Liver and Biliary Flashcards
(43 cards)
1
Q
- disoriented
- poor hygiene and odor of alcohol
- jaundice, splenomegaly and ascites
- asterixis
- spider angiomata
- ALT, AST, Alk Phos and Bilirubin mildly elevated
- Hematemesis
- liver biopsy shows nodular regeneration and scarring
What is the cause of the disorientation (hpatic encephalopathy)?
A
Cirrhosis with portal HTN causing esophageal varices and ascites (decreased oncotic pressure from hypoalbuminemia is also contributory)
-increased ammonia levels cause disorientation
2
Q
- 2 week hx of jaundice and icterus
- similar episode 2 years ago
- borhter with recurrent jaundice
- increased unconjugated bilirubin
- ALT and AST normal
- Jaundice resolves spontaneously
A
Gilbert Syndrome
3
Q
- recent hx of fatigue
- jaunidce and icterus
- increased unconjugated bilirubin
- Normal LFT’s
- anemic
- usually subsides with corticosteroid treatment
A
Autoimmune hemolytic anemia
4
Q
- 2 week hx of fever, malaise, and brown urine
- recent visit to mexico
- jaundice, hepatosplenomegaly
- increased unconjugated bilirubin
- AST and ALT elevated
- IgM anti-HAV positive
- IgG anti-HBsAg positive
A
Acute Viral Hepatitis A
(IgG anti-HBsAg only means previous exposure)
5
Q
- neonate with jaundice
- PE is unremarkable
- increased level of conjugated or unconjugated bilirubin?
A
unconjugated- just due to immaturity of the liver
6
Q
- icterus and jaundice
- low grade fever for 1 month
- RUQ tenderness
- hepatomegaly
- AST, ALT and bilirubin elevated
- PT prolonged
- councilman bodies on biopsy, ballooning degeneration of hepatocytes, bile stasis, mononuclear inflammatory cell infiltrates
A
Acute Viral Hepatitis
7
Q
- 9 month hx of fatigue and recurrent fever
- jaundice, dark urine, hepatomegaly
- elevated biliirubin, low albumin, prolonged PT
- IgG anti-HBcAg positive
- Positive HBsAg and HBeAg
What vascular inflammtory disease is this pt as risk for?
A
Chronic Hepatitis B
(B=transmission through banging)
Polyarteritis Nodosa
8
Q
- vague abd pain
- indigestion
- obese woman with jaundice
- mild increase in ALT, AST and Alk phos
- markers for hepatitis negative
- echogenic stone like material in gall bladder and thickened gall bladder wall
- dense fibrosis and glandular structures in wall of gall bladder
A
Adenocarcinoma of the gallbladder
9
Q
- dry mouth, fatigue, fever, icterus, mild jaundice, hepatomegaly
- negative viral hepatitis markers
- positive antinuclear antibodies
- biopsy shows parenchymal and periportal inflammatory cell infiltrates (mainly lymphocytes and plasma cells)
- goes away with steroid tx
A
Autoimmune hepatitis
10
Q
- abd swelling, weight loss, upper abd pain
- hx of infection with liver fluke C. sinensis
- hypoattenuated mass with lobulated margins on liver
- well differentiated neoplastic glands embedded in fibrous dense stroma on biopsy
A
Cholangiosarcoma
11
Q
- oliguria, azotemia, and increased creatinine levels
- longstanding alcoholic cirrhosis
- normal kindey biopsy
A
Hepatorenal Syndrome
(renal failure caused by vasoconstriction and hypoperfusion of kidneys)
12
Q
- frequent indigestion after meals and abd pain
- moderately obese
- numerous echogenic objects in gallbladder
- gall bladder contains black stones
- this is associated with_________
A
cholelithiasis
associated wtih sickle cell disease (pigment stones form increased hemolysis)
13
Q
- heroin addict
- 5 days of fatigue, malaise, and dark urine
- jaundice and multiple petechial hemorrhages
- high conjugated bilirubin levels
- High ALT, AST and ammonia
- prolonged PT
- condition rapidly deteriorates
A
Hepatitis B virus: biopsy shows massive hepatic necrosis
14
Q
- sudden onset acute abd pain
- abd distension, tap returns blood
- CT shows solitary 20cm mass on liver
- tumor is encapsulated and paler than liver parenchyma
- associated with use of ________
A
Hepatic adenoma
use of contraceptives
15
Q
- 2 month hx of fatigue, abd pain, jaundice and icterus
- hand tremor, lack of coordination, mild jaundice
- copper ring in decemet membrane of iris
A
Wilsons Disease
16
Q
- icterus, abd pain, malaise, weight loss, low grade fever
- distended abd with RUQ pain
- decrease albumin, increased AST, ALT, and alk phos
- PT is prolonged
- leukocytosis
- hepatic steatosis, with hydropic swelling of hepatocytes
A
Alcoholic Hepatitis
17
Q
- 6 month hx of itching, weight loss, fatigure, iterus
- mild jaundice and steatorrhea
- high cholesterol and alk phos
- no evidence of gallbladder obstruction
- antimitochondrial antibody test is positive
- xanthomas
- liver biopsy shows intrahepatic bile duct damage
A
Primary Biliary Cirrhosis
18
Q
If a patient with fatty liver stops drinking what happens to the liver?
A
reverts to normal
19
Q
- progressive skin pigmentation
- large amts of urine and always thirsty
- hepatomegaly
- GTT indicates chemical diabetes
- increased risk for Hepatocellular Carcinoma
A
Hereditary Hemochromatosis
20
Q
- hx of increasing abd girth and pain
- smokes and takes oral contraceptives
A
Budd Chiari Syndrome
21
Q
- 3 month hx of vague upper abd pain after fatty meals
- indigestion
- obese woman, multiple echogenic objects in gallbladder
- yellow stones
- What is a common complication of this?
A
Cholesterol gallstones caused by increased hepatic cholesterol secretion
-extrahepatic biliary obstruction
22
Q
- vague abd pain
- intermittent fever
- weight loss
- hx of chronic hepatitis B
- hepatomegaly and jaundice
- diffusely nodular liver with a dominant mass
- marker for progression if AFP
A
Hepatocellular Carcinoma
23
Q
How is damage to the liver best assesed?
A
liver biopsy
24
Q
- hx of industrial solvent use
- clouded sensorium and lethargy
- extremely high ALT
- dies in hepatic coma
A
Toxic Liver Injury
25
- abd pain, bloating, weight loss, pain in RUQ
- hx of blood transfusion
- hepatomegaly
- low albumin, elevated AFP
- ascites
Hepatocellular Carcinoma-most common cause worldwide is Hep B
26
- abd pain radiating to back, jaundice and icterus
- lighter colored stools
- cachectic
- elevated AST and ALT
- High alk phos
- mass in head of pancreas
Pancreatic carcinoma causing jaundice through extrahepatic biliary obstruction
27
- severe back pain for 3 months and recurrent fever
- hx of ulcerative colitis
- thin and jaundiced
- normal AST, ALT but elevated alk phos
- beaded appearance of extrahepatic biliary tree
Increased risk for \_\_\_\_\_\_\_\_\_
Primary Sclerosing Cholangitis
Risk for Cholangiocarcinoma
28
- hx of jaundice and icteruc
- pitting edema, ascites
- low albumin, high AST and ALT
alpha 1 antitrypsin deficiency
29
- RUQ pain
- shaking chills and fever
- appendectomy 2 weeks ago
- hepatomegaly
- increased alk phos
- leukocytosis
Pyogenic liver abscess
30
- jaundice and icterus
- persistent headaches
- markedly elevated AST and ALT
- later develops hepatic encephalopathy and renal failure
- centrilobular necrosis in liver biopsy
Acetaminophen Toxicity
31
- constant pain in RUQ
- nausea, vomitting, bloody diarrhea and persistent cough
- hepatomegaly
- Fibroblastic proliferation and trophozoites on liver biopsy
Amebic Liver Abscess
32
Multiple large foci of carcinoma indicates\_\_\_\_\_\_\_\_\_
metastases
33
- jaundice and icterus
- similar previous episodes
- ocassional dark colored urine
- high conjugated bilirubin
- autosomal recessive
Dubin Johnson Syndrome
34
- Pregnant woman
- jaundice, icterus, fever, malaise
- positive IgM antibodies to hepatitis E
- High risk for\_\_\_\_\_\_\_\_\_\_\_\_\_
Hepatitis E
High risk for fulminant hepatic failure
35
- diffuse fatty infiltration of liver
- no hx of alcohol use
Non alcoholic fatty liver disease
36
- gradual enlargement of childs abdomen
- massive hepatomegaly
- normal LFT's
- liver biopsy shows normal hepatocytes with PAS + inclusions
- presence of amylopectin
- deposits of abn glycogen in skeletal muscle
Andersen Disease (deficiency of glycogen branching enzyme)
37
- intermittent colicky abd pain with neuropsychiatric symptoms (tremors)
- defect in heme synthesis
- deficiency in porphobilinogen deaminase enzyme
Acute Intermittent Poryphyria
38
- cutaneous photosensitivity
- iron overload in middle aged
- heme synthesis defect
- deficiency in uroporphyrinogen decarboxylase
Chronic hepatic poryphyria
39
- neonate with prolonged jaundice
- multinucleated giant cells on liver biopsy
- usually recover
- Could be caused by \_\_\_\_\_\_\_\_\_
Neonatal Hepatitis
-biliary atresia
40
- obese, RUQ pain, fever, shaking chills
- high Alk phos
- thickening of gallbladder wall
acute cholecystitis
41
- vague abd pain, weight loss
- hx of drug abuse
- hepatomegaly and jaundice
- diffusely nodular liver with dominant mass
Hepatocellular Carcinoma (probably caused by Hep C)
42
- metastatic cancer of the liver
- dense core granule cells
where is it most likely from?
adrenals
43
cause of gynecomastia in a pt with cirrhosis?
hyperestrogenism (because of reduced hepatic catabolism of estrogens)
