Case #4 Flashcards
(74 cards)
1
Q
What does a Guiac test check for?
A
Blood
2
Q
What do H2 blockers do?
A
Block Histamine that would promote acid secretion
Used to treat peptic ulcer disease
3
Q
Hemorrhoids often associated with
A
Liver Hypertension
4
Q
Increased girth with decreased weight may indicate…
A
Ascites
5
Q
Jugular venous distention is an indicator of…
A
Heart Failure
6
Q
What are carotid bruits?
A
Sounds of turbulent blood flow
7
Q
What are rales?
A
Rattling breathing sound heard with stethoscope
8
Q
What are ronchi?
A
Continuious low pitched rattling sound (kind of like snoring)
9
Q
Two vascular signs often associated with liver damage/portal hypertension?
A
Caput medusae
Spider angiomata
10
Q
Positive shifting dullness + fluid wave =
A
Ascites
11
Q
Why would patient #4 have gynecomastia?
A
Alcohol inhibits testosterone, making gy. more likely
12
Q
Clubbing is assocaited with….
A
COPD
13
Q
Asterixis…
A
Flapping tremor of the hand associated with faulty metabolism
14
Q
BUN is an indicator of
A
High – Kidney Probs
Low – Liver Probs
15
Q
What is gamma-GT used for?
A
Indicator of Liver Enzymes
Elevated in people drinking
16
Q
High ammonia indicates….
A
low liver fxn
17
Q
Lactic dehydrogenase indicates…
A
Tissue Damage
18
Q
Direct Bilirubin =
Indirect =
A
D = Conjugated I = Unconjugated
19
Q
Macrocytic Anemia is associated with…
A
B12 deficiency, common in alcoholics
20
Q
Abdominal fluid colors -- Milky indicates... Turbid indicates... Yellow indicates... Green indicates.... Red indicates....
A
M --> Triglycerides, Obstruction T --> Infection D --> Jaundice/Liver Disease G --> Bile R --> Blood
21
Q
Significance of Serum-to-Ascites gradient?
A
Over 1.1 indicates Portal Hypertension
22
Q
Significance of total protein level below 2.5?
A
Indicates cirrhosis
23
Q
What is gastric lavage?
A
Stomach pump
24
Q
What is diazepam used for?
A
Anxiety and anti-seizure
25
Why would patient #4 start a low-sodium, low-protein diet?
To help with edema/ascites
26
What is lactulose?
Sugar that traps ammonia in the colon to help prevent reabsorption
27
What do coffee grounds in vom blood indicate?
Blood interacting with stomach acid
28
What do tarry stools indicate?
Upper GI bleed
29
What happens in esophageal varicies?
- Venous plexous around the esophagus becomes distended
- Veins erode into lumen, causing bleeding
- Exacerbated by coagulopathy
- Significant cause of death
30
What might you look to to indicate low intravascular volume?
Orthostatic Hypotension
Tachycardia
Water reabs -- low hematocrit, hemo, electrolyte conc.
31
What does cirrhosis liver look like?
Small, Fibrotic - Regeneration of damaged hepatocytes and fibrosis
32
Why does cirrhosis present with encephalopathy?
No blood in liver = no filtering
| Ammonia stays put and fucks shit up
33
Why would the liver get larger in an alcoholic?
Fatty Deposits, Inflammation
34
Alcoholic Liver...early, later, and end stage tissue type
Early - Large, Fatty
Later - Large, Tender, Inflamm., Dying cells
Cirrhosis - Small, Fibrotic, Scar with less liver tissue
35
What liver enzyme levels do you see at diff stages of liver damage?
Early -- Normal
Later -- Greatly increased (due to necrosis)
Cirrhosis -- Slightly Elevated-Normal (the cells are already gone)
36
Micronodular cirrhosis typically associated with...
Alcohol
37
Macronodular cirrhosis typically associated with...
Hepatitis
38
Fibrosis leads to vascular obstruction. This leads to...
Portal Hypertension + Ascites
39
Why does vascular block --> Ascites?
Lymph can't get through the liver, percolates off the liver capsule
40
Complications of ascites in liver damage cases?
Sodium retention and hypoalbuminemia
41
Three broad causes of cirrhosis? Examples?
Toxic: Alcohol
Infectious: Hep B and C
Hereditary: Hemochromatosis, Wilson's, alpha1-antitrypsin
42
Four signs of ascites?
Large, protruding abdomen
Increased girth without weight gain
Umbilical Herniation
Fluid Wave on Exam
43
What are the six Fs of abdominal swelling
Flatus, Fat, Fluid, Fetus, Feces, Fatal Growth
44
Problem with lowered albumin?
Decreased blood oncotic pressure
45
Symptoms of hyperestrogenism?
Spider telangiectasia
Palmar erythema
Gynecomastia
No public hair
46
Why the hypercholesterolemia?
Liver processes cholesterol via bile
47
Source of hyperbilirubinemia?
Intrahepatic biliary tract obstruction
| Lack of Processing
48
Relationship of liver damage and coagulation problems?
Liver makes coagulation proteins
| Without it -- Prolonged PT/PTT, bruising
49
Why can't you pee out unconjugated bilirubin?
It isn't water souble
50
How would a gall stone alter bili. levels?
Increased levels of conjugated, but not un
51
Why is urine dark?
Extreme concentration (dehydration)
Hemoglobin/Myoglobin
Conj. Bilirubin
Food/Drug Pigments
52
Hepatic Encephalopathy Symptoms (4)
Asterixsis
Impaired Cognition/Obtundation
Impaired Spatial Perception
Day-Night Reversal
53
Cause of hepatic encephalopathy?
Decreased ammonia metabolism (due to hepatic shunts and liver failure)
54
Which liver enzyme is especially sensitive to alcohol?
Gamma-GT
55
AST vs. ALT -- which one is prone to rise the most in alcoholica?
AST
56
What might cause the highest AST/ALT values?
Acute hepatitis necrosis
57
What disease tends to have elevated alkaline phosphatase?
Extrahepatic obstruction like gall stone or cancer
58
Three most significant vitamin deficiencies in alcoholics?
Thiamine (B1), B12, and Folic Acid
59
B1 deficiency is associated with what three outcomes?
Wernicke's encephalopathy
Korsakov's Syndrome
Cerebellar Ataxia
60
Wernicke vs. Korsakov -- who is reversible?
Wernicke
61
Symptoms of Korsakov?
Memory loss, confabulation
62
What is confabulation?
The brain fills in gaps with false information
63
What does the gait of a person with cerebellar ataxia look like?
Wide based, shuffling
64
Two common symptoms of B12 deficiency.
Macrocytic Anemia
| Sensory/Vibrational Defecits (subacute combined degen)
65
Symptom of Folic Acid Deficiency?
Macrocytic Anemia
66
How to treat patient? (4 steps given)
Increase vascular Volume
Decrease varices bleeding with sclerother. and BBlockers
Treat encephalopathy with lactulose and diet
Decrease Ascites with diet
67
What is delirium tremens?
Acute Alcohol Withdrawl
| Psychomotor Agitation, Can Be fatal
68
How to treat delirium tremens
Benzodiasepines (anticonvulsant)
69
What is a Child-Pugh Score?
A scoring system used to assess likelihood of cirrhosis mortality.
Score over 9 = 80% perioperative mortality
Our Patient = 14
70
Percentage of US adults with unhealthy alcohol use? abuse/dependence?
28%
| 8.5%
71
How many drinks is unhealthy for an adult man? adult woman?
more than 14 drinks/week
more than 7 drinks/week
...the wine glass ceiling
72
Two types of alcohol questioning.
Single-Item Alcohol Screening
| AUDIT-C
73
Optimal goal of brief alcohol intervention in primary care? for a moderate to severe user
Substance Use Disorder Specialized Care
74
What will patients at risk for withdrawl first undergo?
Dotoxification.
