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Gastroenterology > Liver Disorders > Flashcards

Liver Disorders Flashcards

1
Q

What is hemoglobin brokendown into?

A

Heme and globin

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2
Q

Heme is converted to what by-product?

A

Bilivirdin

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3
Q

Bilivirdin becomes what?

A

Unconjugated bilirubin

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4
Q

What is unconjugated bilirubin?

A

Indirect bilirubin in labs

*Non-functional, fat soluble, bound to albumin

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5
Q

Where is unconjugated bilirubin conjugated?

A

Hepatocytes

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6
Q

What are the four phases of bilirubin metabolism?

A
  • Production of bilirubin
  • Uptake via liver cells
  • Conjugation with glucuronic acid
  • Transport via bile/urobilinogen
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7
Q

Where is jaundice typically first seen?

A

Sclera or darkening of urine

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8
Q

What is hyperbilirubinemia?

A

Accumulation of bilirubin in body tissues

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9
Q

What is a normal bilirubin level in newborns (total)?

A

1.0 - 12.0 mg/dL

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10
Q

What is a normal direct bilirubin?

A

0.1 - 0.3 mg/dL

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11
Q

What is the normal indirect bilirubin?

A

0.2 - 0.8 mg/dL

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12
Q

At what lab value is jaundice apparent around?

A

2.5-3 mg/dL

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13
Q

Impaired uptake leading to hyperbilirubinemia is primary the result of

A

Certain drugs, can be treated by removing drug

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14
Q

Is stool color normal in impaired conjugation caused hyperbili?

A

Light to normal

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15
Q

What enzyme is immature in physiologic neonatal jaundice?

A

GT

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16
Q

Why do we use UV light to treat physiologic neonatal jaundice?

A

UV light makes unconjugated bilirubin water soluble –> dissolves in bile

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17
Q

What is Gilbert Syndrome?

A

Hereditary disorder –> reduced function of GT (evident with hemolysis)

Presents later in puberty or adulthood, episodic jaundice and hyperbili (worse with stress, ETOH)

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18
Q

What is conjugated (direct) hyperbilrubinemia primary the result of?

A

Obstruction or hepatocellular dysfunction

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19
Q

Is bilirubin itchy?

A

Yes, patients will be itchy

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20
Q

What symptoms are found in conjugated (direct) hyperbilirubinemia?

A

Dark urine, jaundice, light stools

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21
Q

What are the etiologies causing elevated indirect/unconjugated bilirubin?

A

Hemolysis
Drugs
GT dysfunction

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22
Q

What are the etiologies causing elevated direct/conjugated bilirubin?

A

Liver dysfunction or obstruction

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23
Q

Most liver studies are included in what lab?

A

CMP

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24
Q

Elevations in AST/ALT reflect what hepatic problem?

A

Hepatocellular injury

25
Q

What is the most common cause of AST/ALT elevations?

A

Non-alcohol related fatty liver disease

26
Q

If the AST > ALT the liver injury is more related to what?

A

Alcohol related livery injury or cirrhosis

27
Q

What conditions is a livery biopsy better for

A

Diffuse disorders

28
Q

How is fulminant acute liver failure defined?

A

Development of hepatic encephalopathy within 8 weeks

29
Q

How is subfulminant liver failure defined?

A

hepatic encephalopathy 8 weeks to 6 months after onset

30
Q

What medication most commonly will lead to acute liver failure?

A

Rifampin

31
Q

What is the presentation of acute liver failure?

A

Jaundice
Bleeding disorders
Encephalopathy/AMS

32
Q

What is the cause of systemic inflammatory response syndrome (SIRS)?

A

Death or hepatocytes

*patients are SICK! Multisystem organ dysfunction

33
Q

What is the treatment for acute liver failure?

A

Admit to ICU

*Lots of things to be done

34
Q

Non-alcohol related liver disease exists on a continuum, what are the different stages?

A

Normal liver –> NAFLD –> NASH –> Cirrhosis

35
Q

What liver disease stage is irreversible?

A

Cirrhosis

36
Q

Non-alcohol related fatty liver disease has a significant correlation to what resistance?

A

Insulin resistance

37
Q

What is the presentation of NAFLD?

A

**Primarily asymptomatic
+/- RUQ discomfort
+/- Non-specific constitutional symptoms
+/- isolated hepatomegaly

38
Q

What is the most reliable treatment for NAFLD?

A

Lifestyle modifications including GRADUAL weight loss

39
Q

What are the causes of cirrhosis?

A
  • Viral hepatitis (C&B)
  • Alcohol
  • NAFLD
  • Drug toxicity
  • Autoimmune
  • Metabolic liver disorders
40
Q

What are the three stages of cirrhosis?

A
  1. Compensated
  2. Compensated with varices
  3. Decompensated
41
Q

Are the symptoms of cirrhosis specific?

A

No, wide array of vague presenting symptoms

42
Q

When does the first liver positive physical exam finding appear in cirrhosis?

A

Late stage; will have a firm, palpable, nodular liver

43
Q

What imaging modality is good in assessing liver size?

A

US

44
Q

How do you assess for varices?

A

EGD

45
Q

What vaccines should be given to cirrhosis patients?

A

HAV, HBV, pneumococcal and annual flu

46
Q

What does portal hypertension lead to?

A

Third spacing

47
Q

What are the symptoms of hepatocellular carcinoma (HCC)?

A

Cachexia, weight loss, weakness
Sudden development of ascites
Enlarging liver with palpable mass

48
Q

What is the diagnostic test of choice in working up hepatocellular carcinoma (HCC)?

A

Biopsy

49
Q

What is the definitive treatment for chirrhosis and associated complications?

A

Transplant

50
Q

In order to be eligible for a liver transplant how long must you have sustained from alcohol?

A

6 months

51
Q

Is HIV and Hepatitis a contraindication for a liver transplant?

A

No

52
Q

Patients on the liver transplant list are prioritized by what score?

A

MELD score (eligible if 15+)

53
Q

True or False: Nearly everyone (90%) with harmful alcohol use develops some liver dysfunction

A

True

54
Q

Is there a dose effect associated with ETOH?

A

Yes

55
Q

What is the spectrum of alcohol related liver disease?

A

Alcohol related steatosis –> alcohol related hepatitis –> cirrhosis

56
Q

What is the primary treatment in alcohol related liver disease?

A

Abstinence from ETOH

57
Q

What are the two pharmacological agents that can be used to help abstain from alcohol?

A

Naltrexone (Vivitrol)
Disulfram (Antabuse)

58
Q

Can you use disulfram in the treatment of alcohol related cirrhosis?

A

No, it should be avoided. Can use Naltrexone.

Gastroenterology (12 decks)

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