Gastro Podcast Flashcards
(12 cards)
Bilirubin is a product of
Indirect is, direct is
Process= unconj binds to ____
transported to ___, converted to ___ and eventually
taken to ____ bacteria convert to
10% reabsorbed in ____ and circulates in blood
urine normally has ____
lack of urobilinogen indicates
hemoglobin breakdown
unconj, conj
albumin
hepatocyte, glucuronic acid, conj bilirubin
SI, urobilinogen
ileum
small amt
blockage of biliary system
Hematalogic jaundice is bilirubin ___, predominatly
Max total bilirubin of
indirect bilirubin is bound to __ and poorly filtered by ___, not as likely to produce
Ex H____ due to, i____ due to
these pts are
overproduced, unconj
3-5
albumin, kidney, dark urine
hemolysis (SCA), ineffective erythropoeisis (B12 def, thalassemia)
anemic
Hepato-biliary jaundice inability to ____ bilirubin
Parenchymal liver dz bilirubin is, ex
Cholestatic dz bilirubin is, ex
Splenomeg seen in both
not in _____ bc pts autoinfarct ___ in early life
take up/conj/excrete
mixed, hepatitis/cirrhosis
conj, choledocholithiasis (CBD obs w gallstone) and primary biliary cirrhosis
hepatobiliary/hemato dz
SS sickle cell dz. spleen
Gilbert dz presenttion, exacerbated by
labs show inc
mild scleral icterus, fastng/surg/fever/infect/alcohol
unconj bilirubin
Hepatitis vs cirrhosis
Transaminase is
Signs of inflam
Liver is
Portal htn/fxnal impairment
Cirrhosis n be tender w
Hepatitis usually has no
Liver fxn tests in cirrhosis elevated include
H- elevated, yes, tender, no (when present think chronic hep)
C- not elevated, no, nontender, yes
RHF
splenomeg
PT, bilirubin, albumin
Alcoholic hepatitis liver is
complicated by
systemic infalam findings
tx
Alcoholic cirrhosis aka
liver is, usually have ___ findings
labs reveal
Labs for both
AST vs ALT ratio for alcohol
AST <
Elevated
enlarged, tender
poor nutritional status
fever, inc leuks
systemic CS
Laennecs cirrhosis
small/nodulr, cirrhosis
inc PT/INR, bilirubin, albumin
high
500
MCV
Cirrhosis exam finding caused by blockage of fibrotic liver
severe comp
Cirrhosis may lead to ___ due to high progesterone
portal HTN
GI bleeding w esophageal varices
met alk
DDx of splenomegaly
GI
Reticuloendo
Hematopoetic
OWR can lead to
pt w GI bleeding, look for ___ findings
Portal HTN
Infect, granulomatous dz, lymphoma
Leukemia, extramedullary hemato, hemolysis, sc sickle cell
slow bleeding in organs
cirrhosis
Mixed cryoglobinemia caused by
Extrahepatic cholestasis is a blockage of
Key clinical findings
1st step, differentiate from
2nd is ____, to differentiate from
Intrahepatic ddx, aka
Extrahepatic ddx
polyclonal immune complexes in tissues
CHD, CBD, SoO
jaundice, dark urine, light colored stools
hepatitis
imaging, intra/extrahepatic cholestasis
cholestatic liver dz- drugs, infiltrative dz, PSC, PBC, cholestasis of preg
stone, panc ca, cholangiocarcinoma
Lab findings of cholestasis
minimal __ elev
High ____, absent
Chronic cholestasis leads to
H
F
W panc duct blockage, and loss of panc lipase look for
Generalized pruritis in cholestatic liver dz due to inc
transam (diff from hepatitis)
ALP, GGT, direct bilirubin, urine urobilinogen
Hyperlipidemia(xanthelasma, xanthomas)
Fat soluble vitamin def
steatorrhea
inc serum bile salts, endo opioids, lysophosphatidic acid
Choledocolithiasis is a
Mizzi’s syndrome has
Ascending cholangitis due to
Cholestatic picture labs inc, normal
Liver dz in
look for ___, all pt w ___ are predisposed
liver infact w infect leads to
Hemolysis alone can lead to
CBD stone
extrinsic biliary compression from impacted cystic stone
obstructed duct, infected
inc ALP/GGT/bilirubin, normal transam
SC anemia
pigmentary (cholesterol), chronic hemolysis
abscess
indirect hyperbilirubinemia
Nutmeg liver consequence of chronically high
pO2 is higher
central vein pressure produces
cells that die are near
seen in pt w dz like
Portal triad includes
central venous pressure
away from the vessel
patho, hypoxia
portal vein
constrictive pericarditis
Portal vein, hep artery, CBD
