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CPD I > Upper GI and Hepatobiliary System > Flashcards

Upper GI and Hepatobiliary System Flashcards

1
Q

Primary Biliary Cirrhosis

A

Autoimmune liver disorder with progressive destruction of intrahepatic bile ducts, leading to cholestasis, cirrhosis and liver failure.

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2
Q

In what population should you suspect primary biliary cirrhosis in when they present with unexplained pruritus, fatique, RUQ pain, and/or jaundice?

A

Middle-aged women

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3
Q

What are some classic S/SX of primary biliary cirrhosis?

A

Insidious fatigue, pruritus, dry mouth, and RUQ pain

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4
Q

What is the work-up for primary biliary cirrhosis and what would you expect?

A

Labs: GGT (elev.), ALP (elev.), minimally abnormal AST and ALT, anti-mitochondrial antibodies (elev.)
Procedure: biopsy

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5
Q

Diffuse liver damage due to inadequate blood or O2?

A

Ischemic hepatitis

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6
Q

What are possible causes of ischemic hepatitis?

A

Heart failure or acute hypotension, resp. failure or CO2 toxicity, inc. metabolic demand (e.g. sepsis)

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7
Q

What are the s/sx of ischemic hepatitis?

A

N/V, tender hepatomegaly

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8
Q

What is the work-up for ischemic hepatitis and what would you expect to see?

A

Labs: LFT (very high AST and ALT), bilirubin (mod. inc.), LDH (inc. within hour of ischemic event)
Imaging: U/S. MRI, or arteriography to I.D. obstructed vessel

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9
Q

Focal damage to the biliary tree due to disrupted flow from the hepatic artery via peribiliary arterial plexus?

A

Ischemic cholangiopathy

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10
Q

What is the main cause for ischemic cholangiopathy?

A

Vascular injury during surgical procedures

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11
Q

What are the s/sx of ischemic cholangiopathy?

A

Pruritis, pale stool

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12
Q

What is a typical work-up in a pt with suspected ischemic cholangiopathy?

A

Labs: reveal cholestasis; UA
Imaging: U/S initially; follow-up with MRCP and/or ERCP to r/o cholelithiasis or cholangiocarcinoma

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13
Q

Diffuse venous congestion in the liver that results from RCHF which leads to increased central venous pressure?

A

Congestive hepatopathy

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14
Q

What are the s/sx of congestive hepatopathy?

A

Most are asx, can see RUQ discomfort, severe congestion can result in jaundice

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15
Q

What would a PE on a pt presenting with congestive hepatopathy reveal?

A

Ascites, hepatomegaly, (+) hepatojugular reflex

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16
Q

What would a work-up look like in a pt suspected to have congestive hepatopathy?

A

Moderately elevated LFTs

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17
Q

Obstruction of the hepatic venous outflow from small hepatic veins inside the liver to the inferior vena cava and R atrium?

A

Budd-Chiari Syndrome

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18
Q

What is the most common cause of Budd-Chiari Syndrome?

A

Patients who are in hypercoagulable states

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19
Q

What are the s/sx of Budd-Chiari Syndrome?

A

Acute obstruction: fatigue, RUQ pain, N/V, mild jaundice
Chronic obstruction: may be asx in some patients until it progresses and may cause fatigue, abdominal pain, and hepatomegaly, lower extremity edema

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20
Q

What does a work-up in a pt with possible Budd-Chiari Syndrome look like?

A

Labs: LFTs
Imaging: vascular imaging

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21
Q

Endothelial injury, leading to non-thrombotic occlusion of the terminal hepatic venules and hepatic sinusoids?

A

Veno-occlusive disease

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22
Q

What are some common causes of Veno-occlusive disease?

A

Irradiation, transplant rejection, hepatotoxins

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23
Q

Increased resistance to blood flow, which commonly arises from dz within the liver itself or uncommonly from blockage of the splenic or portal vein?

A

Portal HTN

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24
Q

What are the common causes of portal HTN?

A

Cirrhosis (developed countries), Schistosomiasis (in endemic areas), hepatic vascular abnormalities

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25
Q

What are some concomitants with a Dx of portal HTN?

A

Esophageal varices, portal-systemic encephalopathy

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26
Q

What are the s/sx of portal HTN?

A

Often asx

Sx arise from acute variceal bleeding –> sudden, painless, upper GI bleed

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27
Q

What are the PE findings in a pt who may have portal HTN?

A

Low systolic BP, splenomegaly, ascites, peripheral edema, dilated abdominal wall veins, and caput medusae. May present with jaundice and spider angiomas

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28
Q

What is a typical work-up for portal HTN?

A

US or CT that reveals dilated intraabdominal collateral arteries

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29
Q

Neuropsychiatric syndrome where absorbed products that would otherwise be detoxified through the liver end up in systemic circulation where they may be toxic to the brain?

A

Portal-systemic encephalopathy

30
Q

What are s/sx of portal-systemic encephalopathy?

A

Constructional apraxia, characteristic flapping tremor (asterixis)

31
Q

What is a typical work-up for a pt with portal-systemic encephalopathy?

A

Psychometric eval
CMP: electrolytes, albumin, LFT
EEG shows diffuse slow-wave activity

32
Q

What are the three types of postoperative dysfunctions?

A

Postoperative jaundice
Postoperative hepatitis
Postoperative cholestasis

33
Q

What are some types of solid benign liver tumors?

A

Hepatocellular adenoma, focal nodular adenoma, hemangiomas, lipomas, and fibromas

34
Q

What is the most common type of primary liver cancer and where is it most prevalent?

A

Hepatocellular carcinoma

Most prevalent in E. Asia and sub-Saharan Africa

35
Q

What are the s/sx of hepatocellular carcinoma?

A

Previously stable cirrhosis pt presents with RUQ pain, wt loss, RUQ mass, and unexplained deterioration.

36
Q

What is a typical work-up in a pt with suspected hepatocellular carcinoma?

A

Labs: Alpha-Fetoprotein measurement (elev.)
Imaging: CT, U/S, or MRI
Procedure: biopsy

37
Q

What are the more common primary sites of metastatic liver cancer?

A

GI, breast, lung, pancreas, leukemia

38
Q

What is the work-up for someone with suspected metastatic liver cancer?

A

CT or MRI with contrast

Biopsy of nodule is definitive

39
Q

Presence of one or more calculi (gallstones) in the gallbladder

A

Cholelithiasis

40
Q

What are the five F’s for developing cholelithiasis?

A

Female, fat, forty, fertile, family hx

41
Q

What are the three types of gallstones and which is most common?

A

Cholesterol stones - most common
Black pigment stones
Brown pigment stones

42
Q

What are the s/sx of cholelithiasis?

A

80% are asx

RUQ pain that radiates to back or down the arm, episodic, N/V with episode

43
Q

What is the work-up for a pt suspected to have cholelithiasis?

A

U/S

44
Q

Inflammation of the GB that develops over hours, usually because a gallstone obstructs the cystic duct?

A

Acute cholecystitis

45
Q

What are the s/sx of acute cholecystitis?

A

Pain similar to cholelithiasis, but lasts longer. Vomiting is common.

46
Q

What are any significant PEs that one may find in acute cholecystitis?

A

Right subcostal tenderness, (+) Murphy’s sign, fever

47
Q

What is a typical work-up for acute cholecystitis?

A

Abdominal U/S; CT to help identify complications

48
Q

Longstanding GB inflammation almost always due to stones

A

Chronic cholecystitis

49
Q

What is it called when there is extensive damage done to the GB due to fibrosis?

A

Porcelain gallbladder

50
Q

What is the difference in PE for acute vs. chronic cholecystitis?

A

In chronic, pt is afebrile

51
Q

Biliary colic without gallstones, resulting from structural or functional disorders?

A

Acalculous biliary pain

52
Q

The occurrence of abdominal sxs after cholecystectomy?

A

Postcholecystectomy Syndrome

53
Q

What are the s/sx of postcholecystectomy syndrome?

A

Dyspepsia, non-specific biliary sxs, persistent abdominal pain

54
Q

What is a work-up for PCS?

A

Biliary manometry

55
Q

Presence of stones in the bile ducts causing biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis?

A

Choledocholithiasis

56
Q

What are the four types of stones in choledocholithiasis?

A

Primary stones
Secondary stones (most common)
Residual stones
Recurrent stones

57
Q

Bile duct obstruction allows bacteria to ascend from duodenum resulting in infxn and inflammation

A

Acute cholangitis

58
Q

What is Charcot’s triad in acute cholangitis?

A

Abdominal pain, Jaundice, Fever or chills

59
Q

What are pertinent PE findings in acute cholangitis?

A

RUQ tenderness, tender and enlarged liver, confusion and hypotension (PANIC!)

60
Q

Intrahepatic brown stone formation leading to repeating cycles of obstruction, infxn, and inflammation?

A

Recurrent Pyogenic Cholangitis

61
Q

Chronic choleastatic syndromes characterized by patchy inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic bile ducts?

A

Primary Sclerosing Cholangitis

62
Q

What are the s/sx of primary sclerosing cholangitis?

A

Progressive fatigue then pruritus, jaundice later, steatorrhea and deficiencies of fat-soluble vitamins, symptomatic gallstones and choledocholithiasis in 75%

63
Q

What is the work-up for sclerosing cholangitis?

A

Lab: ALP and GGT elev., Globulins and IgM elev., antimitochondrial Ab is NEGATIVE
Imaging: U/S to r/o biliary obstruction, MRCP

64
Q

Biliary obstruction secondary to biliary tract strictures caused by various opportunistic infxns in AIDS pts?

A

AIDS Cholangiopathy

65
Q

What are the three main types of GB and bile duct malignancies?

A

Cholangiocarcinoma
GB Carcinoma
GB Polyps

66
Q

What is the PE sign for peritonitis?

A

Blumberg sign

67
Q

What are the PE signs for appendicitis?

A

McBurney’s point tenderness
Rovsing’s sign
Psoas sign
Obturator sign

68
Q

What is the PE sign for cholecystitis?

A

Murphy’s sign

69
Q

What are the four major mechanisms of diarrhea?

A

Osmotic
Secretory
Exudative
Motility

70
Q

What are the 5 main PE findings in diarrhea?

A 
Dehydration
Failure to thrive and malnutrition
Abdominal pain
Borborygmi
Perianal erythema

CPD I (7 decks)

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