Q

[Causes of SAAG}

SAAG >= 1.1
Ascitic protein <2.5

A

PORTAL HPN

hepatic sinusoids are damaged

  1. Cirrhosis
  2. Massive liver mets
  3. Late Budd-Chiari
53
Q

[Causes of SAAG]

SAAG >= 1.1
Ascitic protein >= 2.5

A

PORTAL HPN

increased pressure in the hepatic sinusoids

  1. Heart Failure/constrictive pericarditis
  2. Early Budd-chiari
  3. IV obstruction
  4. Sinusoidal obstruction syndrome

remember, HIVES

54
Q

[Ascites]

white, milky,

Triglyceride >2000

A

chylous ascotes

55
Q

[Ascites]

Dark brown fluid, high bilirubin

A

Biliary Tract Perforation

56
Q

[Ascites]

black fluid

A

pancreatic necrosis or metastatic melanoma

57
Q

[Ascites]

Ascitic glucose <50
Ascitic LDH > serum LDH
Polymicrobial

A

Secondary peritonitis

58
Q

[Ascites]

Ascitic fluid lymphocytosis
elevated ascitic adenosine deaminase

A

Tuberculous peritonitis

59
Q

What is the tumor marker for HCC?

A

AFP

60
Q

Screening tool for HCC?

A

Liver UTZ

61
Q

In HCCA, best tool to determine tumor size, extent, presence of portal vein invasion

A

Triphasic CT of the abdomen and pelvis

62
Q

What are the CT triphasic findings HCCA

A
  1. Arterial phase: Pre-arterial blush

2. Venous phase: Delayed washout

63
Q

What are the CT triphasic findings metastatic liver mass

A
  1. Arterial phase: no mass detected

2. Venous phase: mass present

64
Q

Imaging criteria developed for HCC that do not require biopsy proof since it has a 90% specificity

A
  1. Nodule >1cm, with arterial enhancement and portal venous washout
  2. <1cm nodule, growth rates of 2 scans performed <6 months apart
65
Q

HCCA Screening strategies for HBV and HCV carrier

A
  1. UTZ + AFP every 6 months in the presence of cirrhosis or worsening LFT
66
Q

Corkscrew esophagus

A

diffuse esophageal spasm

Internal Medicine (10 decks)

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