week 3 accessory GI

Question 1

What 5 lab values increase in liver disease and why

Answer 1

1. bilirubin - b/c liver can’t conjugate effectively and some leaks out due to dead cells
2. cholesterol - b/c liver can’t make bile effectively so fat can’t be broken down - so cholesterol stays in blood
3. ALT, ALK, AST, GGT - liver enzymes b/c dead hepatocytes
4. INR and PT - because liver can’t absorb vitamin K needed for clotting factors so high risk to bleed and longer bleeding time
5. ammonia - b/c liver can’t convert ammonia to urea to be excreted in the kidney

Question 2

What 4 lab values decrease in liver disease and why

Answer 2

1. potassium - b/c over production of aldosterone that holds Na in
2. Glucose - b/c glycogenesis and glycolysis can’t happen effectively = hypoglycemia
3. pancytopenia - because portal hypertension leads to spleen issues so WBC, RBC, and platelets are stuck in there
4. Albumin - liver can’t make it effectively

Question 3

What are the 2 most common causes of acute pancreatitis?

Answer 3

1. Alcohol
2. Gall stones

Question 4

What saying is for acute pancreatitis causes?

Answer 4

A Hare Had Gout Golfing Monday To Vriday

Question 5

where is pain in acute pancreatitis?

Answer 5

upper left quadrent to the back

Question 6

what lab values go up in pancreatitis?

Answer 6

amalayse and lipase- cells break open
potassium - cell death
blood sugar - can’t send out insulin

Question 7

Why does hypocalcemia happen in pancreatitis?

Answer 7

because fatty acids bind to calcium

Question 8

What organ does pancreatitis affect and why?

Answer 8

the lungs
pulmonary complications - ARDS b/c cytokynes cause inflammation in the lungs and alveoli

Question 9

why does hypovolemia happen in pancreatitis?

Answer 9

because of increased permeability and vasodilation

Question 10

What drugs are used for portal hypertension?

Answer 10

Propanolol (beta blocker)
Lactulose (osmotic laxative)

Question 11

what drugs are used for edema and acities in liver disease?

Answer 11

albumin 25%
spironolactone

Question 12

what is the order of liver degeneration?

Answer 12

normal- fatty- fibrous- cirrosis

Question 13

What drugs are used to lower cholesterol with liver disease?

Answer 13

Atorvastatin- lipid lowering
bile-acid sequestrates - takes bile acid out so more cholesterol is absorbed to make more bile acids

Question 14

what are the symptoms of hepatitis?

Answer 14

jaundice
RUQ pain
fatigue
muscle pain
joint pain
malaise
anorexia
fever

Question 15

What are the symptoms of cirrhosis ?

Answer 15

Dependent Edema
Low blood pressure
High heart rate
High temp
Ascities
SOB
Jaundice – very yellow

Question 16

What are the complications of liver cirrhosis?

Answer 16

1. varacies
2. portal hypertension
3. splenomegaly- pancytopenia
4. hepatic encephalopathy
5. Ascities
6. edema
7. HRS* hepatorenal syndrome - cause of death
8. Bleeding*

Question 17

What meds damage the liver?

Answer 17

Tylenol
meds that have first pass effect

Question 18

why are liver cirrhosis patients at risk for PN?

Answer 18

B/c their ascities - belly too big, can’t take deep breaths and alveoli start to shut down

Question 19

Why do liver cirrhosis patients get red palms?

Answer 19

palmer erythema - too much estrogen

Question 20

Spider angiomas are what?

Answer 20

think nose with red lines

Question 21

Caput Medusae

Answer 21

varicies on the outside of the abdomen

Question 22

what 2 things cause fluid retention in liver cirrhosis patients?

Answer 22

increased aldosterone - Na+ and fluid retention
low albumin - can’t balance it back into the blood stream

Question 23

is glucose high or low in liver cirrhosis?

Answer 23

hypoglycemia

Question 24

What diseases raises blood glucose?

Answer 24

Diabetes
Pancreatitis
High ICP

Question 25

What colour is urine with Bilirubinuria?

Answer 25

tea colour - dark- bad

Question 26

stercobelinigoin turns poop what colour?

Answer 26

brown. When lacking - it’s clay colour

Question 27

what does portal hypertension lead to the development of?

Answer 27

varacies - bleeding

Question 28

what leads to hemorrhagic shock in liver cirrhosis patients?

Answer 28

varacies that bleed b/c clotting is slow
spenomegaly = lack platelets
lack vitamin K for clotting factors

Question 29

what is a common trigger for hepatic encephalopathy?

Answer 29

GI bleed

Question 30

what does a positive murphy’s sign show?

Answer 30

cholecystitis

Question 31

Steatorrhea

Answer 31

fatty stools

Question 32

what 3 test are done for acute cholecystitis ?

Answer 32

1. labs
2. abdominal ultrasound
3. ERCP

Question 33

What additional 2 tests are done for acute pancreatitis?

Answer 33

1. CT
2. MRCP

plus labs, abdominal ultrasound, ercp like cholecystitis

Question 34

where is cullen’s sign found?

Answer 34

around the belly button and to the left a bit

Question 35

where is grey turner’s sign found?

Answer 35

sides - hemorrhagic pancreatitis