Diseases Of The Liver And Biliary System IM Plat Flashcards
(89 cards)
1
Q
Basic patterns of liver disease
A
Hepatocellular
Cholestatic
Mixed
2
Q
Hepatocellular examples
A
Viral hepatitis
Alcoholic liver disease
3
Q
Cholestatic
A
Obstructive biliary diseases
4
Q
Mixed
A
Drug induced liver diseases
5
Q
Major risk factors for liver diseases
A
Alcohol use Medications - herbal compounds Birth control pills, OTC meds Personal habits Sexual activity Travel Exposure to jaundiced or other high-risk persons Injection drug use Recent surgery Remote or recent transfusion with blood and blood products Occupation Accidental exposure to blood or needle stick injury Familial history of liver disease
6
Q
Most common and most characteristic symptom of liver disease
A
Fatigue
7
Q
Hallmark of liver disease and the most reliable marker of severity
A
Jaundice
8
Q
Constitutional symptoms of liver disease
A
Fatigue poor appetite Weakness Nausea Malaise
9
Q
Liver-specific symptoms
A
Jaundice,dark urine, light stools, itching, abdominal pain
Bloating
10
Q
Signs of hepatic disease(12)
A
Icterus Palmar erythema Spider angiomata Hepatomegaly Splenomegaly Ascites Peripheral edema Hepatic encephalopathy Fetor hepaticus Umbilical hernia Caput medusa Hyperestrogenemia (for males)- gynecomastia, testicular atrophy, loss of male pattern hair distribution
11
Q
Superficial tortuous arterioles seen on the arms, face, upper torso, fill outwards from the center
A
Spider angiomata
12
Q
Icterus can be noted on the
A
Sclerae, skin
Mucous membrane below the tongue
13
Q
The most reliable physical finding in examining the liver
A
Hepatic tenderness
14
Q
Hepatomegaly is seen in
A
Venoocclusive disease, infiltrative disorders, hepatic malignancy, alcohol hepatitis
15
Q
Subtle significant finding in liver disease and portal hypertension
A
Splenomegaly
16
Q
Ascites is best appreciated by
A
percussing for Shifting dullness
17
Q
How much volume of ascitic fluid should be present before dullness is appreciated
A
~1500 mL
18
Q
Contributing factors to peripheral edema in liver disease
A
Hypoalbuminemia, venous insufficiency
Heart failure
Medications
19
Q
First signs of hepatic encephalopathy
A
Change in sleep patterns Change in personality Irritability Mental dullness Confusion Disorientation Stupor Eventually coma supervene
20
Q
Acute liver failure neurologic signs
A
Excitability , mania
21
Q
Slightly sweet, ammonia-like odor in patients especially if there is portovenous shunting of blood
A
Fetor hepaticus
22
Q
Umbilical hernia develops in liver disease due to
A
Increased intraabdominal pressures from ascites
23
Q
Appearance of distended and engorged superficial epgastric veins which are seen radiating from the umbilicus across the abdomen
A
Caput medusae
24
Q
Golden-brown copper pigment deposited in the periphery of the cornea
A
Kayser-fleischer rings
25
Kayser-fleischer rings are found in
Wilson's disease
26
Is a condition in which one or more fingers become permanently bent in a flexed position
Dupuytren's contracture
27
Dupuytren's contracture and parotiod enlargement is found in
Alcoholic liver disease
28
Slate-gray pigmentation of skin is found in
Hemochromatosis
29
Also called as bronze diabetes
Hemochromatosis - because it can lead to darkening of the skin and hyperglycemia
30
Tests based on detoxification and excretory functions
Serum bilirubin
| Aminotransferases
31
Enzymes that reflect cholestatsis
Alkaline phosphatase (ALP)
5' Nucleotidase (5NT)
Y- glutamyl transpeptidase (GGT)
32
Tests that measure biosynthetic function of the liver
Serum albumin
| Serum globulins
33
presence of icterus
| Total serum bilirubin is at least
3 mg/dL
34
Unconjugated bilirubinemia
Indirect
35
Conjugated bilirubinemia
Direct
36
Uncojugated bilirubinemia is seen in
| INDIRECT
Hemolytic disorders
Crigler-Najjar
Gilbert's syndrome
37
Conjugated bilirubinemia (DIRECT) is seen in
Liver or biliary tract disease
38
Enzymes that reflect damage to hepatocytes
Aminotransferases
39
Which is the more specific indicator of liver injury
ALT VS AST
ALT
40
Elevatins of >1000 U/L aminotransferases occur almost exclusively in
Viral hepatitis
Ischemic liver injury (prolonged hypotension or acute heart failure)
Toxin- or drug- induced liver injury
Autoimmune hepatitis
Acute phase of biliary obstruction caused by passage of gallstone into the CBD
41
ALP >4X UPPER LIMIT NORMAL
| Indicates
Cholestatic liver disease
Infiltrative liver diseases
Rapid bone turnover
42
AST/ALT <1
Chronic viral hepatitis
| Non-alcoholic fatty liver disease
43
AST/ALT >2
Alcoholic liver disease
Development of cirrhosis
Wilson disease
44
Low ALP may be seen in
Wilson disease (esp those presenting with
Fulminant hepatitis and hemolysis) - due to reduced activity of the enzyme from the displacement of the cofactor zinc by copper
(ALP : BILIRUBIN <4)
45
ALP/AST >3
Cholestatic conditions like primary biliary cirrhosis
46
ALP/AST <1.5
Autoimmune hepatitis
47
5NT is elevated in
```
Cholestatic liver disease
Hepatitis
Biliary cirrhosis
Hepatotoxic drugs
Metastasis
```
48
Primary use of GGT
Identify the source of an isolated elevation in ALP
| GGT not elevated in bone disease
49
Half-life of serum albumin is
18-20 days
| Thus not a good indicator of acute or mild hepatic dysfunction
50
Hypoalbuminemia is
<3g/dL
51
Hypoalbuminemia is more common in
Chronic liver disorders - cirrhosis, reflecting severe liver damage and decreased albumin synthesis
52
Y-globulins are increased in
Chronic liver disease (inc antibody synthesis to fight off intestinal bacteria that the cirrhotic liver failed to clear from the hepatic circulation
53
Single best acute measure of hepatic synthetic functio
Clotting factors
54
All clotting factors are synethesized in the liver except for factor
VIII (8)
55
PT measures clotting factors
II, V, VII, X
56
Prolongation of PT >5 s above the control not corrected by IV Vitamin K portends
Poor prognosis
57
Clotting factors have prognostic value in
Alcoholic hepatitis
| Acute acetaminophen and non acetaminophen related liver injury
58
most commonly employed imaging of the liver
Ultrasound
CT
MRI
59
Is the first line if initial blood test suggest cholestasis
Ultrasound - to check for dilated ducts/ gallstones
60
Procedures of choice to visualize the biliary tree
ERCP
| MRCP
61
Assessment of hepatic vasculature and hemodynamics
Doppler UTZ and MRI
62
Is the first test ordered if suspecting for Budd-Chiari syndrome
Doppler US
63
The criterion standard in the evaluation of patient with liver disease
Liver biopsy
64
Liver biopsy is subject to this error in focal infiltrative disorders
Sampling error
65
Contraindications to percutaneous approach are
```
Significant ascites
Prolonged INR (may use transjugular approach instead)
```
66
Diagnostic tests for autoimmune hepatitis
ANA or SMA
Anti-LKM1
Elevated IgG levels
67
Diagnostic tests for Primary Biliary Cirrhosis
AMA (anti-mitochondrial antibody)
| Elevated IgM
68
Diagnostic tests for primary sclerosing cholangitis
Cholangiography
| p-ANCA
69
Diagnostic tests for Wilson's disease
Decreased serum ceruloplasmin and increased urinary copper
| Increased hepatic copper level
70
Diagnostic tests for hepatocellular cancer
Elevated alpha-fetoprotein level >500
| US or CT image of mass
71
Stratifies liver disease patients into risk groups
CHILD-PUGH SCORE
72
Predicts the likelihood of major complications of cirrhosis (e.g. variceal bleeding, spontaneous bacterial peritonitis)
CHILD-PUGH SCORE
73
What are the parameters needed to evaluate for Child-Pugh score
```
Serum bilirubin
Serum albumin
Prothrombin time
Ascites and
Hepatic encephalopathy
```
74
Child-Pugh score of 5-6
Class A
75
Child Pugh score of 7-9
Class B
76
Child-Pugh score of 10-15
Class C
77
Decompensation indicates
CIRRHOSIS, with a score of >/= 7
78
Has been the accepted criterion for listing a patient for liver transplant
Decompensation
| Score of >/=7
79
Maximum score of Child-Pugh score
15
80
Minimum score of Child-pugh score
5
81
Child Pugh score of 1
| Per parameter
```
SERUM BILIRUBIN: <2 mg/dL
SERUM ALBUMIN >3.5 g/dL
PT 0-4
INR <1.7
No ascites
No hepatic encephalopathy
```
82
Child Pugh score of 2
| Per parameter
```
SERUM BILIRUBIN: 2-3 mg/dL
SERUM ALBUMIN 2.8-3.5 g/dL
PT 4-6
INR 1.7-2.3
ASCITES - easily controlled
HEPATIC ENCEPHALOPATHY - minimal
```
83
Child Pugh score of 3
| Per parameter
```
SERUM BILIRUBIN: >3mg/dL
SERUM ALBUMIN <2.8 g/dL
PT >6 seconds
INR >2.3
ASCITES - poorly controlled
HEPATIC ENCEPHALOPATHY - advanced
```
84
MELD SCORE stands for
Model for end-stage liver disease score
85
scoring system to predict prognosis of patients with liver disease and portal hypertension
Model of End-Stage Liver disease (MELD SCORE)
86
MELD SCORE is calculated using three non-invasive variables
PT-INR
Serum bilirubin
Serum creatinine
87
Budd-Chiari syndrome is caused by
Occlusion of the hepatic veins that drain the liver
88
Classical triad of Budd-chiari syndrome
Abndominal pain
Ascites
Liver enlargement
89
Complications of cirrhosis
Variceal bleeding
| Spontaneous bacterial peritonitis
