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Gastrointestinal System > Noninfectious Hepatobiliary Disease > Flashcards

Noninfectious Hepatobiliary Disease Flashcards

1
Q

What are the three “patterns” to think of when evaluating elevated liver function tests?

A

1) Hepatocellular pattern
2) Hyperbilirubinemia
3) Cholestatic pattern

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2
Q

What tests truly test the function of the liver?

A

INR

Albumin

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3
Q

What enzymes are used in the evaluation of the liver?

A

Aminotransferases
Alkaline phosphatase
GGT

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4
Q

What is the most important part of the evaluation of a patient with elevated LFTs?

A

History

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5
Q

What is a prominent feature of patients with long-standing alcoholic liver disease?

A

Temporal and proximal muscle wasting

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6
Q

What does a Virchow’s node or Sister Mary Joseph’s nodule suggest?

A

Abdominal malignancy

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7
Q

What does JVD suggest?

A

Hepatic congestion

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8
Q

When are right pleural effusions seen?

A

Advanced cirrhosis

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9
Q

What is the hepatocellular pattern of elevated LFTs?

A

Elevated aminotransferases

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10
Q

What are the common diseases that cause the hepatocellular pattern of elevated LFTs?

A 
Alcohol 
Hemachromatosis 
Fatty Liver 
Medications 
Supplements 
Viral Hepatitis
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11
Q

What is the enzyme pattern that is specific for alcoholic liver disease?

A

AST greater than ALT (2:1)

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12
Q

What is the effect of alcohol on GGT?

A

Alcohol induces GGT

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13
Q

What does an AST greater than 300 indicate?

A

An additional problem in addition to alcoholism

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14
Q

What is the difference between alcoholic hepatitis and cirrhosis?

A

Hepatitis:
- Cell injury and hepatocellular swelling

Cirrhosis:
- Regenerative nodules and fibrosis

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15
Q

What is the treatment for Alcoholic Liver Disease?

A

1) Abstinence

2) Liver transplant

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16
Q

Explain the etiology of ascites seen in alcoholic liver disease.

A

1) Cirrhosis causes portal HTN
2) Splanchnic vasodilation and renal vasoconstriction
3) RAA activated–Na+ and H20 retained
4) ADH secreted–retain water

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17
Q

What do you need to remember in terms of dietary and medication restriction in alcoholic liver disease?

A

1) Limit Na+ (water follows Na+)

2) No NSAIDs– will shut down kidneys

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18
Q

What is the utility of the SAAR?

A

Determining the etiology of ascites

  • SAAR greater than 1.1= portal HTN
  • SAAR less than 1.1= NOT portal HTN
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19
Q

How do you treat ascites?

A

1) Na+ restriction
2) Spironolactone and Furosemide
3) Paracentesis
4) TIPS procedure

20
Q

What lab should you check in a patient with suspected hepatic enchalopathy?

A

Ammonia

21
Q

How can hepatic encephalopathy be treated?

A

1) Treat the underlying cause

2) Titrate Lactulose, which changes the colonic pH

22
Q

What is Spontaneous Bacterial Peritonitis?

A

Ascitic fluid infection

  • Advanced cirrhosis
  • Caused by gut flora overgrwoth (E.coli and Klebsiella)
23
Q

How do you approach the management of SBP?

A

1) If you suspect, paracentesis
2) Measure ascitic neutrophils
3) Neutrophils greater than 250–start abx (Ceftiaxone)

24
Q

What is the treatment of choice with a ruptured esophageal varice?

A

Endoscopy followed by:

1) Balloon tamponade
2) TIPS

25
Q

What is Hepatorenal Syndrome?

A

Acute renal failure in the face of underlying advanced liver disease

26
Q

What is the utility of the discriminant function?

A

Determines the prognosis of alcoholic hepatitis

27
Q

What does the discriminant function determine?

A

Determine whether or not to give PREDNISOLONE

28
Q

What is the magic number for the discriminant function?

A

32–greater than 32 give PREDNISOLONE

29
Q

When should you NOT give prednisolone?

A

1) Infection

2) GI Bleed

30
Q

Describe the skin pigmentation seen in patients with Hemochromatosis?

A

“Gray” NOT bronze

31
Q

What do patients with Hemochromatosis have an increased risk for?

A

Hepatocellular Carcinoma

32
Q

What are the labs that are typical of Hemochromatosis?

A
  • High serum iron
  • High ferretin
  • High transferrin

*Classically, the Transferrin saturation is greater than 45%

33
Q

What is the liver enzyme elevation pattern seen in NAFLD?

A

ALT is higher than AST

34
Q

What is the treatment for NAFLD?

A

1) Weight loss
2) Control of DM and hyperlipidemia
3) Low fat diet
4) Alcohol avoidance

35
Q

What is the presentation that would lead you to consider Autoimmune Hepatitis?

A
  • Young to middle aged woman

- Elevated tranaminases with no cause

36
Q

How does Wilson’s Disease typically present?

A

Adolesecent with neurologic or psychiatric dysfunction

37
Q

What PE finding is a hallmark for Wilson’s Disease?

A

Kayser-Fleischer rings

38
Q

What lab finding is characteristic of Wilson’s Disease?

A

Ceruloplasmin

39
Q

What type of hyperbilirubinemia is seen in Gilbert Syndrome?

A

UCB

40
Q

What is the typical presentation of Gilbert Syndrome?

A

1) Healthy young adult
2) Hyper-UCB
3) No evidence of hemolysis

41
Q

What lab elevation is associated with the “Cholestatic pattern?”

A

ALP (and GGT)

42
Q

If you have a UC patient with an elevated ALP, what diagnosis should come to mind?

A

Primary Sclerosing Cholangitis

43
Q

What is pathogmnemonic for PSC on biopsy?

A

1) Beaded appearance of biliary ducts

2) Onion skin on liver biopsy

44
Q

What patient population is PBC most commonly seen in?

A

Middle aged women

45
Q

What are key clinical features of PBC?

A

1) Middle aged woman
2) Positive AMA
3) Elevated ALP
4) Puritis and fatigue
5) Obliterated bile ducts

Gastrointestinal System (42 decks)

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