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GI II Exam 2 > Hepatobiliary Disease > Flashcards

Hepatobiliary Disease Flashcards

1
Q

Why is LFT a misnomer?

A

AST/ALT, ALP, and Bilirubin are more indicative of liver damage compared to function.

Function tests:

  1. PT/INR
  2. Albumin
  3. Cholesterol
  4. Ammonia
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2
Q

Hepatocellular vs. Cholestatic disease

A

Hepatocellular: Injury to hepatocytes

  • Elevated AST/ALT*
  • ALT more specific

Cholestatic: injury to bile ducts
- Elevated ALP and Bilirubin

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3
Q

Bilirubin test are indicative of what?

A

Hepatic uptake, metabolic, and excretory functions

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4
Q

AST/ALT tests are indicative of what?

A

liver cell injury

  • Highest in hepatocellular necrosis
  • Complete biliary obstruction
  • Moderate response to EtOH induced damage
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5
Q

Alkaline Phophatase indications

A

Cholestasis
Biliary obstruction
Liver infiltration
NORMAL elevation in childhood and pregnancy

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6
Q

y-Glutamyl Transpeptidase (GGT)

A

Correlates with ALP

If elevated, think liver problem

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7
Q

What is the best measure of hepatic synthetic function?

A

INR test.

If corrects with Vit. K replacement= fat malabsorption, not liver disease

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8
Q

In Hemolysis, is there an elevation in unconjugated or conjugated bilirubin?

A

Unconjugated

Liver is fine and working to conjugate, but there is an abundance of bilirubin

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9
Q

Murphy’s Sign

A

Tests for acute cholecystitis.

Pain on palpation in RUQ

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10
Q

Cholelithiasis

A

Formation of gallstones

  • Cholesterol
  • Pigment (calcium)
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11
Q

Signs of Cholelithiasis

A
  1. Biliary Colic- steady RUQ pain 30-90 mins post prandial that can radiate to right shoulder
  2. NV
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12
Q

Patient shows an acoustic shadow on Ultrasound. What is this indicative of?

A

Cholelithiasis

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13
Q

F’s of Cholelithiasis

A 
Forty
Fat
Fertile
Female
Family History
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14
Q

What are some protective factors from cholelithiasis?

A

Low carb diet
Physical activity
Caffeinated coffee (thank god)
ASA and NSAIDs

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15
Q

Where is the most common place for a calculous to be impacted and cause acute cholecystitis?

A

Cystic duct

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16
Q

PE presentation of acute cholecystitis

A 
RUQ pain
NV
Fever and Leukocytosis 
Tea-colored urine or acholic stools 
Increased bilirubin, ALP, GGT
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17
Q

Choledocholithiasis

A

Stone in the common bile duct obstructing both biliary and liver secretions. JAUNDICE

  • Can lead to ascending cholangitis
  • ERCP diagnostic and therapeutic
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18
Q

Ascending Cholangitis

A 
Infiltration of duodenal bacteria into the biliary tract
Charcot Triad: 
1. RUQ pain
2. Fever
3. Jaundice

Reynolds Pentad:
Charcot + AMS + hypotension- EMERGENCY

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19
Q

Common bacteria seen on gram stain in ascending cholangitis

A

E. Coli
Klebsiella
Enterococcus

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20
Q

What should be measured prior to performing an ERCP?

A

INR (don’t want them to bleed out)

Pregnancy test in women

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21
Q

Biliary Dyskinesia

A 
Gallbladder just randomly stops working 
Presents like biliary colic
- RUQ pain
- NV
Normal US 
HIDA scan shows abnormal ejection fraction 
Tx: Cholycystectomy
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22
Q

Chronic Cholecystitis

A

Repeated acute cholecystitis
Lab tests are Normal
XR: Porcelain Gallbladder= risk of gallbladder cancer

23
Q

What malignancy is Courvoiseir’s sign indicative of?

A

cancer of the head of the pancreas

Remember: Courvoiseir’s= enlarged NONTENDER Gallbladder

24
Q

Primary Sclerosing Cholangitis

A 
"Beads on a string" due to dilations and strictures in biliary tree
Males
UC association 
PE: Pruritis and Jaundice
Increased risk of Cholangiocarcinoma
25
Q

What is the most common cause of fulminant liver failure (ALF)?

A

Acetaminophen overdose

26
Q

Describe ALF

A

massive hepatic necrosis with impaired consciousness that can result in cerebral edema and sepsis

27
Q

PE exam findings in ALF

A

rapidly shrinking liver, rising bilirubin, prolonged PT, AMS

28
Q

What can be given to a patient suffering from ALF due to Acetaminophen overdose?

A

N-Acetylcysteine (NAC)

Mucomyst (brand)

29
Q

3 top causes of acute hepatitis

A
  1. Viral
  2. Drugs
  3. Ischemia
30
Q

What would be seen on PE in acute hepatitis?

A

Jaundice
Hepatomegaly
RUQ pain
Dermatological changes (Polyarteritis, cryoglobulinemia)

31
Q

A patient presents with NV, RUQ pain, hepatomegaly, a and jaundice. They are a smoker, but now say they can’t even stand the smell. Ddx?

A 
Hepatitis A
- aversion to smoking
- echoic stools 
- elevated bilirubin and ALP 
Detection of IgM anti-HAV is excellent prognosis
32
Q

Common risk factors of HBV

A 
Anal sex
IV drug use 
Medical worker (needle sticks)
Incarcerated
previous STI
33
Q

What kind of lab pattern does HBV show?

A

Hepatocellular (elevated AST/ALT)

34
Q

What are HBV positive patients at risk of developing?

A

HCC

Cirrhosis

35
Q

Describe the window period of HBV infection

A

Early in the disease course, HBsAg is cancelled out by Anti-HBs, and IgM-antiHBc is the only thing detected.

If in stem you see IgM-antiHBc positive, patient has ACTIVE infection

36
Q

Acute HBV infection serology

A

HbsAg +
IgM-antiHBc +
HBeAg and HBV DNA +

37
Q

What does a positive HBeAg and HBV DNA serology indicate?

A

Active replication which is active disease

38
Q

What is the only positive serology finding in an immunized person with no previous infection?

A

Anti-HBs

only see Ab’s to core if you’ve had the infection

39
Q

What is required to have an HDV infection?

A

HBV

40
Q

What type of Hepatitis strain is associated with HIV infection?

A

HCV

41
Q

What Hepatitis strain is associated with immunocompromised patients?

A

HEV

42
Q

What is the minimal time period after ingestion to use the Rumack-Matthew Nomogram to evaluate acetaminophen Overdose?

A

4 hours

Critical ingestion-treatment interval for protection against hepatic injury is 0-8 hours

43
Q

Budd-Chiari Syndrome

A

Occlusion of the hepatic vein or IVC

  • Caused by Right-sided HF or Caval Webs that obstructs IVC
  • Leads to nutmeg liver
  • Screening test of choice is a CEUS (contrast-enhanced ultrasound)
44
Q

What is HELLP syndrome and what is it associated with?

A

Hemolysis, Elevated liver enzymes, Low platelet count,

Associated with Pre-eclampsia and Eclampsia leading to hepatic disease of pregnancy

45
Q

Acute Fatty liver of pregnancy

A

many disorders lead to hepatic dysfunction that can result in failure, coma, and death.

You will get pregnant, and DIE

46
Q

Clinical jaundice is defined as:

A

bilirubin >3 mg/dL

47
Q

2 unconjugated (indirect) bilirubinemias we need to know

A

Hemolytic Syndrome
Gilbert Syndrome

Criggler-Najjar because I said so

48
Q

4 causes of conjugated (direct) bilirubinemias

A
  1. Dubin-Johnson: black liver
  2. Rotor Syndrome
  3. Drug reaction
  4. Pregnancy
49
Q

If GGT is elevated, what is the suspected source of jaundice?

A

Liver

If normal: suspect bone or something else

50
Q

If you suspect Jaundice secondary to hemolysis, what would be seen on CBC?

A

Anemia
Thrombocytopenia
Increased LDH, haptoglobin, reticulocyte count

51
Q

Gilbert Syndrome

A

Reduced uridine diphosphate glucoronyl transferase

  • increased indirect bili
  • Benign, no harmful, actually protective against CV disease
52
Q

Dubin Johnson Syndrome

A

reduced excretion of bilirubin from hepatocytes due to mutation in ABCC2 gene encoding for MDRP2.
Black liver

53
Q

Rotor Syndrome

A

Reduced uptake of bilirubin in the liver causing elevated direct bilirubin.
OATP1B1 protein

54
Q

Bilirubinemia due to pregnancy

A

Mainly Direct bilirubin

- itching in the 3rd trimester, GI symptoms, excellent prognosis

GI II Exam 2 (16 decks)

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