EXAM 2 (LIVER & Flashcards
(234 cards)
1
Q
What is Hepatitis?
A
Inflammation of liver w/ change of function
2
Q
What are the 2 forms of Hepatitis?
A
Acute and Chronic
3
Q
How long does Acute Hepatitis last?
A
Less than 6 months
4
Q
How long does Chronic Hepatitis last?
A
More than 6 months
5
Q
What are the etiologies of Hepatitis?
A
- Viral
- Toxic
- Bacteria
- Protozoa
- Parasites
- Fungi
- Autoimmune disorder
- Obesity
- Genetic
- Ischemic Hepatitis or (Liver shock)
6
Q
What are the different types of Viral Hepatitis?
A
HAV HBV HCV HDV HEV HFV HGV
7
Q
What is HAV +ssRNA?
A
INFECTIOUS HEPATITIS
- Spreads through fecal contamination of food and water, causes an acute and self limiting infection, does not cause chronic hepatitis
8
Q
What is HBV +dsDNA?
A
SERUM HEPATITIS
- Spreads through blood, body fluids, sexual contacts, tattoos, mother to child by breast feeding
9
Q
Which Viral Hepatitis can cause chronic hepatitis, can cause cirrhosis and cancer?
A
HBV +dsDNA (serum hepatitis)
10
Q
What is HCV +ssRNA ?
A
SERUM DELTA HEPATITIS
- Spreads through sexual contacts and hemotransfusions, cross the placenta**
11
Q
What is the MC viral hepatitis that causes chronic hepatitis, cirrhosis, and liver cancer?
A
HCV +ssRNA (Serum non-A, non-B hepatitis)
12
Q
What is HDV -ssRNA?
A
SERUM DELTA HEPATITIS
- The most aggressive form, with high mortality rate, CANNOT exist without B virus**, spreads through blood, typical for IV drug users and hemophilia patients
Causes chronic hep, cirrhosis, liver cancer
13
Q
What is HEV +ssRNA?
A
INFECTIOUS HEPATITIS
- Spreads through contaminated food and water, often causes an acute and self limiting infection, but (UNLIKE to hep A) causes severe: Intralobular necrosis, acute cholangitis, but does NOT cause chronic hepatitis
14
Q
Which Hepatitis does NOT cause chronic hepatitis?
A
HEV +ssRNA
15
Q
What does HEV+ssRNA cause?
A
Severe, intralobular necrosis acute cholangitis
16
Q
What is HFV?
A
DNA (SERUM* MUTATED B VIRUS)
- Spreads through blood transfusion, or oral fecal route, causes chronic hepatitis
17
Q
What is HGV?
A
RNA (GB virus C)
- This is a new discovered hepatitis virus, spreads by blood and sexual contact
18
Q
What does HGV - RNA (GB virus C) not appear to do?
A
Replicate primarily in the liver, its characteristics are in the process of study
19
Q
What is the incubation period of Hep A?
A
28 days (range: 15-50 days)
20
Q
What is incubation period of Hep B?
A
90 days (30-150 days)
21
Q
What is incubation period for Hep C?
A
50 days
15-160
22
Q
What is incubation period for Hep D?
A
60-90 days
30-180
23
Q
What is incubation period for Hep E?
A
40 days
14-60 days
24
Q
What viruses are associated with the Etiologies of Hepatitis ?
A
- Cytomegalovirus
- Epstein-Barr virus
- Yellow fever virus
- Ebola virus and Marburg virus
25
What can Toxic Hepatitis be caused by?
- Medications (Tylenol, birth control pills, Lipitor)
- Mushroom poison
- ALCOHOL (MC****)
26
What are the Bacteria that can cause Hepatitis?
- Staphylococci and Streptococci, causes Toxic Shock Syndromes
- Leptospira (gram-neg spirochete)
- Listeria (gram-positive, no spore forming, rod)
27
What are the Protozoa that can cause Hepatitis?
- Toxoplasma
| - Leishmania
28
What are the parasites associated with Hepatitis?
- Echinococcus
- Toxocara
- Shistosoma
29
What are the Fungi associated with Hepatitis?
- Aspergillus
- Histoplasma Capsulatum
- Candida
30
What is the Autoimmune disease associated with Hepatitis?
Sjogren’s Syndrome
31
How is obesity an etiology for Hepatitis?
Non alcoholic steatosis
32
What are the genetic causes of Hepatitis?
1. Alpha 1 Antitrypsin Deficiency
2. Hemochromatosis
3. Wilson Disease
4. Glycogen storage disorders
33
What is Alpha 1 antitrypsin deficiency?
Abnormal accumulation of the PROTEIN within liver cells
34
What is Hemochromatosis ?
IRON accumulate in multiple body sites, including the liver
35
What is Wilson’s disease?
COPPER accumulate in the liver and brain
36
What is Ischemic Hepatitis (Shock liver) often associated with?
- Heart Failure
- Shock
- Sepsis
37
What is the MC cause of Chronic liver disease according to her graph picture?
Hep C
38
Can acute hepatitis get better?
Yes, and it can get better quickly (typical for ACUTE)
39
What different Hepatitis forms will NOT progress to chronic Hepatitis?
HAV and HEV
40
What signs and symptoms normally result in progression to chronic hepatitis?
Autoimmune, parasites, Protozoa, obesity, genetic, and ischemic etiological agents
41
What happens within the first 2-4 days of Hepatitis ?
NON**- Specific, and characterized by flu-like signs and symptoms
42
What are the specific symptoms of Acute Hepatitis for the first 2-4 days?
- Fever
- Malaise
- Joint aches
- Headache
- Nausea, Vomiting
- Diarrhea
43
What are the symptoms in the Overt stage of Hepatitis?
- Hepatomegaly
- Abdominal discomfort and pain
- Jaundice (yellowing of skin and eyes)
44
Chronic hepatitis usually results from ____
Acute Hepatitis, but sometimes develops insidiously
45
What are the symptoms of Chronic Hepatitis?
“Non-Specific”
- Weakness and Fatigue
46
What are the Signs and Symptoms typical for all forms and etiologies of Hepatitis in Overt Stage?
- Weight loss
- Easy bruising
- encephalopathy
- hepatosplenomegaly
- lymphadenopathy
- dark colored urine
- white stool
47
What are the ways in which you test for Hepatitis?
1. Bilirubin
2. Three types of blood tests
3. Anti-Viral Antibodies and Viral Genetic Materials
4. Serum Proteins
5. Ultrasound
6. Liver Biopsy
48
What does Bilirubin have to do with diagnosis of Hepatitis ?
- There is considerable increase of BLOOD total and conjugated (direct) bilirubin
49
What will you find in the urine with Hepatitis?
BILIRUBIN (which results in dark brown color of the urine, dark beer)
- And an increase concentration of urobilirubinogen
50
What are the 3 types of blood test for evaluation of patients with Hepatitis ?
1. Liver Enzymes aka Aminotransferases
2. Anti-Viral antibodies and viral genetic materials
3. Serum Proteins
51
What are the liver enzymes that are measured for Hepatitis?
- Aspartate aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- Gamma Glutamyltransferase (GGT)
52
Aspartate aminotransferase (AST) aka
Serum glutamic Oxaloacetic transaminase (SGOT) is intracellular enzymes
53
Where is Aspartate Aminotransferase (AST) significantly increased in?
- Acute toxic hepatitis
- Acute viral hepatitis
- Alcoholic liver disease
54
What are the non-specific flu like symptoms of Hepatitis?
- Fever
- Malaise
- Joint aches
- Headache
- Nausea, vomiting
- Diarrhea
55
What are the signs and symptoms typical for acute hepatitis in the "Overt" stage?
- Hepatomegaly
- Abdominal discomfort and pain
- Jaundice: Yellowing of skin (icterus)
56
What are the signs and symptoms of Hepatitis in the Overt stage?
- Weight loss
- Easy bruising
- Encephalopathy
- Hepatosplenomegaly
- Lymphadenopathy
- Dark colored urine
- White stool
57
Finding a dark like color urine would be _____ in the urine, associated with what disease?
Bilirubin, and associated with Hepatitis
58
What would you test in the urine for Hepatitis?
Direct Bilirubin or urrbilirubinogen
59
What are the 3 types of blood test for evaluation of patients with Hepatitis?
- Liver enzymes aka aminotransferases
- Anti-viral antibodies and viral genetic materials
- Serum proteins
60
What do liver enzymes aka Aminotransferases typically mean in the blood?
(Measures liver homeostasis)
- Their high concentrations develop as a result of destruction or inflammation NOT only in liver, but other tissues as well
61
What are the liver enzymes, or "Aminotransferases" ?
- Aspartate Aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- Gamma Glutamyltransferase (GGT)
62
What is Aspartate (AST) aka
Serum glutamic oxaloacetic transaminase (SGOT) is intracellular enzymes
63
Aspartate Aminotransferase (AST), aka SGOT is simnifically increased in:
- Acute toxic hepatitis
- Acute viral hepatitis
- Alcoholic liver disease
64
Where else besides the liver can Aspartate Aminotransferase aka SGOT be found?
- Skeletal muscles
- Heat muscle
- Brain
- Lungs
- Pancreas
65
Alanine Aminotransferase (ALT) aka
Serum Glutamic Pyruvic Transaminase (SGPT) is intracellular enzymes
66
Alanine aminotransferase (ALT) aka SGPT is normally ______
Most concentrated within liver cells and (in lesser degree) in the heart muscle cells, kidneys, pancreas
67
Why would Alanine Aminotransferase (ALT) aka SGPT be elevated?
Acute hepatocyte destruction, or severe, heart, kidney, or pancreas damage*
68
Gamma-glutamyltransferase (GGT) is found predominantly:
In the hepatobiliary cell membranes, but also present in the cell membranes of other tissues (kidney, heart, brain)
69
Gamma glutamyltransferase (GGT) blood concentration is significantly increased in liver diseases associated with:
**
Hepatocyte necrosis, cirrhosis, and alcoholic liver disease
70
Anti-viral antibodies and viral genetic materials can be helpful in diagnosis of:
Acute and chronic viral hepatitis
71
What are the anti-viral antibodies?
- anti-HAV (for Hep A)
- anti-HBV (for Hep B)
- anti-HCV (for Hep C)
72
When examining Serum Proteins in the diagnosis of Hepatitis, what are the rules?
IgM = Acute case
IgG = Chronic case
73
What is Hypoalbuminemia?
Indicates a decreased function of hepatocytes
74
What is "Increased Prothrombin Time" ?
Indicates the decreased production of clotting factors
75
What are the most SPECIFIC tests for liver destruction?
Hypoalbuminemia and Increased prothrombin time
76
What are the complications of Hepatitis?
- Liver Cirrhosis (Hep B, C, D, F, toxic, autoimmune, genetic)
- Hepatic Failure
- Hepatocellular Carcinoma (Hepatoma)
77
What is Liver Cirrhosis?
A consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to loss of liver function
78
What is the major etiological factor for liver cirrhosis?
Alcoholism
79
Alcoholic steatosis aka
Fatty liver
80
What will you see under the microscope with Liver cirrhosis?
Mallory bodies - an eosinophilic cytoplasmic inclusion, alcoholic hyaline, found in liver cells
81
What are the Etioligies of Liver Cirrhosis?
- Non-alcoholic steatohepatitis
- Chronic Hepatitis B, C, D, F
- Autoimmune hepatitis
- Some medicines (eg corticosteroids)
- Genetic diseases (genetic hemochromatosis, Wilson's Disease)
82
What are the signs and symptoms of Liver Cirrhosis?
There may be no symptoms or symptoms may come on slowly, depending on how well the liver is working
83
What do early symptoms of Liver Cirrhosis include?
- Fatigue and loss of energy
- Poor appetite and weight loss
- Nausea and upper abdominal discomfort
- Small, red, spider like blood vessels on the skin (telengiectasia, spider angioma)
84
As liver function worsens, what other symptoms may include?
- Ascites
| - Ascites with "caput medusae"
85
What does Caput Medusae represents:
The dilation of periumbilical collateral veins, and is an important sign of portal hypertension
86
Liver cirrhosis is the MAJOR cause of ____
Esophageal varicies
87
What are the signs and symptoms on your physical exam that you'll see with Liver Cirrhosis?
Ankle swelling (non-pitting, non-pedal edema)
88
What is Ankle swelling (non-pitting) edema due to?
Hypoalbuminemia
89
What is the hand sign that you will see with Liver Cirrhosis?
Palmar Erythema and nail clubbing
90
What will be seen on the skin of someone with Liver cirrhosis?
Easy bruising
91
Abnormal bleeding is associated with what disease?
Liver Cirrhosis
92
Confusion or Problems thinking will be associated with what disease?
Liver Cirrhosis
93
What is a late stage finding with Liver Cirrhosis?
Hepatic encephalopathy
94
What are the Signs and Symptoms of liver cirrhosis in men?
- Impotence
- Hypogonadism (small balls)
- Gynecomastia (breast swelling)
95
With liver cirrhosis, what can the size of the liver be?
- Normal
- Enlarged
- Shrunken
96
What is often found with Liver Cirrhosis ?
Splenomegaly
97
What will the Complete Blood count look like with Liver Cirrhosis?
- Thrombocytopenia
- Leukopenia
- Neutropenia
98
What is the Prothrombin time with Cirrhosis?
Increased
99
What disease is associated with Hypoalbuminemia?
Liver Cirrhosis
100
What are the aminotransferases that are elevated with Liver Cirrhosis?
AST, ALT, GGT
101
Which is higher with Liver cirrhosis, AST or ALT?
AST > ALT
102
What is typically much higher in alcoholic cirrhosis?
GGT
103
What is elevated with Liver Cirrhosis?
ALP and Bilirubin
104
What is the gold standard for diagnosis of Liver Cirrhosis?
Liver biopsy
105
What are the other ways to diagnose Liver Cirrhosis?
- CT of abdomen
- MRI of abdomen
- Upper endoscopy for esophageal varicies
- Ultrasound of abdomen
106
What are the complications of Liver Cirrhosis?
- Bleeding disorders
- Esophageal varicies
- Hepatocellular Carcinoma
- Hepatic encephalopathy
107
What is the treatment for Liver cirrhosis?
It is an Irreversible disease, and the treatment usually focuses on preventing of it progression and complications
108
What is the one of the only real options for today with liver cirrhosis?
Liver transplantation
109
What do most liver transplant recipients receive?
Immunosuppressive drugs (corticosteroids) for prevention of graft rejection
110
What are the 2 forms of Liver Cancer?
1 Primary
2 Secondary (Mets)
111
What is secondary liver cancer?
Begins in another area of the body (colon, breast, stomach) and spreads to liver
112
Liver cancer occupies, in cancer mortality?
3rd position in frequency among MC cancer mortality
113
What are the classifications of Primary liver cancer?
a) Hepatocellular Carcinoma aka Hepatoma
b) Cholangiocarcinoma
c) Angiosarcoma aka Hemangioendothelioma
114
What is the most frequent liver cancer?
Hepatocellular carcinoma aka hepatoma, originates from HEPATOCYTES **
115
Where does Cholangiocarcinoma originate from?
The bile duct cells
116
Angiosarcoma aka Hemangioendothelioma originates from:
Originates from the blood vessel cells in the liver
117
What are the first 3 etiologies of Liver cancer?
1. Chronic infectious hepatitis B, C, D
2. Liver cirrhosis
3. Aflatoxins
118
What are Aflatoxins?
Poisons produced by the plant mold Aspegillus, that grows on wheat, rice, corn, and peanuts
119
What are the last 4 etiologies of Liver Cancer?
4. Wilson's Disease
5. Hemochromatosis
6. Non-alcoholic fatty liver disease
7. Estrogen and anabolic steroids
120
What are the first 3 Signs and symptoms of liver cancer? (late stage)
1. Loss of weight
2. Loss of appetite
3. Upper abdominal discomfort and pain
121
What are the 4-6 signs and symptoms of liver cancer?
4. Nausea, vomiting
5. General weakness, fatigue
6. Jaundice with skin itching
122
What are the 7-9 signs and symptoms of liver cancer?
7. Hepatosplenomegaly
8. Sudden Ascites
9. Back pain
123
During the physical examination of Liver Cancer, what will be found?
Hepatic bruit, it develops because hepatoma
124
Why do you hear a Hepatic bruit during Liver cancer?
It develops because hepatocarcinoma has a lot of blood vessels with turbulent blood flow
125
What would suggest that a patient has developed a Hepatoma?
Hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis developed hepatoma
126
Where will Mets from the liver go to?
To local veins and then to the lungs
- ADVANCED: Bone, spine, brain
127
What are major sources of METS to the liver?
The ones from GI tract organs
- It results from specific venous blood flow from GI tract to v. Porta, which brings the blood to the liver for detoxification
128
How do you diagnose liver cancer?
1. Blood test
2. Ultrasound
3. CT
4. MRI
5. Liver biopsy
6. PET-CT
129
What is the most important increased marker in the blood during liver cancer?
Increased Alfa-fetoprotein
| Normal for infants before 1 year old
130
What else is increased Alfa-fetoprotein found in?
Cancer of testicles and ovaries
131
What are the tumor markers for primary liver cancers?
- Carbohydrate antigen 19-9 (CA 19-9)
- Carcinoembryonic antigen (CEA)
- Cancer antigen 125 (CA125)
132
What does PET-CT do?
Position Emission Tomography Computer Tomography for determination of biochemical activity of the organ and cancer stage
133
What is the treatment for liver cancer?
- Cryotherapy in early stage
- Chemoembolisation
- Radiotherapy
- Liver transplantation
134
Cholelithiasis aka
Gallstone Disease (formation of stones in gallbladder)
135
What is Choledocholithiasis?
Formation and migration of stones inside the biliary tree or common bile duct
136
What are the 3 types of gallstones?
1. Cholesterol stones
2. Pigment stones
3. Mixed
137
What type of stones are radiolucent?
Cholesterol stones (80%)
138
What type of gallstones are radiopaque?
Pigment stones (contain bilirubin and calcium)
139
What are the risk factors for CHOLESTEROL gall stones?
1. Decreased gallbladder motility w/bile stasis
2. Obesity
3. Family history (genetic predisposition)
4. Rapid weight loss
5. Long intervals between meals
140
Risk factors for PIGMENT gallstones:
1. Hemolytic conditions (sickle cell anemia, hereditary spherocytosis, thalassemia)
2. Liver cirrhosis
3. Introductal stasis (choledochal cyst, postsurgical biliary stricture)
141
What are the risk factors for MIXED gallstones?
1. Crohn‘s Disease
2. Partial removal of ilium
3. Decreased gallbladder motility:
Trauma, burns, paralysis
142
Are gallstones asymptomatic?
They may be present for decades before the symptoms develop, and 70-80% of patients remain asymptomatic through their lives
143
What is the major danger of gallstones?
Their ability to move to the bile ducts resulting in duct obstruction
144
With Cholelithiasis, is it worse to get a large or small stone?
The larger the calculi , the less likely they are to enter he cystic or common ducts (obstruction)
SMALL = DANGEROUS
145
What are the signs and symptoms of the sudden “gallstone attack” ?
- Sudden acute pain in the RUQ, lasts 30 min to several hours, until gallbladder relaxes
- Pain radiates to back, between blades, right shoulder, behind sternum
- Change of posture, defecation DO NOT relieve pain
146
When is Murphy’s sign positive w/Cholelithiasis ?
Murphy’s sign is positive in Cholelithiasis only when it’s complicated with Cholecystitis
147
When is Murphy’s sign negative w/Cholelithiasis ?
Murphy’s sign is negative with the stone in BILE DUCT (Choledocholithiasis)
148
What are the signs and symptoms of Cholelithiasis ?
- Tachycardia
- Nausea, vomiting (vomiting does NOT relieve pain)
- Increased production of gas
- Fat Intolerance
149
What are the signs and symptoms of Choledocholithiasis ?
- Acute constant pain in the upper part of abdomen
- Obstructive Jaundice
- Murphy’s sign is NEGATIVE
150
What is the major sign and symptom with Choledocholithiasis ?
The CHARCOT triad (indicates the ASCENDING CHOLANGITIS
151
What is Charcot triad?
URQ pain, Jaundice, and Fever
152
When diagnosis Cholelithiasis, what will be elevated in the blood?
- Increased WBC
- Increased common bilirubin content
- Increased alkaline phosphatase
153
Alkaline Phosphatase is in what organs?
- Liver
- Bile duct
- Kidneys
- Bones
- Placenta
154
What can high Alkaline Phosphatase show?
- Bile duct obstruction
- Presence of Paget’s disease w/ osteoblastic activity, or Mets prostate cancer
- Presence of pregnancy
- Presence of Celiac disease
155
What is the gold standard examination for diagnosis of gallbladder stones and stones in cystic duct?
Ultrasound
156
In regard to Cholelithiasis, the CT scan is used for diagnosis of:
Distal common bile duct stones, “Porcelain Gallbladder”
157
What is MRI used for w/Cholelithiasis?
Diagnosis of stones at any level of bile tree and gallbladder
158
What is the black sheep of diagnosing for Cholelithiasis ?
ERCP
Endoscopic Retrograde Cholangiopancreatography
159
What is X ray sensitive to?
For diagnosis of “Porcelain Gallbladder”
160
What is Porcelain Gallbladder characterized by?
Calcification of gallbladder wall, developing usually in Cholelithiasis complicated by chronic cholecystitis
161
On x ray, where would gallstones be?
In FRONT of lumbar spine
162
What are the complications of Cholelithiasis?
1. Acute Cholecystitis
2. Chronic Cholecystitis
3. Gallbladder Gangrene
4. Perforation or rupture
5. Cholangitis
6. Acute Pancreatitis
163
When would you get Acute Cholecystitis (complication of Cholelithiasis )?
When the CYSTIC DUCT is obstructed
164
How do you develop Chronic Cholecystitis (complication of CHolelithiasis)?
When long term presence of gallstones (Silent stones) leads to fibrosis of the gallbladder wall, will further its calcification (Porcelain Gallbladder)
165
How do you get “Porcelain Gallbladder?”
Chronic Cholecystitis
166
What will happen if there is perforation or rupture of the gallbladder?
Development of Bile Peritonitis and high level of mortality
167
When will you develop Cholangitis?
When the common bile duct is obstructed before joining the pancreatic duct
168
How would you develop Acute Pancreatitis?
When the hepatopancreatic duct or pancreatic duct is obstructed
169
What is Cholecystitis defined as?
Inflammation of gallbladder wall
170
What are the 2 forms of Cholecystitis ?
1. Calculous
| 2. Acalcolous
171
What is Calculous Cholecystitis?
When stones in the gallbladder are formed - 90%
172
Cholecystitis is divided into what 2 categories ?
1. Acute
| 2. Chronic
173
What are the first 4 risk factors for Calculous Cholecystitis ?
- Female sex
- Obesity
- Rapid Weight loss
- Pregnancy
174
What are the last 3 risk factors for Calculous Cholecystitis?
- Increasing age
- ethnic groups (Hispanic, Scandinavia)
- drugs (especially hormonal therapy in women)
175
What are the first 3 etiologies of Acalculous?
1. Critical illness (HIV, diabetes mellitus, myocardial infarction)
2. Major surgery or severe trauma/burns
3. Sepsis
176
What are the last 3 etiologies of Acalculous Cholecystitis ?
1. Long term parenteral nutrition
2. Prolonged Fasting
3. Salmonella Infection
177
What is the Pathogenesis of Chronic Cholecystitis ?
Chronic Cholecystitis occurs after repetitive mild exacerbations of acute cholecystitis, and is characterized by mucosal atrophy and fibrosis of gallbladder wall
178
What are the first 3 signs and symptoms of Acute Cholecystitis ?
1. Acute pain in RUA that is severe and constant, may last for days
2. Pain increases w/breathing
3. Pain radiates to right shoulder, or right scapula, or right mid back (T8-T9)
179
What are signs and symptoms 4-6 of acute Cholecystitis ?
4. Changing position and passing gas do NOT relieve the pain
5. Large amount of meal or fat meal can trigger the pain
6. Pain occurs several hours after eating and awakens the patient during the night
180
What are the symptoms 7-9 of Acute Cholecystitis ?
- Fever and chills
- Nausea and vomiting
- vomiting does NOT relieve the pain (unlike peptic ulcer)
181
What are the first 3 signs and symptoms of Chronic Cholecystitis?
1. The first symptoms are bitter taste and taste of metal in the mouth in the mornings
2. Abdominal discomfort after meals
3. Complaints of gas accumulation
182
What are the last 3 signs of Chronic Cholecystitis ?
4. Nausea
5. Chronic diarrhea
6. Xanthomas
183
What do Xanthomas represent?
Focal accumulation of cholesterol, result from cholestasis or/and hyperlipidemia
184
What signs are present with Cholecystitis?
- Ortner’s
- Georgievskiy-Myussi
- Murphy’s
- Boas
185
What is Ortner’s sign?
Tenderness when hand taps the end of right costal arch
186
What is Georgievskiy-Myussi sign?
Phrenic Nerve sign
- Pain when pressing between edges of RIGHT SCM
187
What is Murphy’s sign?
Specific for cholecystitis but is non-sensitive especially in geriatric patients
188
What is Boas’s sign?
Increased sensitivity below the right scapula (also due to phrenic nerve irritation)
189
When would elevated WBC be present?
With Acute Cholecystitis
190
When is Alkaline Phosphatase elevated?
Acute Cholecystitis (indicates inflammation of the gallbladder wall due to bile duct obstruction)
191
When would you see elevated C reactive protein?
Acute Cholecystitis
192
Blood test for Chronic Cholecystitis frequently show ____ values
Normal
193
What do you use to diagnose Chronic Cholecystitis ?
- Ultrasound sonography
- MRI
- CT scan
- HBS
194
What is the CT scan good for with Chronic Cholecystitis ?
More sensitive that ultrasound sonography in diagnosis of pericholecystic inflammation
195
What is HBS associated with Chronic Cholecystitis ?
Hepatobiliary Scintigraphy - used for differential diagnosis between acute and chronic Cholecystitis
196
What is the DDX for ACUTE Cholecystitis ?
- Acute peptic ulcer
- Perforated peptic ulcer
- Acute pancreatitis
- Ureteral colic
197
What is the DDX for CHRONIC Cholecystitis ?
- Peptic ulcer
- Hiatal hernia
- Colitis
- Chronic pancreatitis
198
What are the complications of Cholecystitis ?
- Perforation or rupture of gallbladder
- Ascending cholangitis
- Local abscess
- Peritonitis
199
What is the management of Acute Cholecystitis ?
Cholecystectomy
200
What is the management of Chronic Cholecystitis ?
Diet modification, antibiotics, restriction of physical activity
201
What is Pancreatitis?
Inflammation of the pancreas when certain enzymes that normally do not become active until they reach the small intestine, become active in the pancreas “digesting” this gland itself
202
What enzyme plays the most important role with Pancreatitis?
Trypsin
203
What are the 2 types of Pancreatitis?
Acute and chronic
204
Is acute pancreatitis reversible?
YES
205
What is chronic pancreatitis characterized by?
Atrophy, fibrosis, and calcification of pancreatic parenchyma (IRREVERSIBLE)
206
What are the first 3 etiologies for acute pancreatitis?
1. Alcohol use
2. Gallstones
3. Trauma of the abdomen (blunt abdominal trauma)
207
What are the last 3 etiologies of acute pancreatitis?
4. Viral infections (mumps)
5. Pseudocysts
6. Medications (corticosteroids, estrogen, statins)
208
What is the etiology for chronic pancreatitis?
- Alcoholism
- Cystic fibrosis
- Pseudocysts
- Idiopathic
209
Does Acute Pancreatitis resolve?
Severe pain in upper abdomen and resolves itself
210
When does acute pancreatitis pain worsen?
After food eating
211
Where does the pain localize with acute pancreatitis?
T8-L1 “Band like pain”
212
Where can pain radiate with acute pancreatitis?
Umbilical, both flanks, left shoulder
213
In what position does the pain become worse with acute pancreatitis?
Lying flat on back
214
When does pain decrease with acute pancreatitis?
Sitting and flexion forward (unlike pain in Cholelithiasis and acute Cholecystitis )
215
What is acute pancreatitis pain ALWAYS accompanied by?
High BP and tachycardia
216
What sign is positive with Acute pancreatitis?
Positive Cullen’s sign
217
What is Cullen’s sign?
Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
218
What is the 2nd positive sign with Acute Pancreatitis?
Grey Turner’s sign
219
What is Grey Turner’s sign?
Ecchymosis of flanks - bruising of the flank, which may be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding
220
What are the 3 signs and symptoms of Acute Pancreatitis?
Nausea, Vomiting, and Fever
221
What are the 2 big things with Chronic Pancreatitis?
Acute pain is NOT resolved itself
Change of position does NOT relieve pain
222
What are the signs and symptoms of Chronic Pancreatitis?
- Severe vomiting,
- fatty stool,
- signs of diabetes mellitus: thirst, polyruia
- Weight loss
223
What is 4-6 times higher in the blood with Chronic Pancreatitis?
Blood amylase and lipase
| LIPASE IS BETTER INDICATOR
224
What is significantly increased with the diagnosis of Pancreatitis?
Urine amylase and blood glucose level
225
What are the 2 complications for Acute pancreatitis ?
Pancreonecrosis and Pancreatic abscess
226
Due to adjacent organs, what can happen due to Acute pancreatitis?
Acute gastritis and Duodenitis
227
What is a serious condition that can arise from acute pancreatitis?
Internal bleeding w/ development of hypovolemic shock
228
Can the lungs be affected with acute pancreatitis?
YES, (enzymes may affect the lung tissue causing its inflammation)
229
What are the 4 complications for Chronic Pancreatitis?
1. Diabetes Mellitus
2. Pancreatic Cancer
3. Calcification of Pancreas
4. Multiple Cysts
230
What is MC type of Pancreatic cancer?
Adenocarcinoma , arising from EXOCRINE component
231
What is a Non-specific sign and symptom of Pancreatic cancer?
Clinical depression (sometimes before cancer is diagnosed)
232
What sign is Present with Pancreatic cancer?
Unexplained Thrombophlebitis (Trousseau sign)
233
What is Endocrine Pancreatic Tumor?
Insulinoma (beta cell)
- Overproduction of insulin = Results in hypoglycemia
234
What does Zollinger Ellison syndrome cause?
It causes multiple peptic ulceration
