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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

18
Q

Which hep viruses have a vaccine

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
Clinical features of biliary colic
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
T or F: with biliary colic, no physical signs can be detected on inspections, palpation nor percussion
True, you'd only see physical signs in acute cholecystitis
27
Acute cholecystitis
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
Acalculous cholecystitis
Acute or chronic cholecystitis in ABSENCE of stones Due to GB ischemia and stasis **warrants ICU admission
29
Choledocholisthiasis
Stones in common bile duct 50% asymptomatic Pale stool, dark urine, fluctuating jaundice
30
Ascending cholangitis
Obstruction of common bile duct--leading to biliary stasis, bacterial overgrowth, suppuration and biliary sepsis Mostly caused by choledocholisthiasis **ER admission
31
Charcot's triad of cholangitis
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
32
Reynold's Pentad for Cholangitis
fever, jaundice, RUQ pain, hypotension, AMS
33
[ ] and [ ] occur when there's an obstruction of the cystic duct, whereas [ ] and [ ] occur with obstruction of the common bile duct
Biliary colic and acute cholecystitis; choledocholithiasis and ascending cholangitis
34
Most common causes of acute pancreatitis
Gallstones (45% cases) and alcohol (35%)
35
Clinical picture of acute pancreatitis
- 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
Cullen's sign with acute pancreatitis
Periumbilical ecchymosis`
37
Grey-turner's sign with acute pancreatitis
Flank ecchymosis
38
[ ] is the most useful imaging for diagnosis and prognosis of acute pancreatitis
CT scan
39
Chronic pancreatitis
Irreversible pancreatic damage characterized by pancreatic cell loss (necrosis), inflammation or fibrosis
40
Most common cause of chronic pancreatitis
Alcohol (90% of cases)
41
Malabsorption syndrome with chronic pancreatitis
With a malfunctioning pancreas, you'll see - steatorrhea (fatty stool) - creatorrhea (presence of undigested muscle fibres in the stool) ☹️ - weight loss
42
Gold standard test for diagnosing chronic pancreatitis
Secretin test

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

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