Bernadino: Liver Dysfunction and Gallbladder Disease Flashcards Preview

GI- Week 6 > Bernadino: Liver Dysfunction and Gallbladder Disease > Flashcards

Flashcards in Bernadino: Liver Dysfunction and Gallbladder Disease Deck (45):
1

What is the most common etiology of jaundice in an infant?

physiologic (goes away in a few weeks)

2

What are the most common causes of jaundice in an adolescent?

Gilbert's syndrome
HAV

3

What are the MC causes of jaundice in young adults?

mostly viral hepatitis
followed by EtOH, autoimmune
biliary tract

4

What are the MC causes of jaundice in the elderly?

malignancy
toxins/drugs
stones

5

What can cause jaundice in the first and second trimester?

viral hepatitis

6

What causes jaundice in the 3rd trimester?

preeclampsia
cholestasis of pregnancy

7

What is Gilbert syndrome?

AD-benign
An increase in unconjugated bilirubinemia brought on by illness, fasting stress, fatigue, EtOH, nicotinic acid intake, premenstrual periods in some women

*my dad has this!

8

What indicates hepatocellular jaundice?

AST/ALT elevation > bilirubin or alk phos

Suggests parenchymal inflam.

9

What causes unconjugated hyperbilirubinemia?

Hemolysis
Gilbert’s syndrome
Medication (typically abx)

10

What causes conjugated hyperbilirubinemia?

Intrinsic liver disease
Medication
Biliary tract obstruction

11

What are the 3 ways that jaundice can present?

1. Jaundice= >2-3 mg/dl
2. first noticeable in sclera (icterus)
3. Intense itching--seen w/ cholestasis but does NOT correlate w/ degree of hyperbilirubinemia

12

What causes the intense itching associated w/ jaundice? How do you tx itching caused by jaundice?

retained bile acids

correct obstruction or use bile acid binding agents

13

Spider hemangiomas, dupuytren's contractures, caput medusa, palmer erythema and xanthelasma are all.....

physical evidence of chronic liver disease

14

What are spider hemangiomas? Are they specific to cirrhosis? How does number and size correlate to severity of liver disease?

altered estrogen metabolism in chronic liver ds.>
small pulsating arteriole>
usually on face or chest

-Not specific to cirrhosis, seen in prego and normal ppl

15

What increases the risk of variceal hemorrhage?

Increased number of spider hemangiomas

16

What are dupuytrens contractures? In what populations are they seen in?

progressive fibrosis of palmar fascia → abnormal flexion of fingers

MC in EtOH related liver ds and WHITE males
-Also seen in diabetes, repetitive use injuries, and malignancies

17

What is caput medusa?

Portal HTN →
blood from portal venous system shunted through periumbilical veins →
umbilical vein →
abdominal wall vessels


*Presence of caput medusa → increased risk of mortality in 1 yr

18

What is a palmer erythema? Is it specific for liver disease?

vasodilation and increased blood flow>
occurs on thenar and hypothenar eminences and finger tipes

*Not specific for liver disease
Seen in:
prego
hyperthyroidism
RA
hematologic malignancies

19

What is an xanthelasma?

chronic cholestasis marked by hypercholesterolemia>
Lipid deposition in the dermis and subcutaneous tissue>
extensor surfaces of extremities and around eyes

20

What is the first choice for diagnosing gallstones or cholecystitis

Transabdominal US

21

How does cholecystitis appear on US?

pericholecystic fluid
GB wall thickening (4 mm)

22

What complications are associated w/ cholelithiasis and cholelocholithiasis?

• Biliary pain
• Acute cholecystitis
• Chronic cholecystitis – scarring wall → no contraction
• Choledocholithiasis - stones in bile duct
• Cholangitis - infxn of bile duct
• Gallstone pancreatitis - reflux into pancreas

23

***What characterizes biliary pain?

colic- crescendo/decrescendo
minutes to hurs
spasm of GB if cystic duct obstruction
often POST PRANDIAL
RUQ
Radiates to interscapular region of right shoulder
N and V
Pain > 6 hrs; fever suggests cholecystitis/cholangitis

24

What causes biliary type pain w/ NO stones?

missed stones
Microlithiasis (stones too small to see on US)
HIDA scan → can show bile leak

25

How does Acute cholecystitis present?

Murphy sign- RUQ tenderness on inspiration
Palpable gallbladder

26

Labs come back and show elevated WBC, mild increase in amylase and lipase and normal liver functions. The US shows gallbaldder w/ wall thickening > 4 mm.

Dx?

acute cholecystitis

27

How do you tx acute cholecystitis?

Broad spectrum abx
Pain management
Cholecystectomy w/in 96 hrs of Sx onset - 70% of pts w/ biliary colic will develop complications w/in 2 yrs of onset of Sx

28

What is Acalculous cholecystitis?

Occurs in 5-10% of acute cholecystitis cases.
Usually in hospitalized, critically ill pts after major surgery or trauma.
Leads to gallbaldder stasis and ischemia.

29

How do ou tx acalculous cholecystitis?

broad spectrum abx
cholecystectomy
cholecyst tube

30

What are serious complications of laprascopic cholecystectomys?

bleeding, abcess formation, leaks

31

What is cholangitis? MC cause?

Infection of the bile duct
85% are caused by gall stones

32

What pathogens can cause cholangitis?

E. coli, Klebsiella, Pseudomonas, enterococci, and Proteus

33

How do you tx cholangitis?

broad spectrum abx
ERCP for bile duct decompression

34

What causes 40% of acute pancreatitis cases?

gallstones and EtOH>
stone passage, stone obstruction>
biliopancreatic reflux

35

How do you manage pancreatitis?

hydration
bowel rest
pain control
possibly abx

36

What are complications associated w/ necrotizing pancreatitis?

organ failure, pseudocyst, diabetes, disconnected duct, etc.

37

What cancer is an uncommon adenocarcinoma that often causes proximal obstruction and has a poor prognosis w/ 5 yr survival?

Gallbladder cancer

38

What is cholangiocarcinoma? What is the diference between intrahepatic and extrahepatic tumors?

adenocarcinoma of biliary epithelium

intrahepatic> early sx
extrahepati> late sx (worse prognosis)

39

How to you tx cholangiocarcinoma?

surgical resection

40

What is the most sensitive method to detect ascites?

transabdominal US

41

What is good at detecting pancreatic cancer and liver metasteses?

CT

42

What is used to dx liver lesions seen on US or CT?

MRI or MRCP

43

What is used to dx sclerosing cholangitis?

MCRP

44

What imaging method is best for looking at stones?

EUS

45

What is a HIDA scan?

IV technetium labeled> taken up and excreted by hepatocytes>
visualization of bile duct, gall bladder, small bowel

*non-visualization of GB is considered a + test