Week 10b: Hepatobiliary Disorders

Question 1

which test is an indicator of hepatobillary disease/alcohol abuse?

Answer 1

GGT

Question 2

which 2 tests are a measure of liver cell production failure?

Answer 2

• low serum albumin

- prolonged prothrombin time

Question 3

any condition in which substances that are normally excreted in the bile are retained

Answer 3

cholestasis

Question 4

intrahepatic cholestasis

Answer 4

• biliary cirrhosis

- primary sclerosing cholangitis

Question 5

extrahepatic cholestasis

Answer 5

• increased pressure in the large bile ducts

- obstruction of the large bile ducts, cholelithiasis, common duct strictures or obstructing neoplasms

Question 6

cholestasis will result in which lab finding?

Answer 6

elevated serum alkaline phosphatase

Question 7

the substance that gives bile its colour

Answer 7

bilirubin

Question 8

free (indirect) bilirubin

Answer 8

insoluble in plasma and transported attached to plasma albumin

Question 9

conjugated (direct) bilirubin

Answer 9

is soluble in the bile and secreted into the bile

Question 10

elevated indirect bilirubin may indicate?

Answer 10

hemolysis

Question 11

elevated direct bilirubin may indicate?

Answer 11

hepatobiliary disorder

Question 12

prehepatic jaundice

Answer 12

• involves unconjugated bilirubin

- major cause: excessive hemolysis of RBCs

Question 13

Intrahepatic jaundice

Answer 13

• involves conjugated bilirubin
• caused by disorders that directly affect the ability of the liver to remove bilirubin from the blood or conjugate it so it can be removed in the bile

Question 14

post hepatic jaundice

Answer 14

• involves conjugated bilirubin

- occurs when the bile flow is obstructed between the liver and the intestine

Question 15

direct hepatotoxic injury Wille cause which lab findings?

Answer 15

• marked elevations in ALT, AST and bilirubin

- minimally elevated alkaline phophatase

Question 16

what occurs during the prodromal or preicterus period of acute viral hepatitis?

Answer 16

• general malaise, myalgia, arthralgia, easy fatiguability, anorexia, nausea, vomiting, diarrhea and/or constipation
• abdominal pain on the right side
• chills and fever
• elevated AST and ALT

Question 17

icterus period of acute viral hepatitis

Answer 17

• follows the prodromal phase by 1-2 weeks
• jaundice is less likely to occur with HCV infection
• rise in bilirubin causes severe pruritus and liver tenderness

Question 18

what occurs during the convalescent period of acute viral hepatitis?

Answer 18

return of appetite and disappearance of jaundice

Question 19

what is the surface antigen in hepatitis B ?

Answer 19

HBsAg

Question 20

HBsAg

Answer 20

appears before the onset of symptoms in Hep B, peaks during the overt disease, declines to undetectable levels in 3-6 months. Persistence beyond 6 months indicates chronic hepatitis

Question 21

What is the core antigen in Hep B?

Answer 21

HBcAg: indicates active viral replication

Question 22

What is the pre-core/core antigen in Hep B?

Answer 22

HBeAg

Question 23

For Hep B, HBIG is usually given within..?

Answer 23

7 days of exposure

Question 24

what are the serological anti bodies that are tested during Hep B?

Answer 24

• anti-HBs
• anti-HBc
• anti HBe

Question 25

alcohol induced liver disease can cause?

Answer 25

hypoglycaemia

Question 26

fatty liver

Answer 26

accumulation of fat in the hepatocytes (steatosis)

Question 27

alcoholic hepatitis

Answer 27

intermediate stage between fatty changes and cirrhosis. Involves inflammation and necrosis of the liver cells

Question 28

Alcoholic cirrhosis

Answer 28

onset of end-stage alcoholic liver disease. Involves fine uniform nodules on the liver’s surface.

Question 29

caput medusae is associated with ?

Answer 29

cirrhosis

Question 30

hepatorenal syndrome

Answer 30

• a manifestation of liver failure

- involves progressive azotemia, increased serum creatinine levels and oliguria

Question 31

hepatic encephalopathy

Answer 31

results in neural disturbances, confusion, coma and convulsions because ammonia is neurotoxic

Question 32

what is a very early sign of hepatic encephalopathy

Answer 32

asterixis

Question 33

what are some common causes of acute pancreatitis?

Answer 33

• gallstones
• alcohol abuse
• hyperlipidemia
• hyperparathyroidism
• infections
• abdominal and surgical trauma
• drugs such as steroids and thiazide diuretics

Question 34

Lab findings in acute pancreatitis?

Answer 34

serum lipase and amylase levels are typically elevated

Question 35

Clinical manifestations of acute pancreatitis

Answer 35

• cyanosis, dyspnea
• decreased or absent bowel sounds
• low grade fever, leukocytosis
• hypotension, tachycardia
• jaundice
• flushing
• abnormal lung sounds (crackles)
• discolouration of abdominal wall (Turner’s or Cullen’s sign)
• signs of shock

Question 36

bruising of the flanks

Answer 36

turner’s sign

Question 37

superficial edema and bruising in the SC tissue around the umbilicus

Answer 37

Cullen’s sign