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Flashcards in Hepatology Deck (283):
1

quid of amebic liver disease

tender liver mass on abdominal ct scan

2

rx of amebic abcess

metronidazole

3

patient with hepatic mass after traveling in endemic areas

amebic abcess

4

drug causing idiosyncratic reaction hepatitis(4)

halothane
phenytoin
isoniazid
@-methyl dopa

5

drugs causing cholestasis(4)

chlorpromazine
erythropoietine
anabolic steroids
nitrofurantoin

6

drugs causing fatty liver disease(3)

tetracycline
acid valproic
ARV

7

drugs causing granulomatous reaction(2)

allopurinol
phenylbutazone

8

2 ways for drugs to cause injury

toxic effect
idiosyncratic reaction

9

quid of toxic effect

reaction is dose dependent

10

example of toxic efffect(2)

tetracycline
acetaminophen

11

quid of idiosyncratic effect

reaction is dose independent

12

example of idiosyncratic effect(2)

isoniazid
ARV

13

clue for non alcoholic steato hepatitis NASH(4)

non drinker
serologic hepatitis negative
obese with high ALP
slightly increase SGOT,SGPT

14

link to have NASH

obesity

15

why obesity causes NASH

fat cells are not responsive to insulin and lipid is deposited in the liver

16

how 's ALT/AST in NASH

AST/ALT<1

17

dx of NASH

Liver biopsy

18

risk factor for NASH(5)

obesity
diabete
hyperlipidemia
parenteral nutrition
medications

19

medication risk factor for NASH(5)

corticosteroids
tamoxifen
amiodarone
diltiazem
HAART

20

quid of Murphy sign

RUQ pain worst during inspiration

21

clue for acute cholecystitis

pain in RUQ worsen with fatty liver meal

22

ALP in chlocystitis

normal

23

where 's stone in acute cholecystitis

in the cystic duct

24

RUQ pain with high ALP(2)

cholangitis
or
choledocolithiasis

25

why you have fever in cholecystitis

secondary infection

26

why infection can happen in acute cholecystitis(2)

because of inflammatio you can have stasis and bacterial overgrowth
risk of gangrene and perforation

27

what's the first step to address in case of variceal bleeding

2 large bore IV needles or central line

28

patien with acute pancreatitis develops palpable epigastric mass

pseudocyst formation

29

why amylase is elevated in pseudocyst

leak of amylase from the pseudocyst into the circulation

30

best image to Dx pseudocyst

US

31

rx of pseudocyst(2)

observation
resolve spontaneously

32

indication of drainage of pseudocyst(3)

more than weeks persistance
infection
> 5 cm

33

patient with high bilirubin direct and hgh ALP next step(3)

CT
or
US
+ antimitochondrial antibody

34

panacinar emphysema plus cirrhosis

@-1 antitrypsine deficiency

35

rx of @ antitrypsine deficiency

Alpha 1 anti trypsine factor

36

asymptomatic elevation of transaminase next step?

good history on risk factor

37

risk factor for hepatitis(5)

drug
alcohol
endemic area travel
blod transfusion
high risk sexual practices

38

Med causing high transaminase(5)

NSAIDS
HMGco A reductase inhibitor
antiepileptic drugs
izoniazid
herbal preparation

39

clue for acute pancreatitis(3)

epigastric pain
rlieve by leaning forward
occuring after binge eating

40

rx of acute pancreatitis(4)

conservatively
analgesics
fluid
NPO

41

analgesics used in acute pancreatitis(2)

fentanyl
meperidine

42

most common type of gallstone in US

cholesterol stone

43

2 types of gallstone(2)

cholesterol
calcium bilirubinate

44

dx of choice of cholecystitis

US abdomen

45

rx for symptomatic cholecystitis

laparoscopic cholecystectomy

46

patient with microcytic anemia and firm hepatomegaly

metastatic cancer from colon

47

first site for matastasis pf colon cancer

hepatic

48

goal standard for metastatic hepatic colon cancer

abdomen CT scan

49

tinding in CT during metastatic hepatic colon cancer

cholestatic syndrome

50

PBC clue

antimitochondrial antibody type IGM

51

Biopsy of PBC(2)

destruction of intrahepatic bile ducts and cholestasis
medium size bile duct

52

first symptom of PBC and why?(2)

pruritis
because of cholestasis

53

conditions associated with PBC(5)

sjogren
scleroderma
celiac disease
autoimmiune thyroid problem
hypothyroidism

54

drug of choice fro PBC treatment

ursodeoxycholic acid

55

definitive rx of PBC and severe disease

liver transplant

56

jews with ictere

dubin jhonson

57

work up for dubin jhonson(2)

Normal AST/ALT
high bilirubin conjuguee

58

differentiate dubin jhonson from rotor

dark granular pigment seen in hepatocytes=Dubin jhonson

59

mechanism of gynecomastia in cirrhosis

excess of estrogen in the body

60

mechanism in testicular atrophy in cirrhosis

lot

61

why T3T4 are low in cirrhosis

no protein to bind T3T4

62

why TSH is normal in cirrhosis

because you lack thyroid binding globulin not T3T4

63

2 causes in cirrhosis causing hypogonadism(2)

hemochromatosis
alcohol

64

what causes hypogonadism(2)

primary hypogonadism
secondary due to hypothalamo hypophysaire dysfuction

65

why lung can have problem in cirrhosis

hapatic hydrothorax

66

why edema in cirrhosis

low albumin level

67

why hepatic hydrothorax in cirrhosis

defect of diaphragm allows ascites fluid to go in pleural space

68

patient with cirrhosis on diuretics develops pleural fluid effusion ,next step

TIPS
transjugular porto systemic shunt

69

cirrhosis and shortness of breath

pleural effusion

70

forst rx for hepatic hydrothorax(2)

diuretic
fluid restriction

71

Triad of charcot(3)

ictere
fever
RUQ pain

72

pentad of renold(3)

triad de charcot
plus
hypotension
confusion

73

pentad of renold or charcot disease?

cholangitis

74

clue for acute cholangitis

high ALP

75

first step in rx of cholangitis

antibiotics

76

patient with cholangitis ,getting worse with antibiotics next step

surgical decompression

77

what'ts the best indicator of progression of HEP C infection in liver

biopsy

78

role of biopsy in HEP C infection(4)

stage of the disease
rule out concommitant disease
guide rx decision
surveillance

79

electrolyte abnormality in cirrhosis

low K+

80

step of management of hepatic encephalopathy(4)

supportive care
rx the precipitating cause
correct volume and electrolyte problem
lower ammonia

81

way to lower ammonia

lactulose

82

when you can add rifamixin in the rx of high ammonia in cirrhosis

when failure with lactulose after 48 h de rx

83

Burn Patient develops RUQ pain

acalculous cholecystitis

84

lactulose side effect

rifamixin

85

quid of acalculous cholecystitis

inflammation of gallbladder without calcul

86

conditions predisposing to acalculous cholecystitis(5)

severe burns
severe trauma
prolonged TPN
prolonged fasting
mechanical ventilation

87

complication of acalculous cholecystitis(3)

gangrene
perforation
emphysematous changes

88

initial work up for acalculous cholecystitis(3)

US abdomen
more specific
HIDA scan
CT scan

89

IV drugs user with ascites

chronic liver disease

90

most common cause of chronic liver disease

alcohol
hep c

91

why splenomegaly in cirrhosis

because of portal HTA

92

rx of hepatitis B preferred drug(2)

tenofovir
entecavir

93

drug used in rx of hep B(4)

tenofovir
entecavir
interferon
3TC

94

Indication of rx(6)

acute liver disease
clinical complications of cirrhosis
advanced cirrhosis with with high HBV DNA
Patient without cirrhosis but with positive HBe AG,
HBV DNA>20000< ALT AST:2f la normale
chemo or immuno suppression

95

why TDF and entecavir are prefered (2)

low risk of resistance
can be used in decompensated cirrhosis

96

cirrhosis and encephalopathy Rx

lactulose

97

cause of precipitation of cirrhosis(9)

infection
hypoxia
hypoglycemia
hypovolemia
porto systemic shunt
excessive nitrogen load
medication
hypokaliemia
metabolic alkalosis

98

medication percipitating cirrhosis

sedatives

99

cause of excessive nitrogen load

bleeding

100

4 phases in chronic infection caused by hepatitis B

immune tolerance
imune clearance
inactive carrier state
reactivatio

101

clue for immune tolerance(4)

high antigene HBS
High HBE antigene
high HBV replication
minimal destruction of hepatocytes

102

duree of immune phase

10 a 30 years

103

what happened in imune clearance phase

destruction of hepatocytes containing HBV

104

clue for this phase(2)

ALT high or normal
HBE antigene positive

105

meaning of HBe

active replication is occuring

106

what to do in the phase of ICP

serial ALT(q3-q 6 months)
serial HBe Ag

107

why serial ALT and HBe in ICP

to fully document clearance

108

clue for inactive carrier(3)

Hbe ag -
Hbe aB +
Low HBV DNA

109

indication to conclude inactive carrier state(2)

>/ a 3 Normal ALT
2 a 3 Normal HBV DNA

110

cue for reactivation of HepB(3)

high ALT
high HBV
fibrosis on biopsy

111

how to follow patient with chronic Hep B

serial ALT

112

what should be done to any patient with chronic hepatis

vaccination for Hep A and B

113

what should be done to any patient with hepatitis C infection

vaccination for Hep A and B

114

indication of rx in chronic Hep C(4)

age > 18 ans
detectable serum RNA
compensated liver disease
liver biopsy with fibrosis

115

quid of compenated corrhosis(2)

INR normal <1,5
no ascites

116

rx of chronic Hepatitis C(2)

Peginterferon
plus
ribarivirin

117

indication of protese inhibitor in rx of hepatitis C infection

HCV 1

118

contrindication of rx with protease inhibitor(3)

uncontrolled depression
alcohol
drug abuse

119

protease inhibitor used in HCV infection(2)

telaprevir
boceprevir

120

patient with cirrhosis high ALT and AST and brownish deposit around cornea

wilson disease

121

quid of keyser fleisher ring

brownish deposit around cornea

122

biopsy finding in wilson

hepato lenticular degeneration

123

why psychiatric problem in wilson

copper leak fromhepatocytes and deposit in basa ganglia

124

eye problem in wilson

keyser fleisher ring

125

dx test for wilson(3)

liver biopsy
low ceruloplasmin
low copper in urine

126

finding in liver biopsy

copper >250 Mcg

127

meaning of low ceruloplasmine

< 20 mg/dl

128

confirmatory dx test

keyser flesher ring

129

Rx of wilson(2)

Penicillamine or trientine
plus
ZN

130

when liver transplantation is indicated in wilson(2)

decompensated liver disease
fulminant hepatic failure

131

best rx of choledocholithiasis

laparoscopic cholecystectomy

132

in case of a patient refusing the surgical rx of choledocholithiasis(2)

ursodesoxycholic acid
avoid fatty foods

133

pancreatitis in non alcoholic patient

gallstone

134

Rx of pancreatitis in non alcoholic patient

cholecystectomy

135

mid epigastric pain with high lipase and amylase

acute pancreatitis

136

quid of hapatic adenoma

hepatic tumor in young female taking OCP

137

complication of hepatic adenoma(2)

intratumor hemorrage
malignant tranformation

138

biopsy in hepatic adenoma

enlarged heaptocytes containing glycogen and lipid deposits

139

rx of hepatic encephalopathy

serum ammonia level

140

why hyperandrogenism in aptient with cirrhosis

inabiloity of the liver to metabolise estrogen

141

effect of high estrogen in cirrhosis(5)

spider angioma
gynecomastia
little testicle
palmar erythema
decreased body haior

142

liver function(3)

metabolic
synthetic
excretoire

143

liver synthesis(3)

protein
cholesterol
clot factor

144

excretory role of liver

bile

145

metabolic role of liver(2)

detoxification of drug
and steroids

146

clue for amebic liver disease(4)

trip to mexico
history of bloody diarrhea
RUQ pain
uniform cyst in right lobe

147

risk factor for gallbladder carcinoma(3)

chronic gallblader inflammation
porcelain gallbaldder
salmonella typhi carriage

148

chronic gallblader inflammation cause

stones

149

indication of cholecystectomy in gallbladder carcinoma

when ca is confined to gallbladder wall(lamina propria)

150

risk factor for porcelain gallblader

chronic inflammation by gallstones

151

complication of porcelain gallbladder

cancer

152

glomerulonephritis with low complement(4)

GNA
MPGN
Lupus
Mixed cryoglobulinemia

153

link between Cryoglobulinemia and RA(2)

IGM will be targeted towards IGG
rhumatoid factor can be positive

154

quid or cryo

it's a vasculitis

155

target in cryo (4)

articulation
skin
rein
foie

156

skin finding in mixed Cryo

purpura

157

first step in aptient with suspected mixed cryo

test for hepatitis C

158

confirmatory Dx for mixed Cryo(2)

kidney biopsy
or
skin biopsy

159

clue for porphyria cutanea tarda(3)

photosensitivity
fragile skin
erosion and vesicles on dorsum of the hands

160

disease causing porphyria cutanea tarda

mixed cryo

161

clue for Mixed Cryo

periodic increase of Tranaminases

162

complication of Mixed cryo(2)

cirrhosis
hepatocellular carcinoma

163

cause of Non alcoholic fatty liver disease in obese patient

insulin resistance

164

physiopatho af NAF liver disease(3)

high lipllysis in periphery
high triglyceride synthesis
high hepatic uptake of fatty acids

165

criteria for NAF liver disease(3)

steatohepattitis
viral serology -
< 20 J/ weeks alcool

166

patient with virl hepatitis develops high PT and decresed transaminases Dx

Fulminant hepatitis

167

decrease transaminase in the setting of viral hepatitis meaning?(2)

recovery
fulminant hepatitis

168

patient with positive HBS antibody (2)

vaccination
prior infection

169

first marker to be positive in Hep B

Hbs Ag

170

second marker to be positive in Hep B

anti hbc IGM

171

most specific marker to Dx acute Hep B

IGM HBC antibody

172

why Hbc ag can not be seen

it's sequestered within HBS ag coat

173

Meaning of HBe Ag

infectivity

174

Meaning of HBe Antibody

low infectivity

175

Meaning of HBc antibody

recovery

176

what are the 3 types of gallstones

cholesterol
pigment stone
mixed stone

177

quid of pigmented stones

calcium bilirubinate stones

178

why pregnant women are prone for cholesterol stones

hypomotility of gallbaldder

179

cause of gallbaldder hypomotility(4)

advanced age
TPN
prolonged fasting
hypertriglyceridemia

180

5 causes of cholesterol gallstones formation

hypomotile gallbladder
malabsorption of acid biliaire
OCP
Meds

181

Med causing cholesterol stones(3)

clofibrate
octreoctide
ceftriaxone

182

risk factor for pigmented stones(3)

hemolysis
chronic biliairy tract infection
parasitic infection

183

protective factor against stones(5)

NSAIDS
Aspirin
caffeine
physical activity
low carbohydrate diet

184

quid pof Hepatic shock

patient with low TA develops high AST/ALT with mild elevation of bilirubin

185

what happen in hepatic shock

ischemic hepatic injury

186

pregnant women develop Hep C infection next step(2)

Hep A vaccine
Hep B vaccine if not immune

187

clue for hepatic cyst (hydatic)(2)

thick wall cyst
egg shell calcification

188

cause of hepatic cyst

ecchinococus granulosis

189

what you should not do in hydatid cyst

aspiration of the cyst

190

why you should not aspirate in hydatid cyst

risk of hypersensitivity

191

rx in hydatid cyst

surgery under albendazole coverage

192

quid of fulminant hepatic failure

acute viral hepatitis complicated with encephalopathy

193

rx of FHF

orthotopic liver transplant

194

other way of considering FHF

hepatic encephalopathy within 8 weeks of acute liver disease

195

young person with high transaminase and neurologic finding resting tremor and muscular rigidity

wilson

196

FHF in pregnant women in 3 e trimestre

Hep E

197

all patients receiving blood before 1986

screen Hep B and C

198

all patients receiving blood before 1992

screen Hep C

199

after marrow transplantation pateint develops decreased bile ducts quantity in liver biopsy what disease has the same pattern

PBC

200

cause of ductopenia(8)

PBC
hogkin
sarcoidosis
cmv infection
HIV
Med induced
failing liver transplantation
graft versus host disease

201

after marrow transplantation pateint develops decreased bile ducts quantity in liver biopsy dx

graft versus host disaese

202

most common cause of ductopenia

PBC

203

other name for ductopenia

vanishing bile duct syndrome

204

asian american with ictere bilirubin in urine

rotor

205

quid of bilirubin in urine

conjugated hyperbilurubinemia

206

bilirubin in gilbert

high conjugated hyper bilirubinemia

207

patient taking INH develops high transaminase < 100 next step(2)

continue with RX
will resolve spntaneously

208

patient with multiple trou noir on CT scan

metastatic disease from colon cancer

209

primary cancer to metastase in liver(3)

colon cancer
lung
breast

210

clue for Ca in the United states

weight loss

211

test of choice for pancreatic cancer

CT abdomen

212

3 causes of decompensated liver with high transaminase
ALT>AST(3)

medication
viral hepatitis
shock liver

213

medication causing decompensated liver with high transaminase

acetaminophen

214

antidote of paracetamol intox

acetylcysteine

215

Transminase in severe hepatic injury

>1000

216

3 causes of ALT>AST(3

medication
viral hepatitis
shock liver

217

complication of elective cholecystectomy

sphincter d'oddy dysfunction

218

3 causes of ALT>AST(3

medication
viral hepatitis
shock liver

219

complication of elective cholecystectomy

sphincter d'oddy dysfunction

220

rx of sphincter d'oddy dysfunction

ERCP with sphicterotomy

221

patient after elective cholecystectomy has persistent RUQ pain DX?

sphincter d'oddy dysfunction

222

ratio AsT/ALT in alcoholic patient(2)

AST/ALT >2

or
AST >ALT 2f

223

why in alcoholic patient AST >ALT

deficiency in pyridoxal 6 phosphate

224

quid of in pyridoxal 6 phosphate

cofactor of ALT

225

U/s in emphysematous cholecystitis (2)

circular linear shadows gaseaous in gallbladder
no gall stones

226

patient with RUQ pain ,abdominal xray showing air fluid level in the gallbladder

emphysematous cholecystitis

227

U/s in emphysematous cholecystitis

circular linear shadows gaseaous in gallbladder

228

cholecystitis with no gall stones

acalculous
emphysematous

229

cause of emphysematous cholecystitis

gas forming bacteria

230

clue for Hep A infection (2)

trip in Mexico
or
endemic area

231

risk factor for Emphysematous cholecystitis

diabetes

232

clue for Hep A infection

trip in Mexico

233

the most common malignant in liver

metastasis

234

patient alternance of dairrhea and constipation presenting with high ALP and multiple hepatic nodules on CT Dx?

Metastasis from colon cancer

235

Multiple nodules in Liver Next step

check GI for primary Cancer

236

transaminase in hepatic shock

ALT
AST > 1000

237

transaminase in post op cholestasis(2)

Normal AST ALT
High ALP

238

hepatic shock

ALT
AST > 1000

239

quid of asymptomatic gallstones

gallstones seen in US but no Symptom

240

rx for asymptomatic gallstone

nothing

241

rx for symptomatic gallstone

laparoscopic cholecystectomy

242

normal liver span

6-12 cm in the midclavicular line

243

3 types of hepatic liver disease linked with alcohol(3)

fatty liver
alcoholic hepatitis
alcoholic fibrosis /cirrhosis

244

clue for fatty liver in biopsy

steatosis

245

clue for alcoholic hepatitis in biopsy(4)

mallory body
liver cell necrosis
perivenular distribution of inflammation
liver cell necrosis

246

what the 2 phases reversible with cessation alcohol

steatosis
hepatitis

247

clue for hypertriglyceridemia in a patient with suspected acute pancreatitis

xanthomas

248

quid of XAnthoma

yellow red papules on arms and shoulders

249

mechanism of xanthoma(2)

fat deposit on tendon
or in subcutaneous tissue

250

in acute pancreatitis what to always do

order profile lipidic

251

bleeding in liver failure(2)

varices
coagulopathy

252

manif of varices

hematemesis

253

manif of caogulopathy

epistaxis
bleeding from IV sites

254

management of coagulopathy

fresh frozen plasma

255

what cause coagulopathy in liver failure

all clot fator are formed in the liver except factor 8

256

why FFP is the best treatment in coagulopathy caused by liver failure

because it has all the clotting factor

257

screening test for acute Hep B(2)

IGm HBc antibody
HBs Ag

258

drug of choice for PBC

ursodeoxycholic acid

259

Dx differentiel in patient with indirect high bilirubinemia(4)

hemolysis
gilbert
criggler najar

260

=/ gilbert from criggler Najar type 1(2)

high bilirubin in Criggler Najar 20-25
in gilbert 3 a 5

261

quid of SAAG

serum albumin ascire gradient

262

SAAG calculation

albumin serique-albumin ascites

263

SAAG> 1,1

hypertension portale

264

AES in patient with acute phase of hepatite B,patient pique non immune a hep B(2)

vaccine +
immunoglobulin

265

quid for acute phase of Hep B(4)

IgM anti HBc
Hbs Ag
HBe Ag
DNA +

266

quid of window phase

IgM anti Hbc +
DNA positive

267

quid of recovery phase(4)

anti HBe
antihbc iGG
anti HB s
DNA -

268

chronic carrier(2)

HBS ag
IGG anti HBC

269

acute flare of chronic

Hbs ag +
HBe Ag
IGG anti HBc
DNA +

270

vaccinated patient

anti hbs ag

271

immune by contact with the virus

IgG anti HbC
anti HBS ag

272

PAS positive in hepatology

@-1 anti trypsine deficiency

273

Symptom of hypogonadism(3)

decraese libido
eerctile dysfunvtion
loss of axillary and pubic hair

274

indication of TIPS

refractory hydrothorax in cirrhosis

275

step in hepatic encephalopathy

search for precipitating cause

276

approach to chronic hepatitis C

Serial ALT to follow up

277

what's the next step after rx acute pancreatitis caused by gallstones

schedule cholecystectomy

278

clue helping in the Dx of cirrhosis encephalopathy

serum ammonia

279

when to make dx of gallbladder carcinoma(2)

per-op
or
post op

280

immunlogy in mixed cryo

IGM is directed towards IGG anti hepatite C virus

281

when to suspect Hep C infection

waxing and waning increase of transaminases

282

extrahepatic manif of chronic hep C(3)

mixed cryo
porphyria cutanea tarda
membranoproliferative glomerulonephritis

283

hepatitis induced by INH transaminase less than 100

continue with the rx