Unrein Hepatitis and Cirrhosis

Question 1

best tests for Wilson’s disease

Answer 1

not cerruloplasmin, it is not reliable

24-hour urine test is best

Question 2

primary biliary cirrhosis

Answer 2

primarily a disorder of middle-aged females
associated with + Anti Mitochonrial Antibody;
alk phos and cholesterol usually elevated

Question 3

primary sclerosing cholangitis

Answer 3

usually males 20-50 yrs

associated with ulcerative colitis

Question 4

Wilson’s

Answer 4

slight male predominance
autosomal recessive
suspect in females with Kayser-fleischer rings and parkinson’s like features
usually dx-ed by age 40
alk phos low normal,
zinc is a cofactor in the production of alk phos and is competitively inhibited by the excess copper

Question 5

hep A transmitted how?

Answer 5

fecal-oral pathogen

Question 6

Hep B

Answer 6

transmitted by blood, bodily fluids and tissue.

Question 7

SAAG

Answer 7

serum-ascitic albumin gradient is calculated by subtracting the albumin concentration of the ascitic fluid from the albumin concentration of a serum specimen obtained on teh same day. It correlates with sinusoidal pressure and is a function of oncotic-hydrostatic balance

In cirrhosis the SAAG is high and the ascites total protein is low

in malignant ascites the SAAG is low and the ascites total protein is high

in cardiac ascites both measurements are high

Question 8

autoimmune hepatitis

Answer 8

dx of exclusion- notable is the absence of viral markers. Often presents with fulminant hepatic enzyme elevation, but not a cholestatic picture. This disorder is common in perimenopausal women

Question 9

core antibody

Answer 9

first immune response you’ll see

Question 10

intrahepatic cholestasis of pregnancy

Answer 10

occurs during the second or third trimester, characterized by mild elevations of bilirubin and alk phos

Question 11

hyperemesis gravidarum

Answer 11

morning sickness

can have elevated transaminases in 50% of cases but not associated with cholestasis or itching

Question 12

HELLP

Answer 12

hemolysis, elevated liver enzymes, and low platelets

life-threatening complication of pregnancy typically occuring in third trimester and requiring urgent delivery

Question 13

acute fatty liver of pregnancy

Answer 13

leads to liver failure with elevated transaminases and an abnormal INR

Question 14

hemochromatosis

Answer 14

iron overload state with an elevated transferrin. Clinical finding can be nonspecific buy hyperpigmentation is a common finding

Question 15

acute cholecystitis

Answer 15

acute symptoms associated with eating fatty meals and females of late reproductive age who are overweight

Question 16

diagnostic test of choice for primary sclerosing cholangitis?

Answer 16

Endoscopic retrograde cholangiopancreatography (ERCP)
you will see arborization of the biliary tree

magnetic resonsnance cholangiopancreatography

Question 17

test to diagnose hemochromatosis?

Answer 17

transferrin saturation

not ferritin; it’s an acute phase reactant

Question 18

irregular pulse with hemochromatosis?

other weirdness of hemochromatosis?

Answer 18

cardiomyopathy and atrial fibrillation

drinking and urinating more (diabetes)

Question 19

hemochromatosis

Answer 19

iron overload
iron deposition on the pancreas, heart and skin –> diabetes, arrhythmias, and hyperpigmented skin.

“Bronze Diabetes”’

Question 20

treatment for non-alcoholic steatohepatitis

Answer 20

weight loss and blood glucose control, with continued monitoring of the patient’s transaminases

Question 21

inh toxicity

Answer 21

a well-known hepatocellular toxin that requires close monitoring of liver enzymes.

Question 22

only time AST is usually greater than ALT

Answer 22

alcoholics

Question 23

asterixis

Answer 23

a “flapping” tremor
often from alcoholism

ammonia-induced

Question 24

treat alcoholic DT

Answer 24

lactulose

bacteria give off H+ that is added to ammonia

Question 25

ascites + sudden increase in abdominal girth

Answer 25

likely spontaneous bacterial peritonitis

Question 26

hepatorenal syndrome

Answer 26

decomposition of the kidneys, not the liver, and is characterized by activation of the RAAS system adn renal vasoconstriction as a result of systemic/ splanchnic vasodilation associated with cirrhosis

Question 27

important effect of cancer

Answer 27

hypercoagulable state

Trousseau syndrome

Question 28

CHF onset should be

Answer 28

relatively gradual

Question 29

hepatomegaly, portal vein thrombosis, or new ascites in someone with chronic hep B is what until proven otherwise?

Answer 29

hepatocellular carcinoma