Hepatology Nazary Flashcards
(112 cards)
1
Q
Extra abdominal causes of acute abdominal pain
A
2
Q
Medical causes of acute abdominal pain
A
- Medical causes of Acute Abdominal Pain:
• Addisonian Crisis
• Acute pleurisy & Pneumonia
• Porphyria
• Pelviureteric Colics
• Pyelonephritis
• Severe hypercalcemia
• SLE & FMF
• Sickle cell crisis
• DKA
3
Q
Most affected area in chirosis
A
Area3 peri central area zone 3
4
Q
Most active cell in chirosis
A
Cell of ito(fat stellate lipocytes) by tgf1
5
Q
Mention causes of chirosis and hepatomedga;y
A
Early stage of infection
Cardiac causes
6
Q
Inherted causes of chirosis
A
Gsd (fasting=syncope)
Galactosemia
Wilson
Hemochrmoatosis
Cf
Alpha 1 anti trypsin deficiency
7
Q
Hepatotropic virus not causing chirosis
A
A e
8
Q
Mrntion drugs causing hepatitis
A
Inh rifampicin
Methyl dopa methotrexate
Am iodrone
9
Q
Immune cause of hepatitis
A
Auto immune hepatitis
Primary biliry chirosis
Sclerosing cholangitis
10
Q
Mention causes of congestive chirosis
A
Constrictive pericaeditis
Rhf
Tr
Ts
High ivc obstruction
Vod
Budd chairi
11
Q
Commonest cause of chirosis in egypto
A
Hcv hbv nash
12
Q
Describe bilharzial hepatitis
A
Fibrosis not chirosis except if mixed infection
13
Q
Mechanism of fibrosis
A
14
Q
Liver chirosis consequences
A
15
Q
Liver chirosis consequences
A
16
Q
Mention chirosis classification score , factors
A
Child pough
Five factors (مياه ascites
مغ hepatic encephalopathy
3 labs
Bilirubin
Albumin
Pt
Compenstaed —5-6 A
Decompensated ——7-9 b
10-15 c
17
Q
Nodular classification of liver
A
Micro < 3mm
Macro > 3mm
18
Q
Sonoelstography findings
A
> 7kpa suggestive
12.5-15 kpa chirosis
19
Q
How to exclude hcc
A
Us / 6 months
Alpha fetoprotein
20
Q
Ttt of choice in chirosis
A
Liver transplantation
21
Q
Durstion for alcholic chirosis
A
> 10 y
22
Q
Why alcholo damage luver
A
Changed by alcholo dehydrogenase into acetaldeyde which is hepatototxic
23
Q
Features for chronic alcholism
A
24
Q
Mention blood in alchohlic chirosis
A
Megaloblastic anemia
Gout
25
Mention anti body elevated in case of alcholic chirosis
Iga
26
Mention the enzymes of liver in slcholic chirosis
Ast/alt >2
Ggt inc
Normal alp
27
Liver biopsy of alcholic chirosis
Fatty infilteration
Esinophilic deposiits. Mallory. Bodeis
Micro nodular
28
Cardiac chirosis cp
Pain
Ascites
Tender liver
29
Bud chiari most important sign and ttt and comp
Rapdily filling ascites
Tipps operation
Fulminant hepatitis
30
Type of duct affected in primary billiary cholasngitid
Intra hepatic ducts
31
Cause of primary billiary chirosis
Auto immune defetc in t suppressor cell so damage to duct
32
Anti bodies of primary biliary cholangitis
Igm
Anti mitochondrail anribodies
AMA
33
Primary biliary cholangitis associated with
Bile duct destruction
Auto immune manifestation
Autoantibodies
AMA igm
34
Mention incidence of primary billiary cholangitis
Female middle age 40 -60
35
Mention earliest symp of primary biliasss
Puritis ——fatigue before jaundice
36
Mention a cause for hepatic osteodystrophy
Primary biliary chirosis
37
Describe cp of primary cholangitis
Female middle age started with puritid snd fstigue before jaundiced
And found skin pigment
Xanthelesma
Clubbing
Steatorhhea
Def of keda
Hepatic osteodystrophyy
38
Mentio comp of primary billiary chird
Liver chiroisis
Metabolic bone dx
Malabsorbtion
39
Mention the blood chemistry of primary billiary chirosis
Alp is very high +- ggt +igm2
40
Mention the earlist liver abnormality incase of primary biliry chirosis
Alp
41
Mention ttt of primary billiary chirsosi
42
Mention duct affected incase of psc
Intra , extra hepatic
43
Mention etiology of psc
Primary with uc
2ry dt stone or strictre
44
Mention incidence of psc
Male in 4 th decade
45
Earliest abnormality incase of psc
Alp and billrubing
46
Mention abs of psc
P-anca
Rf
Sma
Ana not ama
47
Mention charactersitic ersp
Beading of intra and extra hepatic billiary ducts
48
Mention cancers associated with psc
Liver
Gb
Cholingio
Colon
49
Puritis and jaundice flactuating course
Psc
50
Mention cp of psc
Male in 4th decade with ulcerative colitis
Has jaundice and puritis of fluctusting course
Fatigued
Inc incidence of cholangio carcinoma
With steatrea and hepatic osteodystrophy
51
Most imp inv of hemochromatosis
Mri show excess iron in liver and pancreas
52
Mention triad of hemochromatosis
Bronzed pigmentstion
Dm
Hepatomegaly
53
Mention y]yhe most important cause of he,ochrmotosis
HEF on chromosome 6
54
Mention cause of hemochromatosis
55
Mention first organ affected in hemochromatosis
Liver
56
Mention type of chirosis in hemochromatosis
Macro nodulsr
57
Frothy urine
Ile salt , obstructive jsundice
58
Ast sites
Heart kidney muslce liver
59
Alt sites
Liver
60
Alt>ast in
fulminant hepatitis
61
Explain ratios of liver enzyme in alchol chirosis
62
Ldh inc significant
Hepatic necrosis , hepatic ischemia
63
Serum 5 nucleosidase significance
inc in biliary obstruction
64
Ggt significance
Gggt + alp= billiary obt
Ggt alone alchol
65
Alp signficnace
66
Gamma globulins significance
Formed in res inc in infec
67
Gamma globulins produce abs
Igm —-primary billiary chirosis
Igg——- chronic hepatitis
Iga ——— alcohol
68
All coagulation factors made in liver except
8
69
Descrbe amonka cycle
70
Alfa feto protein significance
>400 ng hcc
Inc incidence af indicates neural tube defect of fetus
71
How to differentiate between primary biliary chirosis , sclersing cholangitis , autoimmune hepatitis by immunology
Ama in 1ry biliary chirosis
ANCA 1ry sclersiomg cholangitis
Actin liver micrsomal antibodies in auto immune hepatitis
72
Def jaundice
Yellowish discoloration of skin mucus membrane , conjuctiva dt inc serum billirubin >2-3 mg bec normal q
73
Causes of hemolytic jaundice
74
Blood picture in hemolytic anemia
Inc 5
Dec 3
Inc
Iron ,ferritin , billirubin , reticlocytes , ldh
Dec hb , mcv , haptoglobin
Anemia + iron kyeeer
75
Heptocellular jaundice cause
Lcf
Infectin
Nash
Drugs
Toxins
Famillial
76
Isolated hyperbillrubinemia causes
Gilbert
Crigler najjar
Dubbin johnson
77
Most common familial hyperbillrubinmeia
Gilbert dx
78
Type of billrubin inc in gilbertt
Indirect
79
Describe gilbert dx ttt cp
No ttt
No symp
Normal liver
Lifelomg
Benign.
80
What aggrevate and deaggrevate gilbert dx
Fastin , influenza inc.
Phenobarbitone dec
81
What type of inheritance of gilbert and defe t
Ad
Defect in uptake
82
Mention defect in criggler najjar and type of billrubin
Defect in conjugation enzyme ( glucuronyl transferase )
Indirect
83
Compare between crigller najar types
84
Compare between crigller najar types
85
Difference between rotter and dubin johnson syndrome
Absecnce of black or green pigments with liver biopsy in rotter
86
Mention inhertincd of dubin johnson
Ar
Chromosome 10
87
Mention defect of dubin or rotter
Carrier protein defect
88
Decribe dubin johnson
Ar
Chromosome 10
Carrier protein defect
Direct billlrubin inc
Inc melanin like pigment in lyzozymes
Inc preg ocps
Black or green pigments in liver biopsy
89
What aggrevate dubi johnson
Preg
Ocp
90
Causes of isolated elevation of alp
91
Causes of isolated elevation of alp
92
Obstreutive jaundice triad
Prolonged jaundice
Pale stool
Hepatomegaly
93
Mention cp of obstructive jaundice
94
Compare between hemolytic obstructive hepatocellular jaundice
Jaundice
Stool
Urine
Features
Serum billirubin
Stercobillongen
Urobillinogen
Liver function
Main. Casues
95
Def acute hepatitis
Acute inflammation of liver less than 6 montths
96
Mention non hepatotropic viruses
Cyto megalo virus
Epv in ifectious mono nucleousis
97
Hepto tropic virus with no rna
Hbv
98
Mr]entin heptotropic virus with no vaccine
Hcv
99
Mention mode of transmission in all hepto tropic viruses
100
Mention clinical presentation of acute hepatitis
101
Prolonged cholestaisi is more common in
Hav
102
Idication of hav vaccine hbv and doses and immunity
103
How intestinal bacteria reach general circulation
By passing hepatic filter
Porto systemic colletrals
104
Sbp cp
Neutrophils >250 cell/mm3
Monobacterial e coli
Defect in gut barrier in chirosis
Ishmeia of res
Porto systemic
Impaired function of liver in detoxification
105
GR fetor hepaticus
Due to lack of detoxification of mercaptans
106
What are values of sex hormones in lcf
Inc estrogen , sex hormones binding globulin
Dec test dht
107
Why lcf chirosis causes periphral neuroapthy
Defciency of thiamine cobalmine folic avid
108
Hepatorenal syndrome
Serious complication of cirrhosis
Normal histology
● Functional renal failure with
● Azotemia
● Oliguria
● Intractable ascites
109
Management od ascites
Low na
Dirutics
Paracentesis
110
Mangemet of encephalopathy
Hold oral protein intake
Sterilization of GI tract with antibiotics (e.g., neomycin)
Lactulose (Cephulac) traps NH3 in gut.
Cathartics/enemas
111
Managemt of esophageal variceal bleeding
Stabilize patient
Drug therapy {Proton pump inhibitors, Octreotide (Sandostatin)}
Upper GI endoscopy (band ligation or injection sclerotherapy)
112
Most common cause of chirosis www
Nash
