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Gastrointestinal > Non-infectious hepatobiliary disease > Flashcards

Non-infectious hepatobiliary disease Flashcards

1
Q

What are the three general patterns of liver disease?

A

Hepatocellular pattern
Hyperbilirubinemia
Cholestatic pattern

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2
Q

What are the three components of LFTs?

A

AST/ALT
Alk phos
GGT

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3
Q

What are the two tests that test the synthetic function of the liver?

A

INR

Albumin

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4
Q

35 yo man with arthralgias, myalgias, and subsequent jaundice = ?

A

Viral hepatitis

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5
Q

40 yo female with jaundice and severe, sudden RUQ pain and shaking chills = ?

A

Cholestatic disease

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6
Q

Palmar erythema can be seen in what?

A

Advanced cirrhosis

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7
Q

Ascites with jaundice usually indicates what?

A

Cirrhosis or malignancy with peritoneal spread

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8
Q

Virchow’s node or sister mary joseph nodule usually suggests what?

A

Metastatic malignancy

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9
Q

Liver that is TTP is seen in what?

A

EtOH liver

Hepatitis

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10
Q

Grossly enlarged and nodular liver suggests what?

A

malignancy

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11
Q

Hepatocellular disease is usually caused by what?

A

Alcohol

Hemachromatosis

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12
Q

What is the AST:ALT ratio for EtOH liver?

A

2:1

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13
Q

What is the cholestatic pattern of liver disease?

A

Elevated Alk Phos

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14
Q

Which gender is more susceptible to cirrhosis?

A

Women

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15
Q

What are the histological changes seen in alcoholic liver disease?

A

Macrovesicular fat accumulation

PMN infiltration

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16
Q

GGT is usually elevated by what amount in alcoholic liver disease?

A

x2

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17
Q

AST more than 300 indicates what?

A

Hep C on top of alcoholic cirrhosis

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18
Q

What is the cause of macrocytosis in liver disease?

A

folate/B12 deficiency, or myelotoxicity of EtOH

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19
Q

What is the cause of thrombocytopenia in alcoholic fatty liver?

A

Bone marrow suppression, splenic sequestration d/t portal HTN

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20
Q

What is fetor hepaticus?

A

Thiols pass through the lung from a failing liver, causing horrible breath

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21
Q

What are the two outcomes of alcoholic fatty liver?

A

alcoholic hepatitis or cirrhosis

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22
Q

What is the treatment for etoh liver disease?

A

abstinence and liver transplant

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23
Q

What is the cause of ascites in cirrhosis?

A

Portal HTN causing vasodilatation in the splanchnic system, causing an increase in the renin-angiotensin system, causing water retention

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24
Q

What dietary restriction should be undertaken with ascites?

A

NaCl restriction

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25
Q

What drug should be avoided in pts with cirrhotic liver and ascites? Why?

A

NSAIDs

Will shut down kidneys d/t need for prostaglandin

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26
Q

What is the serum ascites:albumin ratio in portal HTN?

A

> 1.1

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27
Q

What is the goal of treating ascitic fluid?

A

Reduce w/o intravascular volume depletion

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28
Q

What are the two drugs that are used to treat alcoholic liver disease with ascites?

A

Spironolactone and furosemide

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29
Q

What is a TIPS used in treating ascites?

A

Transjugular intrahepatic portosystemic shunt

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30
Q

What happens to the spleen in alcoholic cirrhosis?

A

Splenomegaly

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31
Q

What are the complications with alcoholic liver disease?

A

Hepatic encephalopathy

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32
Q

What are the precipitating causes of hepatic encephalopathy?

A 
Hypovolemia
GIB
Hypoxia
Infx
hypoglycemia
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33
Q

Where does the ammonia come from in hepatic encephalopathy?

A

GI bacteria produce it , but liver cannot handle it

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34
Q

What is the treatment for hepatic encephalopathy? How does this work?

A

Lactulose changes the pH of the intestines, to kill of bacteria

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35
Q

What is spontaneous bacterial peritonitis (SBP) seen in alcoholic liver disease? What two bacteria usually cause this?

A

Ascitic fluid infection w/o a surgically treatable source–usually Klebsiella or E.Coli

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36
Q

Ascitic fluid with PMN over what number indicate the need for immediate abx? What else should be done?

A

250 cells/mm

Paracentesis

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37
Q

What protein level in ascitic fluid indicates high risk for the development of SBP?

A

Less than 1 g per dL

38
Q

What is the abx of choice for spontaneous bacterial peritonitis?

A

Cephalosporin

39
Q

What is the treatment for varices?

A

Band the varices

Beta-blockers (propanolol)

40
Q

What is the treatment for variceal rupture?

A

stabilize them
Protect the airway
Treat the bleed

41
Q

What is the cause of hepatorenal failure?

A

portal HTN reduces blood flow to the kidney

42
Q

What is the discriminant function calculation?

A

4.6[PTT - PT] + (serum bili)

43
Q

Over what score for the discriminant function indicates the need for treatment with prednisolone?

A

32

44
Q

What causes the BUN to increase in alcoholic pts?

A

Increased reabsorption of nitrogen

45
Q

What happens to alk phos in alcoholic cirrhosis?

A

Mildly elevated

46
Q

What is the skin pigmentation with hemochromatosis? What cancer are these pts predisposed to?

A

Gray

hepatocellular CA

47
Q

What is the pathophysiology with hemochromatosis?

A

Increased intestinal Fe absorption d/t genetic defect in hepcidin

48
Q

What are the ssx of hemochromatosis (4)

A

Hepatomegaly
Gray hyperpigmentation
Arthropathy
Cardiac involvement

49
Q

What are the joints that are commonly affected in hemochromatosis?

A

MCPs

50
Q

What are the labs used to diagnose hemochromatosis?

A

High serum Fe, ferritin, and transferrin

51
Q

Transferrin saturation greater than what percent is seen in hemochromatosis?

A

45%

52
Q

What is the treatment for hemochromatosis?

A

Phlebotomy

53
Q

Symptomatic hemochromatosis is how many times more symptomatic in men than women?

A

10x

54
Q

What are the histological characteristics of NAFLD?

A

Similar to EtOH liver, but without h/o alcohol

55
Q

What is the LFT enzymatic ratio with NAFLD?

A

ALT >AST (opposite of alcoholic liver disease)

56
Q

What is NAFLD associated with?

A

DM
Fat
Metabolic syndrome
HTN

57
Q

How do you diagnose NAFLD?

A

Fatty infiltration on imaging
Liver biopsy
Stigma of chronic liver disease

58
Q

What is the treatment for NAFLD?

A

Weight loss
Control DM
Avoid EtOH

59
Q

What is type I autoimmune hepatitis?

A

Elevated transaminases with absence of other causes, and associated with other autoimmune disease

60
Q

What is the lab that is very useful for diagnosing autoimmune hepatitis?

A

Serum protein electrophoresis (more than 80-% of pts have hypergammaglobulinemia)

61
Q

What are the Abx seen in autoimmune hepatitis? (5)

A 
ANA
Anti-dsDNA
**SMA**
ANCA
anti-actin
62
Q

How do you confirm the diagnosis of autoimmune hepatitis?

A

Liver biopsy

63
Q

What is the treatment for autoimmune hepatitis? Is there a cure?

A

Prednisone and azathioprine

No cure, but very good prognosis

64
Q

What is the cause of Wilson’s disease?

A

Impaired excretion of Cu into bile and build up

65
Q

What is the genetic cause of Wilson’s disease?

A

AR

66
Q

What is the cause of arthritis seen in Wilson’s disease?

A

Chondrocalcinosis

67
Q

When are pts diagnosed with Wilson’s disease, usually?

A

5-25 yo

68
Q

What are the ceruloplasmin levels in Wilson’s disease?

A

Low

69
Q

How do you confirm the diagnosis of Wilson’s disease?

A

Liver biopsy

70
Q

What is the treatment for Wilson’s disease?

A

Chelation with penicillamine or trientine/Zn salts

71
Q

Is there a cure for Wilson’s disease?

A

yes–liver transplant

72
Q

What is the pathophysiology of Alpha-1-antitrypsin deficiency?

A

Pathologic polymerization of variant AAT molecules that accumulate in hepatocytes

73
Q

How do you diagnose alpha-1-antitrypsin deficiency?

A

Direct serum measurement of APR

Genotype testing

74
Q

What is the treatment for alpha-1-antitrypsin deficiency?

A

Liver transplant

75
Q

What are the two causes of conjugated bili elevation?

A

Decreased excretion

Backward leakage

76
Q

In whom is Gilbert syndrome common?

A

Young, white males

77
Q

What are the bilirubin findings with Gilbert syndrome?

A

Unconjugated is less than 6 mg/dL, but high

78
Q

What are the 4 sources of Alk phos in the body? How do you determine if it is from the liver?

A

Liver
Bone
Prego (baby)
Gut

GGT will be elevated if it is from the liver.

79
Q

AMA ab is diagnostic for what biliary disease?

A

Primary biliary cirrhosis

80
Q

What is intrahepatic cholestasis? What diseases is this associated with?

A

not dilated bile duct, but slow bile movement

Primary sclerosing cholangitis
Primary biliary cirrhosis

81
Q

What is primary sclerosing cholangitis?

A

Progressive disease with inflammaiton, fibrosis, and sclerosis of intra and extra hepatic bile ducts

82
Q

What disease is primary sclerosing cholangitis associated with?

A

UC

83
Q

What cancer can primary sclerosing cholangitis are susceptible to?

A

Cholangiocarcinoma

84
Q

What ab is elevated in Primary sclerosis? Which is NOT elevated?

A 
Elevated = pANCA
NOT = AMA
85
Q

What mineral is element is elevated in the liver of patients with primary sclerosing cholangitis?

A

Cu

86
Q

Beaded appearance to the bile duct = what disease?

A

primary sclerosing cholangitis

87
Q

What are the things that are needed to diagnose Gilbert syndrome?

A

Unconjugated hyperbilirubinemia

+ no evidence of hemolysis

88
Q

What is the characteristic finding of a liver biopsy with primary sclerosing cholangitis?

A

Onion skin appearance

89
Q

In whom is primary biliary cirrhosis common?

A

Middle aged women

90
Q

What are the diagnostic labs for primary biliary cirrhosis?

A

Elevated alk phos

AMA +

91
Q

Does the AMA antibody found in primary biliary cirrhosis correlate with the disease severity?

A

No

Gastrointestinal (42 decks)

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