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Natsumi - NPLEX 2 > Liver & Gallbladder Condition > Flashcards

Liver & Gallbladder Condition Flashcards

1
Q

More specific to liver (AST or ALT)?

Elevation of AST indicates?

A

ALT “L for liver”

Elevated AST = fatty liver

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2
Q

ALT > AST indicates? (both increased)

A

Viral hepatitis “more LIVER virus”

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3
Q

AST > ALT indicates? (both increased)

A

Alcoholic hepatitis “S for Spirits”

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4
Q

GGT

A

GGT is increased in patients with Gallbladder and liver dz.

These conditions are caused by a number of factors, including drug and alcohol abuse, toxins, or viruses

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5
Q

Increased serum ammonia indicates

A

Cirrhosis, reye syndrome

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6
Q

ALP elevated, GGP normal

A

Extrabiliary - r/o bone dz.

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7
Q

Sudden increase ALP & GGP

A

Hepatocellular carcinoma

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8
Q

alpha-Fetoprotein (AFP) is a tumor marker for

A

Hepatocellular carcinoma

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9
Q

alpha-Fetoprotein (AFP) is a tumor marker for

A

Hepatocellular carcinoma

also increased in viral hepatitis

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10
Q

Increased PT may be seen in cirrhosis? T/F

A

cirrhosis, vitamin K def.

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11
Q

Hypoalbuminemia

A

severe liver disease - cirrhosis

Can’t produce enough albumin!

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12
Q

Bilirubin Excretion
<20% indicates:
20-50% indicates:
>50% indicates:

A

<20% indicates: hemolysis
20-50% indicates: mixed hyperbilirubinemia (viral hepatitis)
>50% indicates: Conjugated hyperbilirubinemia (liver cholestasis, biliary tree obstruction)

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13
Q

Positive urine bilirubin

A

If bilirubin is found in your urine, it may be a sign that you have: A liver disease, such as hepatitis or cirrhosis. A blockage in your bile ducts, the small tubes that carry bile out of your live

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14
Q

Increased urine bilirubinogen

A

viral hepatitis or hemolytic anemia

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15
Q

Alcoholic liver disease, chronic viral hepatitis (B, C, D, but never A & E) , autoimmune hepatitis, hemochromatosis, wilson’s disease can all lead to what condition of the liver?

A

Cirrhosis

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16
Q

Cirrhosis can result from which viral hepatitis (A, B, C, D, E)

A

Hepatitis, B, B+D, C

NEVER A & C

17
Q

A patient with a hx of Alcoholic liver dz. comes to office with pruritus, jaundice, and joint pain. PE revealed hepatosplenomegaly TPP.

Suspicion and Tx?

A

Cirrhosis

Tx: liver transplant if end disease
alcohol cessation, minimize hepatotoxic medication

18
Q

Definitive diagnosis for cirrhosis

A

Liver biopsy is definitive, but start with U/S

CT for varices, nodular liver texture, splenomegaly, ascites

19
Q

Which Hepatitis?

Patient presents to clinic with jaundice, fever, n/v, arthralgia. Mhx indicates no hx of hepatitis. Traveled to Africa 6 weeks ago and accidentally drank river water.

Diagnosis approach and tx?

A

Hepatitis A “drank poop”

  • Fecal oral transmission
  • JAUNDICE is common

Dx: Anti-HAV-IgM/IgG
M = ACTIVE
G = protective antibody “you’re good”

Tx
- Hep A vaccine for prophylaxis tx and tx close contacts

20
Q

Which Hepatitis?

Patient presents to clinic with jaundice, fever, n/v, arthralgia. Mhx indicates no hx of hepatitis. Traveled to Africa 6 weeks ago and accidentally drank river water.

Diagnosis approach and tx?

A

Hepatitis A “drank poop”

  • Fecal oral transmission
  • JAUNDICE is common

Dx: Anti-HAV-IgM/IgG
M = ACTIVE
G = protective antibody “you’re good”

Tx
- Hep A vaccine for prophylaxis tx and tx close contacts

21
Q

Which Hepatitis?

Patient PTC with profound malaise, urticaria, and polyarthritis. Notes that she had several multiple partners in the past 6 months. Additionally, the patient had been sharing needles. PE revealed painful hepatomegaly.

Diagnosis approach and tx? Prognosis?

A

Hepatitis B

HBsAg

Prognosis: 90% recover if immunocompetent
Tx:
Interferon A, Nucleoside analogues (Adefovir), Vaccine

22
Q

SpECiES

What is this mnemonic for

A

Hepatitis B serology

HBsAG: 2-8 weeks after exposure, first marker of infection, up to 5 month is acute

HBeAG & HBV-DNA: infective

Anti-HBc-IgM: ‘window period’ remains active during acute infections

Anti-HBe: Past infection
Anti-Hbs: immunized!

23
Q

Which Hepatitis?

Patient PTC with mild malaise, and nausea. Notes that she had several multiple partners in the past 10 weeks. Additionally, the patient had been using intranasal cocaine.

Diagnosis approach and tx? Prognosis?

A

Hepatitis C

Gold standard = HCV RNA via PCR
Severity determined by biopsy

Tx: Avoid alcohol, oral interferon-free regimen, liver transplant

Prognosis: 80% become chronic, 20% cirrhosis

24
Q

Liver cancer commonly metastasis to which organ

A

Lungs

25
Q

Besides Hepatitis B/C and alcoholic cirrhosis, what else can increase the risk for liver cancer significantly?

A

OCPs, steroids, Aflotoxins from Aspergillus mold in grains and pain (carcinogen)

26
Q

Aflatoxins from Aspergillus mold in grains and pain increase the risk for?

A

Hepatocellular cancer

27
Q

Why is the prognosis of liver cancer poor?

A

1/3 are asymptomatic so late detection

if symptomatic - ASCITES with blood, hepatomegaly, fever. jaundice, weakness, weight loss

28
Q

Imaging procedures for liver cancer

A

MRI angiography

US, MRI, CT

29
Q

Black pigment gallstones are sign of?

A

hemolytic anemia anemia

30
Q

Brown pigment gallstones are sign of? which population is this seen commonly in?

A

bile duct infection

31
Q

Cholesterol stones are common in which population

A

Northern Europeans

32
Q

A 45-year-old Pima Indian female PTC with rapid weight loss, but has been mostly asymptomatic of everything else. Medication includes OCP. Recently, she noticed steady pain in the epigastrium and RUQ that radiates to her right shoulder for minutes to hours, a crescendo-decrescendo pattern, usually after dinner eating fatty foods. What do you suspect?

A

Cholelithiasis

- most are asymptomatic

33
Q

What are the 4 protective factors for cholelithiasis?

Hint: drug, supplement

A

Statins
Vitamin C
Coffee
Exercise

34
Q

Work up for gall stones?

A

US → gallbladder wall thickening >4mm, edema, gallbladder sludge, pericholecystic fluid, sonographic Murphy’s sign

Normal blood work

35
Q

Sonographic Murphy Sign

A

Cholelithiasis, cholecystitis,

36
Q

CA 19-9 elevation

A

GB adenocarcinoma and pancreatic cancer

37
Q

Work up for acute cholecystitis?

A

US

38
Q

A 55 yo Native American F PTC with SEVERE epigastric and RUQ pain accompanied by n/v, anorexia, and low grade fever. PE positive for Murphy’s sign and jaundice. Lab shows ABSOLUTE NEUTROPHILIC LEUKOCYTOSIS with left shift (WBC >12,000) and elevated markers for pancreatic, liver, and biliary markers.

What do you suspect? Tx?

A

Acute cholecystitis

Tx: ED! hydrate, analgesic, antibiotics (ampicillin or Cipro), cholecystectomy

39
Q

Gall bladder adenocarcinoma dominant in which population? Etiology mostly due to? Mode of the initial image? Tx?

A

Elderly women with poor prognosis
Cholelithiasis
US standard in pt with RUQ pain 5-FU adjunct to radiation

Natsumi - NPLEX 2 (37 decks)

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