Liver/Pancreas Flashcards
Portal hypertension
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
5 symptoms of portal hypertension
- esophageal varices
- splenomegaly
- ascites
- hemorrhoids
- caput medusae (looks like a snake is under the skin of the belly :(
Complications of portal hypertension
- GI bleeding
- renal dysfunction
- sepsis
- thrombocytopenia
- hepatic encephalopathy
Hemolytic jaundice + triad
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)
Hepatocellular jaundice
accumulation of conjugated bilirubin in the serum due to hepatocyte dysfunction
- viral hepatitis
- drugs (e.g., acetominophen)
- alcohol
Lab: elevated ALT and AST
Obstructive jaundice + triad
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
Three ddx of jaundice
Hemolytic, hepatocellular, obstructive
Aka spleen, liver, or gallbladder origin
Hepatitis
Inflammation of liver, leading to cell injury and necrosis
Common causes of acute hepatitis
Drugs or viral infection
Common causes of chronic hepatitis
Viral infection, alcohol, drugs, Autoimmune hepatitis, Wilson’s, hemochromatosis
Hepatitis A: key details
- 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
Hepatitis B: key details
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)
Hepatitis D: key details
RNA virus
D + B ❤️–> D requires HBsAG for entry, thus only affects those with Hep B
Hep C: key details
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
Hep E: key details
RNA virus
transmission: fecal-oral
Lab: Anti-HEV
which hepatitis viruses are transmitted by fecal-oral route?
hepatitis A and E (“the vowels hit your bowels”)
Which hepatitis viruses have risk of becoming chronic
B, C, D
Which hep viruses have a vaccine
AB
Wilson’s disease
Autosomal recessive ds resulting in depect in copper metabolism
Clinical features of wilson’s disease:
- Eyes
- Liver
- Movement
- Cerebellum
- Mental state
- Kidneys
- Blood
- Joints
- Kayser-fleischer rings in eyes
- Liver: jaundices, hepatitis
- Movement: flapping tremour and parkinsonism
- Cerebellum: dysarthria, dysphagia, incoordination and ataxia
- Psychosis
- Kidneys: stones and prox. Tubule transport defects
- Intravascular hemolysis
- Arthritis
Somone with Wilson’s will have what lab serum findings
- increased liver enzymes
- decreased serum ceruloplasmin
- increased urinary copper excretion
Hemochromatosis
Increased iron storage resulting in multiorgan system dysfunction
-can be primary (autosomal recessive) or secondary (e.g. thalassemia or increased iron intake)
Clinical features of hemochromatosis:
- Liver
- Pancreas
- Skin
- Heart
- Joints
- Genitourinary
- Cirrhosis and jaundice
- Diabetes mellitis and chronic pancreatitis
- Bronze/dark skin
- Cardiomyopathy
- Arthralgia (esp. in MCP joints) and chrondrocalcinosis (pseudogout)
- Impotences, decreased libido and amenorrhea
Biliary colic
Gallstone transiently impacted in cystic duct with no infection
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
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
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
Acalculous cholecystitis
Acute or chronic cholecystitis in ABSENCE of stones
Due to GB ischemia and stasis
**warrants ICU admission
Choledocholisthiasis
Stones in common bile duct
50% asymptomatic
Pale stool, dark urine, fluctuating jaundice
Ascending cholangitis
Obstruction of common bile duct–leading to biliary stasis, bacterial overgrowth, suppuration and biliary sepsis
Mostly caused by choledocholisthiasis
**ER admission
Charcot’s triad of cholangitis
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
Reynold’s Pentad for Cholangitis
fever, jaundice, RUQ pain, hypotension, AMS
[ ] 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
Most common causes of acute pancreatitis
Gallstones (45% cases) and alcohol (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
Cullen’s sign with acute pancreatitis
Periumbilical ecchymosis`
Grey-turner’s sign with acute pancreatitis
Flank ecchymosis
[ ] is the most useful imaging for diagnosis and prognosis of acute pancreatitis
CT scan
Chronic pancreatitis
Irreversible pancreatic damage characterized by pancreatic cell loss (necrosis), inflammation or fibrosis
Most common cause of chronic pancreatitis
Alcohol (90% of cases)
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
Gold standard test for diagnosing chronic pancreatitis
Secretin test
