Al-Mehdi: Hepatobiliary Pharm Flashcards by Madeline Wing

Q

____used for emulsification of fat (breakdown and absorption)

A

bile acids

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Q

cholic acid
deoxycholic acid
chenodeoxycholic acid

A

human bile acids

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Q

cholesterol gallstone formation in a nutshell

A

cholesterol into larger vesicles and then cholesterol crystal

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Q

why can a gallstone cause pain that comes and goes

A

the pain is due to the contraction of gallbladder by CCK

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Q

what blocks CCK from being released from I cells

A

Trypsin

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Q

oral dissolution therapy used to treat cholesterol gallstones

A

URSODIOL

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Q

used in cholestatic disease (primary biliary cholangitis)

A

URSODIOL

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Q

simple gallstone is _____ predominant

A

female

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Q

chronic pancreatitis is _____ predominant

A

male

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Q

diagnostic tests for chronic pancreatitis

A

IV secretin (for volume and HCO3-)
IV CCK (for pancreatic digestive enzymes)

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Q

elevation in anti-smooth muscle antibody

A

autoimmune pancreatitis

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Q

COX 3 inhibitor used to treat pain in chronic pancreatitis

A

acetaminophen

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Q

u-opioid agonist used to treat pain in chronic pancreatitis

A

tramadol

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Q

alpha2 subunit VGCC N-type inhibitors used to treat pain in chronic pancreatitis

A

Gabapentin and pregabalin

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Q

drug used to treat pain + loss of exocrine function in chronic pancreatitis

A

PANCRELIPASE

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Q

____ cells can be stimulated and transformed and produce collagen, leading to fibrosis of liver

A

stellate cells

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Q

highly specific for hepatocyte and cholangiocyte membranes and used if ALP is elevated to distinguish from bone damage

A

GGTP

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Q

hepatocellular damage markers

A

ALT/AST

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Q

This 43-year-old man with 3-year history of mild UC presents with pruritus and an ↑ serum ALP. 7 months later, jaundice and weight loss developed. ERCP: a 2-cm mass obstructing the common hepatic duct (arrows). A catheter passed beyond the obstructing mass shows marked dilatation of the left main duct proximal to the obstruction; the right main duct is completely occluded.

A

primary sclerosing cholangitis

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Q

young men
autoimmune/toxic trigger (LPS)
strong association with IBD

A

primary sclerosing cholangitis

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Q

jaundice, hepatomegaly, pruritis, fatigue, abd pain
pANCA +
AMA -

A

primary sclerosing cholangitis

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Q

A

primary sclerosing cholangitis

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Q

UDCA (Ursodiol) has no benefit treating what

A

primary sclerosing cholangitis

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Q

high risk for cholangiocarcinoma

A

PSC

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3 ways to Rx PSC:

1. vanco + metronidazole 2. fecal microbiota transplant 3. FXR agonist

_____ activation decreases synthesis of bile acids and also increases their transport out of hepatocytes

FXR

FXR agonist (used to treat primary biliary cholangitis)

OBETICHOLIC ACID

middle-aged elderly women anti-microbial antibodies chronic granulomatous inflammation fatigue, pruritis, cirrhosis AMA + pANCA -

primary biliary cholangitis

first line treatment for primary biliary cholangitis

UDCA (ursodiol)

2nd line treatment for primary biliary cholangitis

FXR agonist (OBETICHOLIC ACID)

portal tract expanded and lymphocytes surrounding destructive granulomatous rxn centered on bile duct

primary biliary cholangitis

major labs for biliary obstruction

ALP and GGT

major lab elevation for hepatitis

AST/ALT

alcohol and enzyme-inducing drugs elevate what lab

GGT

level of bilirubin to see jaundice clinically

3.0

what is characteristic for bacterial infection

neutrophil bands

immature neutrophils produced by bone marrow that are increased in the blood when your body is fighting infection

neutrophil bands

charcot triad in cholangitis

jaundice + abd pain + fever

raynolds pentad in cholangitis

charcot triad + confusion + hypotension

to treat autoimmune hepatitis

PREDNISONE + AZATHIOPRINE

ALP > ALT/AST

biliary obstruction

palmar erythema is pathognomonic for what

liver disease

Asterixis ("flapping tremor") is pathognomonic for what

liver disease

to treat alcoholic hepatitis

PREDNISONE PENTOXYFILLINE

non specific TNF inhibitor to treat alcoholic hepatitis

PENTOXYFILLINE

to treat non-alcoholic fatty liver disease

no drugs approved yet

vitamin E pentoxyfilline metformin pioglitazone

used to help in non-alcoholic liver disease but doesn't treat

GLP-2 analogue used to treat short bowel syndrome

TEDUGLUTIDE

multiple protein kinase inhibitor used to treat hepatocellular carcinoma

SORAFENIB

HFE gene mutation loss of hepcidin (increase of iron release and absorption)

hereditary hemochromatosis

Rx hereditary hemochromatosis

phlebotomy

how to deal with iron overload in thalassemia major

blood transfusions DESFEROXAMINE

ATP7B mutation

Wilson Disease

hepatolenticular degeneration (basal ganglia damage)

Wilson's Disease

Rx Menkes disease

copper

pathognomonic for what

Wilson Disease

Rx Wilson Disease

copper chelators (TRIENTINE)

splanchnic vasoconstrictor used to treat variceal bleeds

Octreotide

to Rx ascites

Spironolactone (K+ sparing diuretic) Furosemide (loop diuretic)

bacteria produce NH3 from proteins in the gut, cirrhotic liver cannot convert NH3 to urea-----> hyperammonemia

hepatic encephalopathy

Asterixis ("flapping tremor"), lethargy, confusion, ataxia, slurred speech, coma

hepatic encephalopathy

Rx hepatic encephalopathy

LACTULOSE (ammonia to ammonium) RIFAXIMIN (inhibits RNA polymerase) ACARBOSE

avoid copper____ in patients with wilson's disease

IUD