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SUMMED2 > GI-LFT, Biliary DZ > Flashcards

GI-LFT, Biliary DZ Flashcards

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1
Q

What 3 categories define liver function?

A
  1. Hepatocellular – Transaminase AST/ ALT
    ratio determine etiology
  2. Cholestatic – Alkaline Phosphatase. Biliary Tree
  3. Bilirubin:
  4. total
  5. indirect-uncongugated,
  6. direct bilirubin:
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2
Q

What other metoblic panels are made by liver?

A

GGT- alcholism
Albumin- DM
Clotting factors

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3
Q

Mr. Pepsi has inc LFT with AST predominant AST/ALT >1. What are DDX?

AST/ALT- N 40
Ideally- 14-20

A

Alcoholism-**AST rarely >300 AST= alcohol

IF INC ALT >500

  1. viral HEP C/B
  2. acetaminophen, TB drugs, antifungal, methotrexate, NSAIDs, herbals, occupation
  3. Hepatocellular damage
  4. Autoimmune Hepatitis- inc
  5. Fatty liver
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4
Q

What are non hepatic causes of inc AST/ALT

A 
MSK injury
Adrenal insuff
MI
Celiac
AN
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5
Q

Name steps for evaluation of INC AST, ALT

A
  1. confirm >3m, recheck
  2. Ask habits alcohol, RX, illness
  3. Rx meds drug toxicitys
  4. Ratios- AST/ALT
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6
Q

Mr pepsy has h/o of IVDA. Which further test would be used?

A

Hepatitis panel (A, B, C)

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7
Q

Mr. pepsy CBC came back ABN, what addn test are needed?

A

Ferritin, Fe/TIBC
hemochromatosis (high iron levels)

Copper /ceruloplasmin- in young patient- Wilson’s dz

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8
Q

Mr. Pepsy has HSM during PE. What is next workup?

A

US: fatty liver, splenomegaly

tumor

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9
Q

IF nothing is identifiable for the cause of INC AST/ALT, what is next?

A

Referral

Liver biopsy- liver regenerates, major blood supply

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10
Q

What could be causes of Mr. Boney’s mild elevation of Alk Phos and mild elevation of transaminases?

A

ALK PHOS-MC Biliary tract
Metastatic or biliary Ca

  • PBC primary biliary cirrhosis
  • *Fatty liver
  • Biliary stones
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11
Q

What is DDx when Alk Phos is dominant and GGT is INC?

A

Hepatobiliary dz
US RUQ- dilated Bile ducts?

Kids normal high Alk Phos levels- growing, 400s

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12
Q

Mr. Boney has INC Alk phos and has NORMAL GGT gamma-glutamyl transpetidases, isoenzyme detects origin?

A

Bone origin

bone cancer= INC Alk

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13
Q

What type of bilirubin if INC may come from hemolysis, heart failure, hyperthyroidism?

A

Unconjugated bilirubin
fat soluble BBB, W/IN plasma, attached to albumin. 1st process of hemolysis of RBC

Spilling of bilirubin in the blood
Reticulocyte count INC = immature new red blood cells
Serum haptoglobin = RBC are split open, you also get low levels of haptoglobin

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14
Q

What type of bilirubin if INC came from gallbladder and liver?

A

Conjugated bilirubin WATER soluble, NO BBB, W/in BILE, NO albumin, EXcreted in URINE

DDX-Choledocholistasis
Biliary Obstruction
Cholangiocarcinoma
AIDS
PSC
HEPABC
Pregnancy
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15
Q

What two congential d/o relate to hyperbilirubinemia?

A

Gilbert’s- MC * indirect/uncong bilirubin. All LFTs are normal, asymptomatic. Just a little bit higher than normal.

Dubin Johnson

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16
Q

MC ETOH or choledocholithiasis (gallstone) cause inflammation here which result in n/v, dyfx digestion.

A 
Pancreatitis:
Meds
Trauma, structural
Chronic- ETOH
FH
malnutrition
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17
Q

Mr. KFC finishes his 3piece meal and c/c n/v, indigestion. PMH DM. What can result from this eating?

A

Pancreatitis d/t Hypertriglyceridemia- INC TGs 4-500 ABN

FH genetic

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18
Q

Vacuoles are formed d/t blockage. Trypsin release lead to what of the pancreas?

A

AUTODIGESTION from Digestive enzymes
cell death
enzymes released in blood

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19
Q

What are causes of HYPOtension, ARDS, DEC clotting factors, hypocalcemia?

A

Pancreatic enzymes released into circulation

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20
Q

Mr. KFC c/c ABD pain, stabbing thru back. Constant pain radiating to back, flank, shoulder. He states leaning forward and fasting helps?

A

Clinical symptoms of Pancreatic- retroperitineal

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21
Q

Mr. KFC has abdominal rigidity on PE. What other signs are expected with pancreatitis?

Study These Flashcards
A

Abdominal guarding
Fever
Tachycardia
Shock- when severe

22
Q

Mr. KFC should get what diagnostic studies for is suspected pancreatis?

Study These Flashcards
A

MC-CT w/ Contast

Abdominal XR, US-stones

23
Q

Mr. KFC labs show INC BUN. Why and what are other findings in labs?

Study These Flashcards
A

DX-INC amylase and lipase***

BUN- dehydration
Hypocalcemia- d/t enzymes
Leukocytosis- INC WBC infx
Hyperglycemia- pancreas not working to release insulin
INC LFT- biliry obstruction Alk phos
24
Q

What are the complication of pancreatiis?

Study These Flashcards
A 
GI bleed- MC
Shock-ED
Hypoxia- pleural effusion RDS
Pseudocysts- damaged pancreas
Abscess
25
What are complication of alcholism on prancreas?
``` Bile duct obstruction Ascites- leakage Pancreatic pseudocyst Recurrent epigastric pain Amylase inc Emaciation Edema Brusises DM Jaundice Gi bleeds Polyarteriis- small jt of hand and feet ```
26
What is complication of stool with chronic pancreatisis?
Steatorrhea- white stool | greasy, floaty;
27
``` Mr. Vodka labs show the following INC amylase, lipase Hyperglycemia: INC bilirubin hypoproteinemia, Why are these present? ```
Chronic Pancreatitis findings Hyperglycemia: advanced parenchymal damage bilirubin, alk phos due to extrahepatic, biliary obstruction Malabsorption: hypoproteinemia, d/t deficiency of fat soluble vitamins Stool analysis for fat content Ascites- INC protein/amylase
28
``` The following complication that pose rare risk of death are related to;? GI bleed- esophageal varices, cirrhosis Biliary tract infection Liver failure Malabsorption Electrolyte abnormalities ```
Chronic pancreatitis | Death rare from pancreatitis associated
29
What is 1st line of treatment for pancreatisis?
NO ETOH Pancreatic ensyme w/ meals Analgesics Small meal
30
What is MCC of Cholelithiasis/ gallstones?
``` Most are cholesterol related 50% symptoms P obese DM Statins GI d/o Estrogen-F Hemolysis Billary infx- INC unconjugated bili ETOH ```
31
What are the 4 F related to risk of Cholethiasis?
FAT FORTY FEMALE FERTILE
32
Mrs. Jasper 40yo cc/ RUQ and mid epigastric pain, that is intermittent for 1 wk. Pain often sharp and severe after eating KFC meals. What is DDX and other findings?
Cholelithiasis: Biliary colic- intermittent pain Pain- radiate to back and R shoulder wrap around DX- NEG Murphy sign w/ US NORMAL LFTs
33
What labs are necessary for gallstones?
LFT- If no obstruction w/ gallstone, then LFT normal If obstruction w/ gallstone, then Alk Phos will be elevated CBC Chem7 DX- Retroperitoneal ABdomen US- stone have acoustic shadow
34
Why is elective cholecystectomy important?
IF sx, very important LOW Risk of CA If gallbladder is calcified 50% recurrence rate- no surgery
35
What are non surgical treatment?
Oral bile salts slowly dissolves stones Lithotripsy ERCP- last
36
Are severity of symptoms related to prognosis of gallstones?
NO | ONLY Length of time w/ symptoms inc risk
37
These risk are assoc with what concern a. Acute cholecystitis b. Cholangitis with liver abscess c. Necrotizing pancreatitis d. Gallstone ileus with SBO e. Gallbladder CA
MORBIDITY People who elect NOT to have cholecystectomy (cholecy-gallbadder, bile, fat) Tell PT go to ED for RUQ severe pain that doesn't go away w. FEVER
38
*Mr. Bile c/c of severe RUQ pain w fever. Pain moves to around to R shoulder, 1-2hr after meals. Fever for 2 day 100.4.
``` Acute cholecystitis SEVERE CONSTANT RUQ PAIN R UPPER SHOULDER LAB- LFTS, CBC, CHEM **DX- US- RUQ distended gallbladder fluid ```
39
What is on PE w/ Pt of acute cholecystitis?
* Fever * RUQ tenderness * Involuntary guarding * (+) Murphy’s sign. KEY BUT WITH CHOLECYSTITIS **AND CHOLECLITHTISAS = NEG. MURPHYS
40
Mr. Bile came in today because of RUQ, SHAKING CHILLs; FEVER. His daughter notice yellow JAUNDICE of skin. What is the triad called?
CHARCOTS TRIAD-Indicates ASCENDING CHOLANGITIS- stasis infection in bilary tract. cholecystitis moved from biliary tract to common bile duct. **GRAM NEG BACTERIA TRAVEL UP TO BILE DUCT OR HEPATIC DUCT RESULT OF OBSTRUCTION
41
What occurs if the infection moves into common bile duct?
CHOLANGITIS Gallbladder will stop working L/T infection and abscess TX- ABX GRAM - /ANAEROBES IF acsending to common hepatic EMERGENCY SURGERY
42
Mr. Bile labs are as follows: What is this condition? • *Leukocytosis w/ left shift • *Elevated Alk Phos, Total (direct) bili, GGT • Variable elevations in ALT, AST
ACUTE CHOLANGITIS | immature neutrophils-bands- INFECTION
43
Ms. KFC labs are as follow: What is this condition • Leukocytosis • Elevated Amylase, mild • Elevated ALT/AST, mild • Total bilirubin and Alk Phos not elevated • Order US
ACUTE CHOLECYSTISIS
44
What are main difference btwn ACUTE Cholecystitis vs Cholangitis
1. CHOLANGITIS- JAUNDICE, COMMON BILE DUCT SURGERY, INC ALK PHOS, LEFT SHIFT 2. CHOLECYSTITS- ELEVATED AMYLASE, ALT/AST
45
*Mr. Bile c/c of severe RUQ pain w fever. Pain moves to around to R shoulder. Fever for 2 day 100.4. What is treatment?
1. Cholecystectomy definitive treatment 2. IV, ABX GRAM - 3. Analgesics 4. NPO-
46
Ms. Frost has PHM of IBD, what are some complications?
Primary Scleroising cholangitis- inflammation, fibrosis, and stricturing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree MC w/ IBD with ABNormal LFT MC do have UC, NOT Crohn CP- ASY, Itching**, fatigue, nt sweats, jaundice LABS- INC Alk Phon, bilirube, Mild AST/ALT DX- MRI, US Prognosis- CA, biliary strdictus, bone dz, ADEK defiicent
47
What is a Rare T-lymphocyte-mediated attack on small intralobular bile ducts; MC W 30-65
Primary Biliary cholangitis (primary biliary cirrhosis)
48
What is Intrabiliary pigment stone formation, resulting in strictures of the biliary tree and biliary obstruction with recurrent bouts of cholangitis? MC Southeast Asia
Recurrent pyogenic cholangitis
49
Ms. Harris had painless jaundice, cough, no hempotosis RUQ pain, edema and weight loss.
Cholangiocarcinoma | Rare bile duct cancer, often associated with PSC,
50
Any pt with itching and pain or painless jaundice, what should be workup?
Check their LFT SrC and BUN- kidney fxn. Very concerning for biliary tract cancer

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