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CD 3305 (mod 11/12) > Liver/Pancreas > Flashcards

Liver/Pancreas Flashcards

1
Q

Portal hypertension

A

Increased pressure in portal vein due to impaired venous drainage through the liver due to liver damage. Causes include liver cirrhosis, PV thrombosis, alcoholic hepatitis, and R-sided heart failure

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2
Q

5 symptoms of portal hypertension

A
  • esophageal varices
  • splenomegaly
  • ascites
  • hemorrhoids
  • caput medusae (looks like a snake is under the skin of the belly :(
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3
Q

Complications of portal hypertension

A
  • GI bleeding
  • renal dysfunction
  • sepsis
  • thrombocytopenia
  • hepatic encephalopathy
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4
Q

Hemolytic jaundice + triad

A

Excessive destruction of red blood cells or absorption of a hematoma
-unconjugated (indirect) hyperbilirubinemia

Triad: anemia + jaundice + splenomegaly

Peripheral smear: shows reticulocytes (aka baby RBCs)

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5
Q

Hepatocellular jaundice

A

accumulation of conjugated bilirubin in the serum due to hepatocyte dysfunction

  • viral hepatitis
  • drugs (e.g., acetominophen)
  • alcohol

Lab: elevated ALT and AST

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6
Q

Obstructive jaundice + triad

A

bile ducts are obstructed (by gallstones or cancer) so bile cannot drain out of the liver and overflows into the blood

Triad: jaundice + pruritis + dark Urine

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7
Q

Three ddx of jaundice

A

Hemolytic, hepatocellular, obstructive

Aka spleen, liver, or gallbladder origin

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8
Q

Hepatitis

A

Inflammation of liver, leading to cell injury and necrosis

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9
Q

Common causes of acute hepatitis

A

Drugs or viral infection

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10
Q

Common causes of chronic hepatitis

A

Viral infection, alcohol, drugs, Autoimmune hepatitis, Wilson’s, hemochromatosis

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11
Q

Hepatitis A: key details

A
  • RNA virus
  • transmission: fecal-oral (poor hygiene or sexually transmitted)
  • incubation period: 4-6 weeks
  • elevated transaminase
  • lab: anti-HAV IGM (“A” for Hep “A” 😮

Can be asymptomatic in kids

Never becomes chronic!!!

Tx is supportive

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12
Q

Hepatitis B: key details

A

DNA virus

Incubation period: 6 weeks to 6 months

Transmission: vertical, sexual T, IV needles, travel, bodily fluids

(That’s about all she included in the review)

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13
Q

Hepatitis D: key details

A

RNA virus

D + B ❤️–> D requires HBsAG for entry, thus only affects those with Hep B

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14
Q

Hep C: key details

A

RNA virus (genotype 1 is MC in north america)

Transmission: blood-borne (IV drug use, tattoos, blood transfusions)

Lab: increased ALT/AST, anti-HCV (“C” for Hep C lol)

80% of acute hep C becomes chronic–> increased risk for hepatocellular carcinoma

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15
Q

Hep E: key details

A

RNA virus

transmission: fecal-oral

Lab: Anti-HEV

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16
Q

which hepatitis viruses are transmitted by fecal-oral route?

A

hepatitis A and E (“the vowels hit your bowels”)

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17
Q

Which hepatitis viruses have risk of becoming chronic

A

B, C, D

18
Q

Which hep viruses have a vaccine

A

AB

19
Q

Wilson’s disease

A

Autosomal recessive ds resulting in depect in copper metabolism

20
Q

Clinical features of wilson’s disease:

  1. Eyes
  2. Liver
  3. Movement
  4. Cerebellum
  5. Mental state
  6. Kidneys
  7. Blood
  8. Joints
A
  1. Kayser-fleischer rings in eyes
  2. Liver: jaundices, hepatitis
  3. Movement: flapping tremour and parkinsonism
  4. Cerebellum: dysarthria, dysphagia, incoordination and ataxia
  5. Psychosis
  6. Kidneys: stones and prox. Tubule transport defects
  7. Intravascular hemolysis
  8. Arthritis
21
Q

Somone with Wilson’s will have what lab serum findings

A
  • increased liver enzymes
  • decreased serum ceruloplasmin
  • increased urinary copper excretion
22
Q

Hemochromatosis

A

Increased iron storage resulting in multiorgan system dysfunction

-can be primary (autosomal recessive) or secondary (e.g. thalassemia or increased iron intake)

23
Q

Clinical features of hemochromatosis:

  1. Liver
  2. Pancreas
  3. Skin
  4. Heart
  5. Joints
  6. Genitourinary
A
  1. Cirrhosis and jaundice
  2. Diabetes mellitis and chronic pancreatitis
  3. Bronze/dark skin
  4. Cardiomyopathy
  5. Arthralgia (esp. in MCP joints) and chrondrocalcinosis (pseudogout)
  6. Impotences, decreased libido and amenorrhea
24
Q

Biliary colic

A

Gallstone transiently impacted in cystic duct with no infection

25
Q

Clinical features of biliary colic

A

Steady, severe dull pain in epigastrium or RUQ lasting <6 hours

Can present as chest pain, right shoulder tip pain or scapular pain

Occurs at night or after fatty meal

26
Q

T or F: with biliary colic, no physical signs can be detected on inspections, palpation nor percussion

A

True, you’d only see physical signs in acute cholecystitis

27
Q

Acute cholecystitis

A

Inflammation or gallbladder due to gallstone impaction in cystic duct

  • biliary colic + infection
  • murphy’s sign, fever, anorexia
  • lab: increased WBC, elevated bilirubin

Ultrasound shows gallbladder wall thickening

28
Q

Acalculous cholecystitis

A

Acute or chronic cholecystitis in ABSENCE of stones

Due to GB ischemia and stasis

**warrants ICU admission

29
Q

Choledocholisthiasis

A

Stones in common bile duct

50% asymptomatic

Pale stool, dark urine, fluctuating jaundice

30
Q

Ascending cholangitis

A

Obstruction of common bile duct–leading to biliary stasis, bacterial overgrowth, suppuration and biliary sepsis

Mostly caused by choledocholisthiasis

**ER admission

31
Q

Charcot’s triad of cholangitis

A

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis

32
Q

Reynold’s Pentad for Cholangitis

A

fever, jaundice, RUQ pain, hypotension, AMS

33
Q

[ ] and [ ] occur when there’s an obstruction of the cystic duct, whereas [ ] and [ ] occur with obstruction of the common bile duct

A

Biliary colic and acute cholecystitis; choledocholithiasis and ascending cholangitis

34
Q

Most common causes of acute pancreatitis

A

Gallstones (45% cases) and alcohol (35%)

35
Q

Clinical picture of acute pancreatitis

A
  • Pain: epigastric, radiating to back, improved when leaning forward, nausea and vomiting
  • fever
  • jaundice (compression of bile duct)
  • tetany
  • hypovolemic shock
  • acute resp distress syndrome
  • coma
36
Q

Cullen’s sign with acute pancreatitis

A

Periumbilical ecchymosis`

37
Q

Grey-turner’s sign with acute pancreatitis

A

Flank ecchymosis

38
Q

[ ] is the most useful imaging for diagnosis and prognosis of acute pancreatitis

A

CT scan

39
Q

Chronic pancreatitis

A

Irreversible pancreatic damage characterized by pancreatic cell loss (necrosis), inflammation or fibrosis

40
Q

Most common cause of chronic pancreatitis

A

Alcohol (90% of cases)

41
Q

Malabsorption syndrome with chronic pancreatitis

A

With a malfunctioning pancreas, you’ll see

  • steatorrhea (fatty stool)
  • creatorrhea (presence of undigested muscle fibres in the stool) ☹️
  • weight loss
42
Q

Gold standard test for diagnosing chronic pancreatitis

A

Secretin test

CD 3305 (mod 11/12) (8 decks)

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