Liver

Question 1

how big is the liver?

Answer 1

Size of a football

Question 2

what is one of the primary products of the liver?

Answer 2

Bile (80% or > cholesterol)

Question 3

2 forms of bile

Answer 3

conjugated and unconjugated

Question 4

What are the LFTs?

Answer 4

Transamin (SGOT/AST, SGPT/ ALT)

Alkaline phosphatase

Question 5

What are 2 serum proteins to measure?

Answer 5

albumin

prealbumin

Question 6

what is a coagulation indicator?

Answer 6

Prothrombin

Question 7

what is a good measure of someones nutritional status. Can show if they need artificial nutrition.

Answer 7

Prealbumin

Question 8

Ways to look at the liver

Answer 8

Plain films
US (good for hallow vs. solid)
CT of RUQ and abdomen

Question 9

What is percutaneous transhepatic cholangiograph? (PTC)

Answer 9

Puncture through the liver to one of the major vessels and put dye in there to show biliary drainage system.

Question 10

What is an MRI choloangiopancreatography

Answer 10

High resolution, close-up of the main junctions where the cystic ducts and common bile duct join into the ampulla

Question 11

Invasive tests for liver issues.

Answer 11

Needle biopsy
open biopsy
ERCP
surgical exploration & excision

Question 12

a yellow green coloration of the skin, sclera & mucous membranes. May be associated w/ pruritis

Answer 12

Jaundice

Question 13

Jaundice is detected when bilirubin levels are above what?

Answer 13

2.5 mg/100 mL

Question 14

Mechanisms that can cause jaundice. 6 causes

Answer 14

Excessive bilirubin production (pre conjugation)
Decreased hepatic uptake (pre conjugation)
Impaired conjugation
Intrahepatic cholestasis
Extra-hepatic obstruction
Hepatocellular injury

Question 15

What does indirect bilirubin mean?

Answer 15

Unconjugated

Question 16

if bilirubin is unconjugated will be in the urine?

Answer 16

No, urine will be free of bilirubin

Question 17

What are ways to get excess unconjugated bilirubin (bilirubinemia)?

Answer 17

RBC destruction, decreased uptake, concurrent illness

impaired conjugation, hereditary

Question 18

what can cause conjugated (direct) bilirubinemia?

Answer 18

Intracellular, canalicular, ductule, septal, intralobular problems

Question 19

What is the onset with direct bilirubinemia?

Answer 19

Gradual with pruritis

Question 20

what symptoms will you have with conjugated bilirubinemia?

Answer 20

pale stools
dark urine
steatorrhea (odor, float) from lack of fat absorption

Question 21

What will labs look like with conjugated bilirubinemia?

Answer 21

^ Alk phos
mild LFT
normal albumin
coagulopathy

Question 22

what are symptoms of indirect bilirubinemia

Answer 22

anemia on CBC due to RBC destruction

jaundice

Question 23

How do you revere the coagulopathy found with conjugated bilirubinemia.

Answer 23

Vitamin K

Question 24

what causes extrahepatic obstruction?

Answer 24

Stone, stricture, tumor block biliary tree

Question 25

Signs of extrahepatic obstruction.

Answer 25

GB may be palpable, painless

Question 26

What is a sudden onset of extrahepatic obstruction often associated w/

Answer 26

Colangitis

Question 27

What does extrahepatic obstruction look similar to?

Answer 27

intrahepatic cholestasis

Question 28

What do you see on labs for extrahepatic obstruction

Answer 28

High direct biliruin High alk phos moderate high LFTs

Question 29

What symptoms will someone with extrahepatic obstruction have?

Answer 29

Dark urine pale stools possible coagulopathy

Question 30

Hepatitis picture with prodromal anorexia, nausea, abd pain, malaise. Hepatomegaly, ecchymoses, tender

Answer 30

Hepatocellular dz

Question 31

what will labs look like with hepatocellular dz?

Answer 31

alk phos 2-4x upper limit of normal | LFTs >5x (ULN) (except with Hep C or alcoholism)

Question 32

After 7 days of hepatocellcular dz what will happen?

Answer 32

Coagulopathy due to decreased clotting factors

Question 33

What will happen after 10-14 days of hepatocellular dz?

Answer 33

hypoalbuminemia

Question 34

What can you see with chronic hepatocellular dz.

Answer 34

``` chronic fibrosis portal HTN ascites gynecomastia atrophy of the testes encephalopathy ```

Question 35

Why do you get encephalopathy with hepatocellular dz?

Answer 35

unconjugaeted bilirubin is lipophilic so it can cross the BBB

Question 36

How much of alcoholic cirrhosis is silent?

Answer 36

Up to 40%

Question 37

what do the majority of people with cirrhosis have?

Answer 37

portal HTN

Question 38

what is a codition with excessive levels of iron in blood and body than can damage liver, testes, ovaries, heart.

Answer 38

hemochromatosis

Question 39

What are heredity and metabolic cuases of cirrhosis

Answer 39

Wilson's, Gaucher's Primary biliary cirrhosis (PBC) Faconi's Cardiac

Question 40

what is an inflammatory biliary dz common in women. Need a liver tranplant.

Answer 40

Primary biliary cirrhosis (PBC)

Question 41

signs of chronic viral and alcoholic hepatitis

Answer 41

``` Varices Ascities Hypersplenism peripheral edema encephalopathy ```

Question 42

why is there peripheral edema with chronic hepatitis?

Answer 42

such low protein in blood, so fluid part of blood isn't held in by osmotic pressure and seeps into soft tissue

Question 43

what is the leading cause of death with chronic viral and alcoholic hepatitis

Answer 43

bleed- esophageal varcieal or gastric infection encephalopathy

Question 44

What is there a chronic morality risk of with chronic viral and alcoholic hepatitis?

Answer 44

hepatocellular carcinoma

Question 45

Progressive fibrotic liver disease Associated with other autoimmune disorders Cholestatic and fibrotic manifestations

Answer 45

primary biliary cirrhosis

Question 46

Labs to get with primary biliary cirrhosis

Answer 46

Alk Phos SED/ CRP Anti-Mitochondrial Ab IgM (high)

Question 47

what is the key finding with primary biliary cirrhosis

Answer 47

positive anti-mitro Ab

Question 48

Patient presents with dypnea, arthritis, skin discoloration, fatigue.

Answer 48

hemochromatosis

Question 49

what is a TIPS

Answer 49

Trans hepatic intraperiotoneal shunt | artificial connection b/w portal circulation and systemic circulation to take pressure off portal system

Question 50

how do you treat wilson's

Answer 50

d-penicillamine (chelator)

Question 51

Txs for primary biliary cirrhosis

Answer 51

``` ursodiol colchicine MTX Vit ADK cholestyramine zinc transplant diet ```

Question 52

treatment for hemochromatosis

Answer 52

phlebotomy

Question 53

what are signs of alcoholic liver dz

Answer 53

caput medusa | parotid gland enlargement

Question 54

what is a chemical toxin that farm workers may encounter. causes tumors of the liver

Answer 54

aflatoxin

Question 55

drugs that can cause tumors of the liver

Answer 55

Estrogens anabolic steroids alcohol

Question 56

what type cancer is almost always in someone with hep c

Answer 56

hepatocellcular carincoma

Question 57

what lab is diagnostic for a hepatocellcular carcinoma

Answer 57

alpha fetoprotein

Question 58

How do you get HAV (hepatitis A virus)?

Answer 58

Fecal-oral child care NICU men having sex with men

Question 59

How do you get HAB?

Answer 59

percutaneous perinatal sexual

Question 60

How do you get HCV?

Answer 60

Percutaneous | primarily IVDA

Question 61

What is HDV like?

Answer 61

HBV

Question 62

What is HEV like?

Answer 62

HAV

Question 63

how many binge drinkers develop fatty liver?

Answer 63

90% of binge drinkers

Question 64

who are more susceptible to liver injury with less intake.

Answer 64

women

Question 65

what type hepatitis has a 4-24 week incubation is has an insidious/acute onset

Answer 65

HBV

Question 66

what type hepatitis has a 2-6 week incubation and onset is acute

Answer 66

HAV

Question 67

What type of hepatitis has a 5-10 weeks incubation on insidious onset

Answer 67

HCV

Question 68

do the hepatitis viruses actually kill cells?

Answer 68

No, the body's rxn to the viruses actually do harm

Question 69

what is the pathologic picture of hepatitis

Answer 69

monocyte infiltration cell necrosis hyperplasia & cholestasis

Question 70

Patient presents with Fever, spider angioma, hepatomegaly, splenomegaly, ascites, caput medusa, malnutrition, ecchymoses, parotid enlarge-ment, jaundice, nausea what do you suspect

Answer 70

alcohol harm to the liver

Question 71

what ratio is elevated in alcoholic hepatitis?

Answer 71

ALT/AST >1

Question 72

what will be elevated with chronic alcoholic hepatitis.

Answer 72

MCV (mean corpuscular volume) | cell size is large

Question 73

what drugs can cause cholestatic liver problems?

Answer 73

OCP Erythromycin Tegretol Chloropro

Question 74

What can outdated tetracycline lead to?

Answer 74

Problem with liver

Question 75

what drugs can give you fatty liver

Answer 75

methotrexate | protease inhibitor

Question 76

what drugs can lead to hepatitis

Answer 76

halothane INH keocon verapmail

Question 77

what can you get miex hepatitis/ cholesterol from

Answer 77

azathi niacin statins

Question 78

what drugs can lead to necrosis of liver cells

Answer 78

``` Acetaminophen Carbon Tetetrachloride Amanita (mushrooms) DMF Yellow phosphorus ```

Question 79

What drugs can cause granulomas in the liver?

Answer 79

Sulfonamide allopruinol quinidine (off market)

Question 80

how much time do you have to give antidote for acetamenophen OD?

Answer 80

17 hours

Question 81

treatment for hep b and D

Answer 81

Interferon, Lamuvidine

Question 82

treatment for hep c

Answer 82

Interferon, Ribavirin

Question 83

treatment for hep A and E

Answer 83

supportive

Question 84

ABCDEF pneumonic for fulminant hepatitis

Answer 84

Acetaminophen Hep A autimmune hept Het B Hep C cryptogenic Hep D, drugs Esoteric causes- wilson's Budd-Chiar syndrome Fatty infiltration- acute fatty liver preggo, Reye's