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GI II > Week 4 (Exam 2) > Flashcards

Week 4 (Exam 2) Flashcards

1
Q

Who gets sinusoidal obstruction syndrome?

A

Stem cell transplant and chemo patients

People who drink exotic teas

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2
Q

Auto-immune pancreatitis Type 1 vs Type 2

A

Type 1: systemic, IgG4 related from plasma cells

Type 2: pancreas only (except in UC), Mass lesion

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3
Q

What is the classic presentation of a symptomatic, ruptured AAA?

A

Abdominal and/or flank pain
Hypotension
Shock / Pulsatile Abdominal Mass

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4
Q

What lab values are more specific for actute vs chronic changes in liver function?

A

Acute: PT
Chronic: Albumin

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5
Q

What are the black box warnings for Entecavir?

A

Severe acute Hep B exacerbations
Lactic Acidosis
Hepatomegaly
Esp those co-infected with HiV

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6
Q

CPA1

A

Carboxypeptidase A1
Exopeptidase in regulating zymogen activation
7q32

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7
Q

Palpable stool in abdomen, empty rectal vault, needing help to poop, failure to pass meconium in the first 1-2 days of life. What is the diagnostic test?

A

Rectal Bx for Hischprung

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8
Q

Diagnostic Labs of Chronic Pancreatitis

A

Fecal Elastase down below 100
Glucose / HbA1c (development of DM)
Elevated IgG4

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9
Q

Primary Sclerosing Cholangitis (PSC) Etiology

A

IBD (mostly UC)

Decreased risk with smoking and coffee

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10
Q

Where does Liver regeneration occur?

A

Canals of Hering

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11
Q

Pancreatic Intraepithelial Neoplasia (PanIN)

A

Non-invasive precursor lesion that leads to invasive pancreatic lesions

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12
Q

Treatment of hepatic encephalopathy

A

Lactulose to make 2-3 soft stools/day

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13
Q

How do you treat a Acetaminophen (Tylenol) overdose?

A

N-acetylcysteine (NAC) ideally within 8 hours of ingestion

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14
Q

Budd Chiari imaging findings

A

Occluded Hepatic or IVC flow
Prominent Liver Caudate Lobe on Imaging
Caval / spider web hepatic veins on venography
Nutmeg Liver

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15
Q

What 6 things developing within the first 48 hours indicate a worsening prognosis of acute pancreatitis?

A 
Calcium less than 8
Hematocrit drop more than 10%
O2 (arterial) less than 60
BUN rising above 5
Base deficit over 4
Sequestration of fluid over 6
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16
Q

Clinical presentation of Gallstones

A

Asx, initiated by eating a fatty meal
RUQ or Epigastric Pain (6 hours, progressive)
Radiates to Right Shoulder or Back

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17
Q

Presentation of Intrahepatic Cholestasis of Pregnancy

A

Benign, third trimester of pregnancy.
Itching, GI symptoms, Abnormal liver excretory tests
Cholestasis on bx

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18
Q

Treatment of alpha-1 antitrypsin deficiency

A 
Stop Smoking
Liver Transplant (children)
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19
Q

Acute Hepatitis Pattern

A

Acute Hepatitis PatterElevated Transaminase levels, various increases in other enzymes

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20
Q

What is an Indirect Coombs test?

A

Tests fir Abs that could hypothetically bind certain RBCs (if mixing / transfusion were to occur)

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21
Q

H&P of PBC

A

Hx of UTIs, smoking, hormone replacement, hair dye

Pruritus, Progressive Jaundice, Xanthelasma

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22
Q

Large HBsAg

A

Viral Envelope glycoprotein associated with complete virions

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23
Q

HBV Pol

A

DNA polymerase and Reverse Transcriptase activity

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24
Q

Weight Loss, Anorexia, Malaise

A

Signs of advanced pancreatic carcinoma

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25
Q

What are the TRUE liver function tests?

A 
PT/INR
Albumin
Cholesterol
Ammonia
(AST and ALT are only for liver damage)
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26
Q

PiZZ Mutation

A

Glu to Lys at 342
mut a1AT-Z polypeptide is abnormally folded and polym.
Leads to ER stress, Unfolded Protein Response, Apoptosis. PAS+

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27
Q

Vinyl Chloride

A

Historical association with Angiocarcinoma

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28
Q

Primary Biliary Cirrhosis most characteristic finding

A

Anti-Mitochondrial Abs against E2 component of Pyruvate Dehydrogenase Complex (PDC-E2)

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29
Q

Labs of Hep B

A

Markedly Elevated Aminotransferases early in course

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30
Q

Choledochal Cysts

A

Congential dilations of the common bile duct

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31
Q

What are the drug interactions associated with Elbasvir / Grazoprevir?

A

Co-Admonistration with moderate CYP3A inducers not recommended (decreases plasma concentration)

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32
Q

Associated conditions of PSC

A

UC, Pancreatitis, Idiopathic Fibrosing Disease, Males

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33
Q

1 cause of Acute (Fulminant) Liver Failure

A

Acetaminophen

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34
Q

Alpha-1 Antitrypsin Deficiency Complications

A

Young age emphysema

Micronodular Cirrhosis, risk of HCC

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35
Q

Diagnostics for Non-alcoholic fatty liver disease

A 
Ultrasound elastography (liver stiffness for fibrosis)
Liver bx (diagnostic): polymorphonuclear neutrophil infiltration and Mallory Hyaline (same as alcoholic)
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36
Q

What is Murphys sign for?

A

Acute Cholecystitis

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37
Q

How does ARDS appear upon Xray?

A

Bilateral Diffuse Fluffly Infiltrates (white all over)

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38
Q

Treatment of Biliary Dyskinesia

A

Supportive
Low Fat Diet
Cholecystectomy

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39
Q

Morphology features of progressive chronic liver damage

A

scarring

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40
Q

Complications of Acute Pancreatitis

A

3rd Spacing
Pre-renal azotemia
Infected Necrosis
Acute Respiratory Distress Syndrome

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41
Q

Where is the narrowing of the esophagus that catches most orally ingested foreign bodies?

A

Upper Esophageal Sphincter: At the level of the aortic arch and diaphragmatic hiatus

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42
Q

What is the initial (non-surgical) tx for appendicitis?

A

NPO, IVF, Antiemetic, Pain Meds, maybe pre-op abx

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43
Q

Who is most at risk for Hep E?

A

Immunocompromised pts

Transplant pt tx w/ Tacrolimus can show chronic progressing to cirrhosis

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44
Q

Wilsons Tx

A

Oral Penicillamine, Liver transplant

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45
Q

Caroli Disease

A

Multifocal cystic dilation of large intrahepatic bile ducts

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46
Q

What is the MOA of Telbivudine?

A

Nucleoside Analogue

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47
Q

Treatment options for HCC

A

Surgery / Transplant
Radiofrequency Ablation
Transcatheter Arterial Embolization

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48
Q

Complications of Chronic Pancreatitis

A

Brittle DM
Pancreatic Insufficiency (steatorrhea, malnutrition)
Pancreatic CA

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49
Q

Findings of alcoholic steatohepatitis

A

AST:ALT is 2:1

Elevated Alk Phos

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50
Q

Single Large, hard, scirrhous tumor with fibrous bands and large polygonal cells with granular cytoplasm

A

Fibrolamellar Carcinoma (Hepatocellular carcinoma variant)

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51
Q

Presentation of Acute Pancreatitis

A

Epigastric pain boring straight through to the back
Cullen or Grey Turner’s
ARDS (Crackles, difficulty breathing)
(+) Chovstek and Trousseau

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52
Q

Biliary Dyskinesia Diagnostics

A

RUQ pains
Normal Ultrasound
HIDA scan: radio-nucleotides, abnormal ejection fraction (less than 35 - 38% get a cholecystectomy)

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53
Q

Most common congenital gallbladder anomaly

A

Folded Fundus: creates a Phrygian Cap

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54
Q

Hep C family

A

Single Stranded RNA

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55
Q

Wilson Disease Dx

A

Low Ceruloplasmin

High Serum Cu in liver, Basal ganglia, brainstem, cerebellum

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56
Q

Pancreas Wraps around C Loop of duodenum

A

Annular Pancreas

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57
Q

Small HBsAg

A

Viral Envelope glycoprotein released by infected hepatocytes free of viral core elements

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58
Q

Physical findings in Primary Sclerosing Cholangitis (PSC)

A

Prurutis, Jaundice
Fatigue
Osteoperosis
Can lead to ascending cholangitis (can be initial presentation)

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59
Q

Serous Cystic Neoplasm

A

Always Benign

Common on Pancreatic Tail

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60
Q

What labs do you want to monitor to screen for HCC?

A

Alpha Fetoprotein and Ultrasound every 6 mos

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61
Q

Lab finding in Pancreatic Cancer

A

CA 19-9 above 100 without biliary causes

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62
Q

Cirrhosis Pattern

A

Decreased Albumin, Elevated Gamma Globulins, Elevated PT

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63
Q

Choice of imaging for Budd Chiari

A

Contrast Enhanced Ultrasound

Color or Pulsed-Doppler Ultrasonography

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64
Q

Signs of Pancreatic Insufficiency

A

Steatorrhea
Fecal Elastase below 100
Detection of decreased fecal chymotrypsin

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65
Q

What are the 3 prognostic indicators for acute pancreatitis?

A

Ranson Criteria
BISAP
APACHE II

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66
Q

Single Best acute measure of hepatic synthesis function

A

Coagulation Factors

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67
Q

What is the most common location of intussusception?

A

Ilium into the coilon at the ileocecal junction

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68
Q

Peliosis

A

Efflux of hepatic blood is impeded

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69
Q

Lab findings in Alcoholic Liver Disease

A 
AST 2x higher than ALT
Bilirubin above 10 mg/dL
Leukocytosis
Anemia (usually macrocytic)
Thromboctopenia, maybe
PT prolongation
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70
Q

Mucenous Cystic Neoplasm

A

Almost all in women

Common on Pancreatic Tail

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71
Q

What are the Black Box warnings for Lamivudine?

A

Lactic Acidosis
Severe Hepatomegaly
Exacerbations of Hep B
Different Formulations

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72
Q

What do you use for serologic diagnosis of Hep B if the production of Anti-HBs is delayed?

A

IgM anti-HBc

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73
Q

Cavernous Hemangioma of the Liver

A

Most common benign neoplasm of liver

Often mistaken for malignancy

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74
Q

Tx of PBC

A

Ursodeoxycholic Acid (Liver transplantation if fails)

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75
Q

Treatment of Secondary Peritonitis

A

Surgery to plug the flora leak

Antibiotics (fluoroquinolone-esque abx + metronidazole)

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76
Q

Cullens and Gray Turners Sign

Abdominal Pain

A

Pancreatitis

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77
Q

Most likely cause of elevated conjugated bilirubin in an infant?

A

Biliary Atresia

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78
Q

What are the drug interactions associated with Ledipasvir / Sofosbuvir?

A

Poly Glycoprotein Inducers may alter concentrations (St Johns Wort, etc)

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79
Q

What is the threshold for diagnosis of an abdominal aortic aneurism?

A

3.0 cm

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80
Q

What type of cell death is seen in acute toxic or ischemic injury?

A

Coagulative Necrosis

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81
Q

HELLP

A

Hemolysis
Elevated Liver enzymes
Low Platelets
(this is eclampsia)

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82
Q

Radiological findings in Chronic Pancreatitis

A

Calcifications (tumefactive chronic pancreatitis)

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83
Q

Etiology of non-alcoholic fatty liver disease

A

Metaolic Syndrome (increases risk of CKD and colorectal CA)

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84
Q

Small portal vein obstruction cause 1

A

Schistosomiasis

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85
Q

Which is the Chovstek and which is the Troussseau sign?

A

Both are for hypocalcemia. Chovstek is a facial twitch, Trousseau is a hand posture upon blood pressure check

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86
Q

What is the MOA of Ledipasvir / Sofosbuvir?

A

Ledipasvir: Hep HCV NS5A inhibitor
Sofosbuvir: HCV Nucleotide Analog NS5B Polymerase Inhibitor

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87
Q

Wilson Disease H&P

A

Young: Hepatitis, Hemolytic Anemia, Neuro-Psych
Brownish Kayser Fleischer Ring around iris edge
ass’d with renal calculi, hemolytic anemia, subQ lipomas

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88
Q

What are the Indications of PEG IFN Alfa-2a?

A

Treating chronic hep C with compensated liver disease not previously treated with IFN-a.
Treating chronic Hep B in people with compensated liver disease and evidence of viral replication and liver inflammation

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89
Q

Trypsin Inhibitor

A

Kazal Type I (SPINK1)

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90
Q

MEN2A

A

Thyroid (elevated calcitonin)
Adrenal (elevated catecholamines)
Parathyroid (hypercalcemia)

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91
Q

Fibropolycystic disease of the liver lesion embryology

A

Ductal Plate malformation from persistent fetal periportal ductal plates
Increased risk of cholangiocarcinoma

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92
Q

What are the major risk factors of gallstones?

A

Family History, Fair, Fat, Female, Forty

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93
Q

Etiology of Biliary Dyskinesia

A

Unknown

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94
Q

Choledochal Cyst predisositions

A

Stone Formation
Stenosis and Stricture
Pancreatitis
Obstructive Biliary Complications within Liver

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95
Q

What family is Hep A in?

A

ssRNA

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96
Q

alpha 1 antitrypsin deficiency diagnostics

A

PiZ / PIZZ gene on chromosome 14

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97
Q

HCV characteristic histology

A

Portal tract expansion by a lymphoid follicle

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98
Q

What are the indications for Telbivudine?

A

Chronic Hep B patients with evidence of viral replication, persistent elevations in ALT or AST or histologically active disease

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99
Q

What is the best predictor of HBV chronicity?

A

Age at time of infection (younger more likely to be chronic)

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100
Q

How do you treat auto-immune hepatitis?

A

Prednisne

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101
Q

What is the MOA of Tenofovir?

A

Reverse Transcriptase inhibitor (remember HIV?)

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102
Q

HBx

A

Transcriptional Transactivator of viral genes

Implicated in related Hepatocellular Carcinoma

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103
Q

What are the major Unconjugated / indirect Jaundices?

A

Hemolytic Syndrome
Gilbert Syndrome
Crigler Najjar Syndrome

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104
Q

Primary Biliary Cholangitis (PBC) Etiology

A

Autoimmune destruction of small bile ducts, cholestasis
Female / 50 y.o. Predominance
Asx isolated elevation in Alk Phos OR impaired bile excretion

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105
Q

PBC Diagnostics

A 
Antimitochondrial Abs (AMA)
Increased Alk Phos and IgM
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106
Q

CCK functions

A
  1. Smooth Muscle Contraction (release bile from GB)

2. Tell Spincter of Oddi to Relax

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107
Q

Labs for Hep D

A

HDV RNA on PCR

108
Q

Etiology of Hemochromatosis

A

HFE gene mutation on chr 6
Increased Fe absorption in duodenum
Increased accumulation of hemosiderin in so many organs

109
Q

Hepatoblasoma presentation

A

Pediatric Abdominal Swelling

Sx related to liver dysfunction

110
Q

What is the best way to measure the severity of GERD?

A

24-hour intra-esophageal pH

Impedance monitoring

111
Q

Hep D Labs

A

HDV RNA (PCR)

112
Q

What is the duration of Hep A?

A

Incubation 2-3 weeks, up to 6

Self-Limited

113
Q

What are the main differences in physical presentation between HBV and HCV?

A

HBV: Polyarteritis Nodosa
HCV: Mixed Cryoglobulinemia

114
Q

Associated conditions of PBC

A

Sjogrens, Scleroderma, Thyroid Disease, Females

115
Q

What are the major adverse reactions of Telbivudine?

A

Increased Creatine Kinase

116
Q

Hemochromatosis tx

A

Phlebotomy
PPI
Deferoxamine (chelating agent)

117
Q

Clinical findings of Dubin-Johnson Syndrome

A

Benign, symptomatic. Liver Darkly Pigmented on gross examination. Excellent Px

118
Q

What enzyme hasn’t kicked in at birth, leading to physiologic jaundice of the newborn?

A

UGT1A1

119
Q

Complications of Hemochromatosis

A

Infections of Yersinia Enterocolitica, vibrio vulnificus, listeria

120
Q

Complications of Hep C

A

Cirrhosis
Hepatocelluar Carcinoma
HIV Co-Infection
pathogenic factor in Mixed Cryoglobulinemia

121
Q

Charcot Triad

A

RUQ pain
Fever with Chills
Jaundice
(this is found in Ascending Cholangitis)

122
Q

Multiple Nodules, looking like cirrhosis, but no fibrous septa

A

Nodular Regenerative Heyperplasia (in liver)

123
Q

Risk factors for Hep D

A

HBsAg+, especially IV drug users (percutaneous)

124
Q

Chronic Pancreatitis Sx

A 
Abdominal and Back Pain
Calcifications
Pseudocyst
Pancreatic Exocrine Insufficiency
DM
125
Q

How do you interpret SAAG results?

A

= ascites albumin - serum albumin
Greater than 1.1 think portal HTN
greater than 250 PMNs/mL think SBP

126
Q

Treatment of Auto-immune Hepatitis

A

Glucocorticoids

127
Q

What is the Black Box warning for Ribivarin?

A

Serious Disorders and birth defects

DO NOT USE in pregnancy and for 6 most after treatment

128
Q

What babies are most at risk for hyperbilirubinemia?

A

Born to moms who are Type O or Rh(-)

129
Q

Findings of Intrahepatic Cholestasis of Pregnancy

A 
Pruritis
Darkening of Urine
Light Stools
Jaundice
Total bilirubin usually below 5, do a bx for canalicular cholesasis
130
Q

How do you treat SBP?

A

Ceftriaxone of Cefotaxime with IV albumin

131
Q

Most common cause of jaundice in pregnancy

A

Viral Hepatitisw

132
Q

Acute Liver Failure Treatment

A

Liver Failure

N-Acetylcysteine in Acetaminophen OD

133
Q

Clinical Features of Gilbert Syndrome

A

Benign hereditary jaundice
hyperbilirubinemia after 24 - 36hr fast
No treatment required
Reduced CVD mortality

134
Q

What is GGT sensitive for?

A

Liver Disease

135
Q

MEN2B

A 
Marfanoid body
Medullary thyroid cancer
Pheocromocytomas
Neuromas on face structures
Often a new mutation: no family history
136
Q

Define Acute Liver Failure

A

Liver disease associated with encephalopathy and coagulopathy that Occurs Within 26 Weeks of the Initial Liver Injury in the Absence of Pre-Existing Liver Disease

137
Q

Portal Triad

A 
Portal Vein (branch)
Hepatic Artery (branch)
Bile Duct (branch)
138
Q

Single well-demarcated lesion with central scar

A

Focal Nodular Hyperplasia (in liver)

139
Q

Diagnostic Radiography of Acute Pancreatitis

A 
Sentinel Loop (air filled intestine, usually in LUQ)
Colon Cutoff Sign (gas-filled blunt ended transverse)
Rapid-Bolus intravenous Contrast-Enhanced CT:
   (avoid when serum Cr > 1.5 mg/dL)
140
Q

What is the MOA of Boceprevir?

A

NS3/4A protease inhibitor for Chronic Hep C
Combo with Peginterferon alfa and Ribavirin
Use when previous IFN and Ribavirin therapy fails

141
Q

Associations of Hepatoblastoma

A

FAP

Beckwith-Wiedemann Syndrome

142
Q

Physical presentation of Preeclampsia and Eclampsia

A

Maternal Hypertension
Proteinuria
Peripheral Edema
Coagulation Abnormalities

143
Q

Chronic Hepatitis Pattern

A

Acute (elevated transaminase) AND cirrhosis (decreased albumin, elevated gamma globulins, elevated PT) patterns

144
Q

Autoimmune Hepatitis HLA alleles for Caucasians, Japanese, South Americans

A

Caucasians: DR3
Japanese: DR4
South Americans: DRB1

145
Q

How do you interpret a Child Turcottte Pugh score vs a MELD/MELD-Na score?

A

CTP: A-C (C or above a “7” is worst)
MELD: Over 10 is bad, Over 14 you want a transplant

146
Q

Minimal risk, mainly women, hepatocellular adenoma subtype.

A

HNF1-a

147
Q

CASR

A

Calcium sensing Receptor
Senses Calcium and controls it. Mut activates Trypsin
3q13

148
Q

Most common bugs of SBP

A

E Coli

Klebsiella

149
Q

Detection of intra vs extra hepatic adenocarcinoma

A

Intrahepatic: Incidental on imaging
Extrahepatic: Like biliary tree obstruction

150
Q

What are the warnings associated with Velpatasvir / Sofosbuvir?

A

Can potentiate bradycardia with Amiodarone co-admin

Caution those using b-Blockers or with underlying cardiac comorbitidies / Advanced liver disease

151
Q

What is the transmission of Hep A?

A

Fecal Oral

152
Q

Biliary Dyskinesia Physical Signs

A

RUQ Pain
Severe Pain
Nausea

153
Q

Oral contraceptives and anabolic steroids, can cause pain from rapid growth, hemorrhage, rupture.

A

B-Catenin Hepatocellular Adenoma

154
Q

Diagnostic Labs of Acute Pancreatits

A

Lipase 3x more than Upper Limit Normal

155
Q

Fibropolysistic Disease of the liver findings

A

Von Meyenburn Complexes: hamartomas
Simple Multiple Biliary Cysts: Caroli Disease
Congenityal Hepatic Fibrosis: Caroli Syndrome

156
Q

Physical signs of Pancreatic Cancer

A

Painless Jaundice
Trousseau Sign of Malignancy (red leg spiral)
Courvoisier Sign (palpable gallbladder)

157
Q

What are the contraindications of Boceprevir?

A

All the same as PEG-IFN-alfa and Ribavirin (kills fetuses)

158
Q

What is the MOA of Lamivudine?

A

Nucleoside Analogue for Hep B (also tx HIV)

159
Q

PRSS1

A

Serine Protease 1
Cationic Trypsin. GOF mut prevents trypsin inactivation
7q34
40% chance of developing pancreatic cancer

160
Q

Caroli Syndrome

A

Disease (multifocal cystic dilation of large bile ducts)

+ Congenital Hepatic Fibrosis

161
Q

What is the MOA of Velpatasvir / Sofosbuvir?

A

Sofosbuvir: HCV nucleotide analog NS5B Pol. Inhibitor
Velpatasvir: HCV NS5A Inhibitor

162
Q

Tests for Cholestatic function

A

Primary Alkaline Phosphatase and Bilirubin Elevated

Jaundice and pruritus, bile can’t reach duodenum

163
Q

What is the MOA of Elbasvir/Grazoprevir?

A

Hep C NS5A inhibitor (Elbasvir)

NS3/4A Protease Inhibitor (Grazoprevir)

164
Q

What are the indications for Ribivarin?

A

Nucleoside analogue for HCV in combo with IFN Alfa-2a

Ages 5+ with compensated liver disease (not previously treated with IFN Alfa-2a) and adults co-infected with HIV

165
Q

MOA of Gilbert Syndrome

A

Reduced activity of Uridine Diphosphate Glucuronyl Transferase

166
Q

What is Entecavir MOA?

A

Hep B nucleoside analogue reverse transcriptase

167
Q

What are the Drug interactions associated with Velpatasvir / Sofosbuvir?

A

PGP inducers / CYP inducers

168
Q

What is the major cell type involved in hepatic scarring?

A

Hepatic Stellate Cell (stores Vit A, Converted to fibrinogenic myofibroblast)

169
Q

Precipitants of hepatic encephalopathy

A

GI bleeding
Constipation
Sepsis

170
Q

What does an apoptotic cell look like?

A

Round / Oval mass of intensely eosinophilic cytoplasmic fragments of dense nuclear chromatin

171
Q

What are the major precautions for Lamivudine?

A

Pancreatitis

172
Q

Alcoholic Liver Disease Px

A

A Maddrey’s: Poor starting at 32 and up
Glasgow good starting at 9 and up
MELD: Above 21 Is super bad

173
Q

Asterixis

A

Flapping Tremor found in hepatic encephalopathy

174
Q

Treatment for Chronic Pancreatitis

A

Supportive: Pain Control, Pancreatic Enzyme Supplement

Treat associated DM

175
Q

Hypertonia

A

Phase 3 of bilirubin toxicity in a neonate

176
Q

Obstructive Liver Disease Pattern (cholestasis)

A

Elevated ALP and Bilirubin

177
Q

Hyperbilirubinemia physical presentation

A

Icterus
Pruritus, xanthomas, ADEK deficiencies
Elevated GGT and Alk Phos

178
Q

TIGAR-O

A

Chronic Pancreatitis: Toxic-Metabolic (alcoholic); Idiopathic (early onset); Genetic (CFTR); Autoimmune (IgG4); Recurrent; Obstructive

179
Q

Complications of Budd Chiari

A

Hepatocellular Carcinoma

180
Q

What are the major adverse reactions to adefovir?

A

Asthenia

Increased Creatinine in pre and post transplantation

181
Q

What are some warnings associated with Ledipasvir / Sofosbuvir?

A

Only use in combination with Ribavirin

182
Q

Complications of Primary Sclerosing Cholangitis (PSC)

A

Increased risk of cholangiocarcinoma

183
Q

Window Period of Hep B

A

Between HBsAg disappearing and HBsAb appearing
Considered Acute
Only detectable with HBcAb IgM

184
Q

Ground-Glass Liver

A

Hepatocytes in chronic Hep B infection

Accumulation of HBV surface Ag

185
Q

Hemochromatosis Diagnostics

A 
HFE gene mutation
Elevated plasma Fe with over 45% transferrin saturation
MRI and Ct for quantification
Liver bx for cirrhosis
Screen all first degree family members
186
Q

Anti-HBe Ab

A

Signifies that acute Hep B has Peaked and is on the wane

187
Q

What family is the Hep D virus in?

A

Defective RNA

188
Q

Morphology features of chronic hepatitis

A

Increased portal chronic inflammation

189
Q

What unique warning comes with Tenofovir?

A

New onset or worsening renal impairment

190
Q

What are the two types of gallstones?

A

Cholesterol and Pigment (calcium bilirubinate)

191
Q

What are the two main causes of Acute Pancreatitis?

A

Biliary Tract Gallstones

Heavy Alcohol Use

192
Q

Gallstone Ileus / Bouveret Syndrome Etiology

A

Large stone erodes directly into an adjacent loop of small bowel

193
Q

How would you identify chronic liver failure in a patient?

A

Acute symptoms
Palmar Erythema, Spider Angiomata, Hypogonadism, Gynocomastia
Portal HTN

194
Q

Lab Findings of Pancreatitis

A 
Elevated Lipase (and amylase, less specific)
Maybe glycosuria and hypocalcemia from fat necrosis
195
Q

What is the MOA of Adefovir?

A

Nucleotide Analogue for 12 y.o.+

196
Q

How would you identify acute liver failure in a patient?

A

N/V, icterus, jaundice, elevated liver enzymes…
Coagulation Abnormalities
Hepatic Encephalopathy leading to Asterixis

197
Q

Complications of acute cholecystitis

A

Gangrene of gallbadder

Emphysematous cholecystitis

198
Q

3 of what 5 tings indicate severe acute pancreatitis complicated by necrosis?

A 
Age over 55
WBC over 16 x 10^3
Glucose over 200
Lactic Dehydrogenase over 350
Aspartate aminotransferase over 250
199
Q

Most important test when assessing ascites

A

CBC w/ Diff to rule out SBP (PMN over 250)

200
Q

Rotor Syndrome MOA

A

Reduced hepatic reuptake of bilirubin conjugates

201
Q

Elevated vs Normal gamma glutamyl transferase (GGT) upon ALP fractionation

A

Elevated most commonly from Liver

Normal consider Bone or Placenta

202
Q

What are the black box warnings for Tenofovir Disoproxil?

A

Lactic Acidosis / Severe Hepatomegaly w/ Steatosis

Post-Tx Exacerbation of Hep B

203
Q

What is the main function of a-1 Antitrypsin

A

Inhibition of proteases (esp Elastase, Cathepsin G, Proteinase 3) that are normally released at inflammation sites by neutrophils

204
Q

Diagnostics of HCC

A

Pt with known liver disease gets a bad ultrasound or has rising a fetoprotein

205
Q

What would you order for a suspected duodenal injury?

A

CT with contrast

206
Q

What are the indications for Velpatasvir / Sofosbuvir?

A

HCV without Cirrhosis (or at least compensated)

Combine with Ribavirin when its decompensated

207
Q

Primary Sclerosing Cholangitis (PSC) Diagnostics

A

Elevated Alkaline Phosphatase and Bilirubin
Beads on a string bile duct
“onion skin” periductal fibrosis on biopsy

208
Q

Neoplasm on the head of the pancreas, connected to the ductal system. Mainly in men

A

Intraductal Papillary Mucinous Neoplasm

209
Q

Defining histologic feature of chronic viral hepatitis

A

portal lymphocytic (or lymphoplasmacytic) inflammation with fibrosis

210
Q

Most pancreatic cancers are ______ and incite _____

A

Adenocarcinomas

Dense Desmoplastic reaction

211
Q

Hypoperfusion + retrograde congestion =

A

centrilobular hemorrhagic necrosis

from right sided cardiac decompensation

212
Q

Hep E family

A

ssRNA

213
Q

CTRC

A

Chymotrypsin C
Degrades Trypsin, Protecting the pancreas
1p36

214
Q

Budd Chiari Etiology

A 
Hepatic Vein Obstruction (or IVC)
Caval Webs, R Heart Failure (causing Nutmeg Liver)
Hypercoaguable State (like PV)
215
Q

What is the diagnostic test for gallstones?

A

Ultrasonography, acoustic shadow cast

216
Q

Classifications of Auto-Immune Hepatitis

A 
Type I (classic): Anti-Smooth Muscle / Anti-Nuclear Abs
Type II: Anti-Liver / Kidney Microsomal Abs
217
Q

Complications of Chronic Cholecystitis

A

Porcelain Gallbladder on Xray (calcified lesion)

Increased risk of gallbladder cancer

218
Q

What is the BISAP score for acute pancreatitis?

A 
Bun over 25
Impaired mental status
SIRS of 2-4
Age over 60
Pleural Effusion
219
Q

Rotor Syndrome Findings

A

Asymptomatic like DJ, except no pigmented liver

220
Q

How do the numbers of complications in acute pancreatitis correlate to mortality rate?

A

0 - 2: 1%
3 - 4: 16%
5 - 6: 40%
7 - 8: 100%

221
Q

Hepatocellular Adenoma associated with obesity and metabolic syndrome. Higher risk of malignant transformation

A

Inflammatory Adenomas

222
Q

What are the major signs of acute cholecystitis?

A

Tea Colored Urine or Acholic Stools
Acute attack after large fatty meals
Murphy sign

223
Q

Etiology of Chronic Pancreatitis

A

Usually from alcoholism
Recurrent episodes of acute pancreatitis
Malabsorption (exocrine insufficiency, steatorrhea)
DM (endocrine insufficiency)

224
Q

What are the Black Box warnings of PEG IFN Alfa-2a?

A

Serious disorders and Ribavirin Ass’d Effects

fetal death?

225
Q

How much alcohol does it take to cause alcoholic liver disease?

A

Takes 10+ Years:
Males: over 80g /day
Females: over 30-40 g/day

226
Q

What is the Hep B family?

A

Partially dsDNA

227
Q

Hemochromatosis Mutation

A

HFE: C262Y

228
Q

Treatment / Management of Acute Pancreatitis

A
  1. IV fluid resuscitation
    Treat the cause
    Severe: Early surgical consult, ICU monitoring
229
Q

Alcoholic Liver disease bx findings

A

Mallory-Denk Bodies (alcoholic hyaline)

230
Q

Liver failure from heart failure Dx

A

Elevated Serum N-terminal-ProBNP or BNP

Hallmark Shock Liver of aminotransferase levels (often above 5k units/L), early rapid rise in LDH

231
Q

Hypochloremic, Hypokaelmic, Metabolic Alkalosis

A

Pyloric Stenosis

232
Q

What are the major Conjugated / direct jaundices?

A

Dubin - Johnson
Rotor
Drug Reaction
Pregnancy

233
Q

What is the transmission of Hep B?

A

Parenteral, Sexual, Perinatal (esp BHsAg+ mothers)
Percutaneous
Endemic to Southeast Asia and Sub Saharan Africa

234
Q

Acute Liver Failure Diagnostics

A

Rapidly Rising Bilirubin Level
PT prolongation even as AST/ALT fall
Acetaminophen level via Rumack-Matthew Nanogram

235
Q

Alpha 1 Anti-Trypsin Deficiency etiology

A

AR deficiency leads to Pulmonary Emphysema
Hepatocellular accumulation of misfiled proteins causes Liver Disease
Most Common Inherited hepatic disorder in pediatrics

236
Q

What is a Direct Coombs Test?

A

Looks for Abs on a baby’s RBCs.
when hyperbilirubinemia is maybe from hemolysis
(ABO incompatibility in newborns)

237
Q

What are the major warnings indicated with Adefovir?

A

Nephrotoxicity (look for drug-drug interactions)

Exacerbations of Hep B

238
Q

Tests for Hepatocellular damage

A

Primary AST and ALT

239
Q

You can get Emphysema with your pancreatitis. How would you treat it?

A

Surgical debridement and antibiotics

240
Q

Hypertonia of muscles, opsithononus (ricin arching), retrocollis, maaaaaaybe fever

A

Phase 2 of bilirubin toxicity in a neonate

241
Q

Diagnostics of Hepatic Encephalopathy

A

Clinical

elevated ammonia levels

242
Q

What are the black box warnings for Telbivudine?

A

Lactic Acidosis
Severe hepatomegaly with Steatosis
Severe Exacerbations of Hep B

243
Q

Pseudocysts vs Congenital Pancreatic Cyst

A

Pseudocyst lacks epithelial lining

244
Q

What are the major contraindications of Telbivudine?

A

Combination with PEGylated IFN alfa-2a increases risk of peripheral neuropathy

245
Q

Wilson Disease Etiology

A 
AR mut on Chr 13 at ATP7B
Impaired Copper excretion and incorporation
Accumulation in liver brain and eyes
Toxic to RBC: hemolytic Anemia
Neuropsychiatric disease in young adults
246
Q

Hemochromatosis H&P

A

Tetrad: Cirrhosis w/ hepatomegaly, Abnormal Skin Pigmentation, DM, Cardiac Dysfxn
Later: Hypogonadism

247
Q

Cholestatic Jaundice (conjugated), Hepatomegaly, Acholic Stools

A

Biliar Atresia

248
Q

Poor Suck, High Pitched Cry, Listlessness, poor tone, yellow skin, maaaaaaybe seizure

A

Phase 1 of bilirubin toxicity in a neonate.

249
Q

MEN1

A

Parathyroid (hypercalcemia, more PTH)
Pancreas (Gastrinoma, insuinoma / hypoglycemia)
Pituitary (Acromegaly, Cushing)

250
Q

Physical presentation of Chronic Pancreatitis

A

Pain (cardinal symptom)
Steatorrhea
Unintentional Weight loss
Fatigue

251
Q

Symptoms of Hep B

A

Fever, Enlarged Liver, Jaundice

Polyarteritis Nodosa

252
Q

Intrahepatic vs extra hepatic biliary tree adinocarcinomas

A

Intrahepatic: Intrahepatic Cholangiocarcinoma
Extrahepatic: Biliary Adenocarcinoma

253
Q

HBcAg

A

Nucleocapsid protein
Role in Assembly of complete virions
Longer polypeptide transcript with precode and core region (HbeAg)

254
Q

Reynold Pentad

A

Charcot Triad
Confusion
Hypotension
(acute suppurative cholangitis, Endoscopic Emergency)

255
Q

MOA of Dubin-Johnson Syndrome

A

reduced hepatocyte excretory function

256
Q

What are the contraindications of Ribivarin?

A

Pregnancy and Hemoglobinopathies

257
Q

What imaging techniques would you use for children vs adults?

A

Adults: CT abdomen and pelvis w/ contrast
Children: Ultrasound RLQ first, then CT if (-)
Pregnant: MRI

258
Q

What are the labs in Hep A?

A

Markedly elevated AST / ALT
Elevated bilirubin and Alk Phosphatase = Cholestasis
IgM anti-HAV

259
Q

Prognosis of Chronic Pancreatitis

A

Pancreatic CA is main cause of death

260
Q

Treatment of Primary Sclerosing Cholangitis (PSC)

A

None

261
Q

Anti-HBs Ag

A

Rises after resolution of acute Hep B (may be delayed)
Persists for life, confers protection
Not in cases that become chronic

262
Q

Hepatomegaly, Abdominal Pain, Ascites

A

Classic Triad of Hepatic Vein Thrombosis

263
Q

What are the contraindications of Elbasvir / Grazoprevir?

A

Patients with moderate or severe Hepatic Impairement

ALT elevations

264
Q

Diagnostic labs of Acute Cholecystitis

A

Leukocytosis
Bilirubinemia
Increased ALP and GGT

265
Q

How do you treat biliary cholangitis / cirrhosis?

A

Urodeoxycholic acid

266
Q

Treatment of Alcoholic Liver Disease

A

Daily Multivitamin: Glucose, Thiamine to avoid Wernicke Korsakoff
Steroids and Pentoxifylline for severe cases

GI II (4 decks)

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