Clinical

Question 1

What are the 2 aminotransferases found in hepatocytes?

Answer 1

ALT and AST

Question 2

Which aminotransferase is more specific for liver injury?

Answer 2

ALT

Question 3

Other than the hepatocyte membrane, where else can u find alkaline phosphate?

Answer 3

bone and placenta

Question 4

So if u test and find a high alk phos, why must u need to further test?

Answer 4

to see if the increase is from the liver or other tissues

Question 5

Which test can u do to test for liver alk phos?

Answer 5

Alk phos isoenzyme

Question 6

How can u test for liver fxn by using an enzyme of intrahepatic biliary ducts that is more specific than alk phos?

Answer 6

GGT

Question 7

Case: your pt has highly conjugated bile. What could be the 2 etiologies?

Answer 7

hepatocyte dysfxn or impaired bile flow

Question 8

Case: your pt has lowly conjugated bile. What could be the 2 etiologies?

Answer 8

Hemolysis and resorption of hematomas

Question 9

Which 4 factors does INR measure the level of, as a part of liver fxn tests?

Answer 9

II, V, VII, X

Question 10

Factors II, V, VII, and X are also dependent on what vitamin?

Answer 10

Vitamin K

Question 11

What are the 3 main causes of vitamin K deficiencies?

Answer 11

1. taking an antibiotic while fasting
2. small bowel mucosal disorders (celiacs)
3. severe cholestasis

Question 12

If you’re missing vitamin K, do u bleed longer or shorter?

Answer 12

Longer.

Question 13

So to determing if prolonged PT is from vit K deficiency or liver dysfxn, what will be the results of the PT if it is indeed a vitamin K deficiency?

Answer 13

it will normalize once u give 10mg x 3 days of vit K

Question 14

Which 2 enzymes are elevated in hepatocellular disorders?

Answer 14

ALT + AST

Question 15

The differentating point between acute and chronic disorders of the liver is before/after what time?

Answer 15

3 months

Question 16

What are the most common Sx of acute hepatitis?

Answer 16

malaise, anorexia, abd pain, jaundice, AST/ALT > 500 U/L

Question 17

How much is AST increased vs ALT in alcoholic hepatitis?

Answer 17

AST:ALT > 2:1

Question 18

In alcoholic hepatitis, what other substance is elevated within the blood?

Answer 18

bilirubin

Question 19

How much are the aminotransferases increased in chronic hepatitis?

Answer 19

2-5 fold

Question 20

Jaundice will occur in a patient with a serum bilirubin over what level?

Answer 20

2.5 mg/dL

Question 21

What Sx suggest biliary obstruction to cause jaundice?

Answer 21

abd pain, fever, or palpable gallbladder

Question 22

How can u Dx cholestatis?

Answer 22

US

Question 23

How often should u do a liver US for PHC in a pt with HBV and liver cirrhosis?

Answer 23

6-12 months

Question 24

IF there is an accidental needle-stick with a pt with HCV, what is the necessary followup testing?

Answer 24

HCVAb and ALT at 4-6 months.

Question 25

What % of NEONATAL pt's develop chronic hepatitis in HBV infections?

Answer 25

90%.

Question 26

What % of adult pt's develop chronic hepatitis in HBV infections?

Answer 26

5%

Question 27

During the prolonged immune tolerant phase of chronic HBV infections, what is the ALT levels?

Answer 27

normal

Question 28

During the HBeAg+ chronic HBV phase of chronic HBV infections, what is the ALT levels?

Answer 28

elevated (its an active infection)

Question 29

Case: a young female presents to the office with signs of chronic liver disease + amenorrhea. She has a Hx of Hashimoto thyroiditis. What is the most likely Dx?

Answer 29

autoimmune hepatitis

Question 30

What things will show up on the labs for autoimmune hepatitis?

Answer 30

ANA, SMA, SLAA, LKM Abs

Question 31

What is the first choice for treatmetn of autoimmune chronic hepatitis?

Answer 31

corticosteroids (prednisone, 30-60mg daily)

Question 32

Which drug can u give with prednisone so u can lower the dose of the steroid?

Answer 32

azathioprine

Question 33

Which enzyme is incrased in hepatomas?

Answer 33

α-fetoprotein level

Question 34

What is the equation for serum-ascitic fluid albumin gradient (SAAG)?

Answer 34

SAAG = [serum albumin] - [ascetic fluid albumin]

Question 35

A SAAG . 1.1 g/dL indicates what?

Answer 35

portal HTN

Question 36

What can cause a SAAG of , 1.1g/dL?

Answer 36

ascites from peritoneal carcinomatosis or TB

Question 37

What are the 2 drugs u can give for the Tx of ascites?

Answer 37

sprionolactone and furosemide

Question 38

What is the goal (in volume) of fluid loss per day in the Tx of ascites?

Answer 38

1 L/day

Question 39

This is a bacterial infection of ascetic fluid without an intra-abdominal source of infection.

Answer 39

spontaneous bacterial peritonitis (SBP)

Question 40

What are the Sx of SBP?

Answer 40

fever, abd pain, and abd tenderness

Question 41

How do u Dx SBP?

Answer 41

paracentesis and a WBC count and culture

Question 42

Which antibiotic should u give for the Tx of SBP?

Answer 42

3rd generation cephalosporin

Question 43

Which antibiotic should u give for the prophylaxis of SBP, typically in cirrhotic pts?

Answer 43

norfloxacin

Question 44

What 3 things can predispose u to hepatic encephalopathy?

Answer 44

increased dietary protein, constipation, or sedatives.

Question 45

Which 2 beta blockers can u give to prevent bleeding of esophageal vasices?

Answer 45

nadolol or propranolol

Question 46

In which patients should u use TIPS?

Answer 46

to control refractory variceal bleeding

Question 47

Should you Tx pt's with asymptomatic gallstones?

Answer 47

No