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

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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

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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

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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)

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5
Q
  • neonate with jaundice
  • PE is unremarkable
  • increased level of conjugated or unconjugated bilirubin?
A

unconjugated- just due to immaturity of the liver

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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

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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

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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

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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

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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

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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)

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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)

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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

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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

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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

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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

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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

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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?

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)