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Clin med GI > Liver disease > Flashcards

Liver disease Flashcards

(132 cards)

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1
Q

What creates bilirubin

A

Hemoglobin gets broken down into heme and globin.

Heme then turns into bilivirdin which becomes unconjugated bilirubin

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2
Q

Which type of bilirubin is bound to albumin

A

unconjugated

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3
Q

What helps make bilirubin conjugated

A

glucoronic acid in the liver

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4
Q

What happens clinically when there is an excess of bilirubin

A

Jaundice

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5
Q

Where is jaundice seen first

A

typically the sclera and darkening urine

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6
Q

Where does conjugation of bilirubin occur

A

hepatocytes

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7
Q

What bilirubin level will cause jaundice

A

2.5-3mg/dL

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8
Q

What should total bilirubin be

A

.2-1.2mg/dL

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9
Q

What level should indirect bilirubin be in labs

A

.2-.8mg/dL

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10
Q

What type of bilirubin is considered unconjugated on labs

A

indirect

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11
Q

What type of bilirubin is considered conjugated on labs

A

direct

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12
Q

What causes unconjugated hyperbilirubinemia

A

Overproduction of hemolysis

impaired uptake secondary to certain drugs

impaired conjugation by glucuronyl transferase

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13
Q

What causes an overproduction of hemolysis

A

sickle cell
hereditary spherocytosis
Rh incompatibility
transfusion reaction

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14
Q

What is the clinical presentation of indirect hyperbilirubinemia

A

+splenomegally
increased unconjugated bilirubin

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15
Q

What causes an impaired uptake of bilirubin

A

Rifampin
cholecystographic contrast

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16
Q

What is the clinical presentation of hyperbilirubinemia from impaired uptake

A

Light to normal colored stool
normal to dark urine
*resolves with drug removal

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17
Q

What causes impaired conjugation with hyperbiliruinemia

A

physiologic neonatal jaundice
Gilbert syndrome
Criglar-Najjar syndrome

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18
Q

What causes neonatal jaundice

A

Fetal bili is cleared by mom
immature GT in newborns

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19
Q

When does bilirubin develop in newborns

A

2-5 days of life

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20
Q

What occurs if bilirubin levels >20mg/dL in newborns

A

encephalopathy and kernicterus

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21
Q

What will make unonjugated bilirubin water soluble = dissolve in bile

A

UV light

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22
Q

How long does it take a newborns bilirubin to return to normal

A

2 weeks

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23
Q

Which gender is Gilbert syndrome more common in

A

Males

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24
Q

What is the underlying issue occurring in Gilbert disease

A

Reduced GT function

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25
When is Gilbert syndrome diagnosed
puberty or early adulthood
26
What symptoms do those with Gilbert syndrome have
episodic jaundice and hyperbilirubinemia
27
What makes Gilbert syndrome worse
stress fatigue ETOH illness decreased caloric intake
28
What is Crigler-Najjar syndrome
Autosomal recessive inherited GT disorder *partially to complete loss of glucyronyl transferase
29
Which type of Crigler-Najjar is less severe
type 2
30
When is Crigler-Najjar syndrome diagnosed
Neonates and will persist through life
31
What will the bilirubin level be in those with Crigler-Najjar syndrome
20-45 *early liver transplant needed to prevent kernicterus
32
What is occurring with direct hyperbilirubinemia
Decreased excretion of bilirubin
33
What causes direct hyperbilirubinemia
An obstruction of hepatocellular dysfunction
34
if a patient has an elevated alkaline phosphatase, what type of direct bilirubinemia do they likely have
obstructive
35
What kind of direct bilirubinemia is indicated by elevated AST/ALT
hepatocellular issues
36
What can LFTs help distinguish between
different liver disorders
37
What liver info is included on a CMP
T. Bili albumin total protein Alk phos ALT/AST
38
Outside of a CMP, what else needs to be ordered to get a complete look at the liver on labs
prothrombin time (INR) urine bilirubin GGT 5'-nucleotidase
39
If there is an elevation of AST/ALT, what is it indicative of
hepatocellular injury *most common cause if Non-alcoholic fatty liver disease (NAFLD) *AST- primarily liver *ALT is in other tissue
40
Does the degree of ALT/AST = disease severity
no
41
If AST>ALT what is it indicative of
alcohol related liver injury and cirrhosis *3:1 is highly suggestive
42
If ALT and AST >1000 units/L what is it indicative of
viral hepatitis ischemic injury toxins drug induced autoimmune
43
When will Alk Phos be elevated
Cholestasis infiltrative disease
44
What is low serum albumin reflective of
chronic liver disease cirrhosis
45
What is elevated PT reflective of
poor hepatocyte function
46
What clotting factors are made in the liver
10, 9, 7, 2 (1972) *vitamin K dependent clotting factors
47
What is a definitive study for determining cause and severity of liver disorders
Liver bx
48
When is a TJLB typically preformed over a bedside liver bx
ascites coagulopathy
49
What are the types of acute liver failure
Fulminant subfulminant
50
Does acute liver failure need a pre-existing liver disease to occur
no
51
What is acute on chronic liver disease
acute deterioration in chronic liver disease
52
What is fulminant liver disease
development of hepatic encephalopathy within 8 weeks
53
What is subfulminant liver disease
hepatic encephalopathy 8 weeks to 6 months after onset
54
What is the INR in most people with acute liver failure
>1.5
55
What is the #1 cause of acute liver failure
acetaminophen toxicity (APAP)
56
What is the #2 cause of acute liver failure
idiosyncratic drug reaction *TB drugs, anti epileptics, antibiotics)
57
How do those is acute liver failure present
jaundice bleeding disorders encephalopathy/AMS
58
What are later complications of acute liver failure
Systemic inflammatory response syndrome (SIRS) from death of hepatocytes Multisystem organ dysfunction
59
How do you treat acute liver failure
Admit to ICU consult transplant team
60
What causes of acute liver failure has the best prognosis
viral Hep A APAP Shock pregnancy induced *may not ned transplant
61
What is the rate length of those in ALF who get a liver transplant
2 years (90%)
62
What determines the liver transplant priority
MELD score *determines severity of liver disease in those >12
63
What is the antidote for APAP overdose
N-acetylcystine
64
with liver transplant, who does UNOS give priority to
Absence of pre-existing liver disease life expectancy less than 7 days ICU w/ dialysis, 2.0 INR, ventilation onset of hepatic encephalopathy within 8 weeks of onset of ALF
65
What is occurring in fatty liver disease
Progressive hepatocyte dysfunction and accumulation of fatty tissue that eventually leads to fibrosis and ultimately cirrhosis
66
what is NASH
non-alcoholic steatohepatitis *occurs after NAFL
67
Which gender is NAFL seen in most
men *hispanic at highest risk
68
What does NAFL have a strong correlation with
insulin resistance
69
What is NAFL commonly associated with
metabolic syndrome obesity (BMI>30= 5x increase) T2DM Dyslipidemia
70
How do you diagnose NAFL
Dx of exclusion.. must r/o ETOH liver disease
71
What is the treatment for NAFL
Lifestyle modifications -gradual weight loss - anti diabetic agent - treat dyslipidemia
72
What are risk factors for progression to NASH
obesity older age non African ethnicity female DM HTN Worse US
73
What are the top causes of cirrhosis
Viral hepatitis Alcohol NAFL
74
What are the 3 stages of cirrhosis
Compensated compensated with varices decompensated
75
What is occurring with decompensated cirrhosis
ascites vatical bleeding encephalopathy jaundice
76
What is occurring in the liver leading to cirrhosis
hepatocyte dysfunction, increased resistance to flow, portal HTN and portosystemic shunting = symptoms
77
What are the initial symptoms of cirrhosis
fatigue disturbed sleep muscle cramps weight loss
78
How will the liver present with cirrhosis
firm, palpable, nodular liver
79
What may be seen on laboratory workup with cirrhosis
microcytic anemia TTP elevated bili prolong PT-INR Elevated AST/ALT low albumin hepatorenal syndrome etc
80
What is imaging used for with cirrhosis
US to assess liver size and assess HCC Doppler US for liver patency of hepatic, splenic, portal veins liver bx for cirrhotic histology EGD for varices of UGI bleeding
81
What is the only curative treatment for cirrhosis
liver transplant
82
What is a side effect of portal HTN
third spacing
83
What is done to treat ascites with cirrhosis
paracentesis (both diagnostic and therapeutic)
84
What are complications from a paracentesis
Bleeding infection bowel perforation
85
What labs should be done with a paracentesis
cell count culture albumin total protein LDH cytology
86
What is lights criteria
Determines whether accumulation of fluid is transudative vs exudative
87
What type of ascites is transudative
heart failure cirrhosis nephrotic syndrome pulmonary embolism
88
What types of ascites are exudative
TB pancreatitis malignancy hemo/chylothorax esophageal rupture bacterial/viral pneumonia
89
How do you treat ascites in cirrhosis
Sodium restriction spironolactone + furosemide large volume para (5L) TIPS
90
What is a cirrhosis complication from ascites
spontaneous bacterial peritonitis
91
What is the treatment of spontaneous bacterial peritonitis
cefotaxime
92
What is the most common cause of spontaneous bacterial peritonitis
E.coli and strep
93
What is hepatorenal system characterized by
Azotemia Shock Macroscopic kidney injury no improvement in renal function despite D/C diuretics
94
What is the life expectancy of those with hepatorenal syndrome
3 months
95
How do you treat hepatorenal syndrome
dialysis and TIPS
96
What causes hepatic encephalopathy
Altered CNS function from ammonia buildup
97
What is the characteristic signs of hepatic encephalopathy
Asterixis
98
Which medications can help reduce ammonia levels in the body
Lactulose rifamixin
99
How can coagulopathy with cirrhosis be treated
Vitamin K supplementation *FFP if vit K ineffective
100
What are the signs and symptoms of an acute UGI bleed
Hematemesis coffee ground emesis melena
101
What is the abx of choice with esophageal varices
fluoroquinolones
102
What medication can be given for acute control of bleeding
octreotide
103
What types of cirrhosis is at greatest risk of converting to HCC
ETOH Hepatitis
104
What are the contraindications for liver transplant
Malignancy (except HCC) Sepsis Advanced cardiopulmonary disease
105
What MELD score makes a patient eligible for liver transplant
over 15
106
What MELD score makes a patient eligible
107
What is Budd chiari syndrome
hepatic vein obstruction
108
What can be used for an alcohol screening
AUDIT-C
109
What is unhealthy alcohol use in men classified by in women?
5+ drinks in a day 4+ drinks in a day
110
How many grams of alcohol in 1 standard drink
14
111
What is the primary liver dysfunction do people develop from harmful alcohol use
steatosis
112
What is alcohol related hepatitis
acute hepatitis from binge drinking
113
What are risk factors for alcohol liver disease
concurrent APAP use concurrent obesity, DM, HCV
114
Which gender is at higher risk for alcohol related liver disease
women
115
How long does it generally take for the liver to progress from injury to cirrhosis
decades *dose dependent
116
What type of imaging is done to evaluate fibrosis of the liver
fibroscan
117
How can you treat fatty liver disease
abstinence from ETOH Disulfram improve nutritipon treat vitamin deficiencies
118
What type of vitamin deficiencies generally occur with fatty liver disease
thiamine folate zinc B6 B12
119
How do you treat cirrhosis
abstinence from ETOH Naltrexone (avoid disulfram) rehab/ mental health care
120
What medication can be given to help prevent varices in cirrhosis
beta-blocker
121
What is the second highest reason for a liver transplant
ETOH cirrhosis *require 6 months abstinence
122
What is ETOH related hepatitis
Hepatocyte injury characterized by acute / chronic inflammation, fibrosis, parenchymal necrosis
123
What is the only difference in labs in ETOH hepatitis vs any other liver disease
Leukocytosis with left shift
124
What can be used to help treat ETOH related hepatitis
ETOH abstinence corticosteroids pentoxifylline
125
What is the most important prognostic factor in ETOH hepatitis
continued drinking
126
What is Budd-Chiari | And what is its cause
Hepatic vein obstruction Secondary to a clot | Generally from a hypercoagulable state
127
What is the screening test of choice for Budd-Chiari
Doppler US TJLB is US nonconclusive
128
What is the mainstay treatment for Budd-Chiari
LMWH | +/- TIPS or angioplasty
129
What is the confirmatory test for portal vein thrombosis
MRA | possible EGD
130
How does bacteria get into the liver to cause an abscess
via bile duct | #1 cause secondary to obstruction
131
What are the common organisms that cause liver abscess
E. Coli Klebsiella enterobacter | *staph if it is granulomatous
132
What is the treatment for a liver abscess
IV 3rd gen cephalosporin + metronidazole 2-3 week duration

Clin med GI (9 decks)

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