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GI II Exam 2 > Hepatobiliary Disease > Flashcards

Hepatobiliary Disease Flashcards

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1
Q

Why is LFT a misnomer?

A

AST/ALT, ALP, and Bilirubin are more indicative of liver damage compared to function.

Function tests:

  1. PT/INR
  2. Albumin
  3. Cholesterol
  4. Ammonia
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2
Q

Hepatocellular vs. Cholestatic disease

A

Hepatocellular: Injury to hepatocytes

  • Elevated AST/ALT*
  • ALT more specific

Cholestatic: injury to bile ducts
- Elevated ALP and Bilirubin

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3
Q

Bilirubin test are indicative of what?

A

Hepatic uptake, metabolic, and excretory functions

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4
Q

AST/ALT tests are indicative of what?

A

liver cell injury

  • Highest in hepatocellular necrosis
  • Complete biliary obstruction
  • Moderate response to EtOH induced damage
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5
Q

Alkaline Phophatase indications

A

Cholestasis
Biliary obstruction
Liver infiltration
NORMAL elevation in childhood and pregnancy

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6
Q

y-Glutamyl Transpeptidase (GGT)

A

Correlates with ALP

If elevated, think liver problem

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7
Q

What is the best measure of hepatic synthetic function?

A

INR test.

If corrects with Vit. K replacement= fat malabsorption, not liver disease

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8
Q

In Hemolysis, is there an elevation in unconjugated or conjugated bilirubin?

A

Unconjugated

Liver is fine and working to conjugate, but there is an abundance of bilirubin

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9
Q

Murphy’s Sign

A

Tests for acute cholecystitis.

Pain on palpation in RUQ

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10
Q

Cholelithiasis

A

Formation of gallstones

  • Cholesterol
  • Pigment (calcium)
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11
Q

Signs of Cholelithiasis

A
  1. Biliary Colic- steady RUQ pain 30-90 mins post prandial that can radiate to right shoulder
  2. NV
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12
Q

Patient shows an acoustic shadow on Ultrasound. What is this indicative of?

A

Cholelithiasis

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13
Q

F’s of Cholelithiasis

A 
Forty
Fat
Fertile
Female
Family History
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14
Q

What are some protective factors from cholelithiasis?

A

Low carb diet
Physical activity
Caffeinated coffee (thank god)
ASA and NSAIDs

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15
Q

Where is the most common place for a calculous to be impacted and cause acute cholecystitis?

A

Cystic duct

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16
Q

PE presentation of acute cholecystitis

A 
RUQ pain
NV
Fever and Leukocytosis 
Tea-colored urine or acholic stools 
Increased bilirubin, ALP, GGT
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17
Q

Choledocholithiasis

A

Stone in the common bile duct obstructing both biliary and liver secretions. JAUNDICE

  • Can lead to ascending cholangitis
  • ERCP diagnostic and therapeutic
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18
Q

Ascending Cholangitis

A 
Infiltration of duodenal bacteria into the biliary tract
Charcot Triad: 
1. RUQ pain
2. Fever
3. Jaundice

Reynolds Pentad:
Charcot + AMS + hypotension- EMERGENCY

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19
Q

Common bacteria seen on gram stain in ascending cholangitis

A

E. Coli
Klebsiella
Enterococcus

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20
Q

What should be measured prior to performing an ERCP?

A

INR (don’t want them to bleed out)

Pregnancy test in women

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21
Q

Biliary Dyskinesia

A 
Gallbladder just randomly stops working 
Presents like biliary colic
- RUQ pain
- NV
Normal US 
HIDA scan shows abnormal ejection fraction 
Tx: Cholycystectomy
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22
Q

Chronic Cholecystitis

Study These Flashcards
A

Repeated acute cholecystitis
Lab tests are Normal
XR: Porcelain Gallbladder= risk of gallbladder cancer

23
Q

What malignancy is Courvoiseir’s sign indicative of?

Study These Flashcards
A

cancer of the head of the pancreas

Remember: Courvoiseir’s= enlarged NONTENDER Gallbladder

24
Q

Primary Sclerosing Cholangitis

Study These Flashcards
A 
"Beads on a string" due to dilations and strictures in biliary tree
Males
UC association 
PE: Pruritis and Jaundice
Increased risk of Cholangiocarcinoma
25
What is the most common cause of fulminant liver failure (ALF)?
Acetaminophen overdose
26
Describe ALF
massive hepatic necrosis with impaired consciousness that can result in cerebral edema and sepsis
27
PE exam findings in ALF
rapidly shrinking liver, rising bilirubin, prolonged PT, AMS
28
What can be given to a patient suffering from ALF due to Acetaminophen overdose?
N-Acetylcysteine (NAC) | Mucomyst (brand)
29
3 top causes of acute hepatitis
1. Viral 2. Drugs 3. Ischemia
30
What would be seen on PE in acute hepatitis?
Jaundice Hepatomegaly RUQ pain Dermatological changes (Polyarteritis, cryoglobulinemia)
31
A patient presents with NV, RUQ pain, hepatomegaly, a and jaundice. They are a smoker, but now say they can't even stand the smell. Ddx?
``` Hepatitis A - aversion to smoking - echoic stools - elevated bilirubin and ALP Detection of IgM anti-HAV is excellent prognosis ```
32
Common risk factors of HBV
``` Anal sex IV drug use Medical worker (needle sticks) Incarcerated previous STI ```
33
What kind of lab pattern does HBV show?
Hepatocellular (elevated AST/ALT)
34
What are HBV positive patients at risk of developing?
HCC | Cirrhosis
35
Describe the window period of HBV infection
Early in the disease course, HBsAg is cancelled out by Anti-HBs, and IgM-antiHBc is the only thing detected. If in stem you see IgM-antiHBc positive, patient has ACTIVE infection
36
Acute HBV infection serology
HbsAg + IgM-antiHBc + HBeAg and HBV DNA +
37
What does a positive HBeAg and HBV DNA serology indicate?
Active replication which is active disease
38
What is the only positive serology finding in an immunized person with no previous infection?
Anti-HBs only see Ab's to core if you've had the infection
39
What is required to have an HDV infection?
HBV
40
What type of Hepatitis strain is associated with HIV infection?
HCV
41
What Hepatitis strain is associated with immunocompromised patients?
HEV
42
What is the minimal time period after ingestion to use the Rumack-Matthew Nomogram to evaluate acetaminophen Overdose?
4 hours | Critical ingestion-treatment interval for protection against hepatic injury is 0-8 hours
43
Budd-Chiari Syndrome
Occlusion of the hepatic vein or IVC - Caused by Right-sided HF or Caval Webs that obstructs IVC - Leads to nutmeg liver - Screening test of choice is a CEUS (contrast-enhanced ultrasound)
44
What is HELLP syndrome and what is it associated with?
Hemolysis, Elevated liver enzymes, Low platelet count, | Associated with Pre-eclampsia and Eclampsia leading to hepatic disease of pregnancy
45
Acute Fatty liver of pregnancy
many disorders lead to hepatic dysfunction that can result in failure, coma, and death. You will get pregnant, and DIE
46
Clinical jaundice is defined as:
bilirubin >3 mg/dL
47
2 unconjugated (indirect) bilirubinemias we need to know
Hemolytic Syndrome Gilbert Syndrome Criggler-Najjar because I said so
48
4 causes of conjugated (direct) bilirubinemias
1. Dubin-Johnson: black liver 2. Rotor Syndrome 3. Drug reaction 4. Pregnancy
49
If GGT is elevated, what is the suspected source of jaundice?
Liver | If normal: suspect bone or something else
50
If you suspect Jaundice secondary to hemolysis, what would be seen on CBC?
Anemia Thrombocytopenia Increased LDH, haptoglobin, reticulocyte count
51
Gilbert Syndrome
Reduced uridine diphosphate glucoronyl transferase - increased indirect bili - Benign, no harmful, actually protective against CV disease
52
Dubin Johnson Syndrome
reduced excretion of bilirubin from hepatocytes due to mutation in ABCC2 gene encoding for MDRP2. Black liver
53
Rotor Syndrome
Reduced uptake of bilirubin in the liver causing elevated direct bilirubin. OATP1B1 protein
54
Bilirubinemia due to pregnancy
Mainly Direct bilirubin | - itching in the 3rd trimester, GI symptoms, excellent prognosis

GI II Exam 2 (16 decks)

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