Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med - GI > Liver Disease and Alcohol-Related Liver Disease - collins (INCOMPLETE _ DO X slides) > Flashcards

Liver Disease and Alcohol-Related Liver Disease - collins (INCOMPLETE _ DO X slides) Flashcards

(95 cards)

Start Studying
1
Q

when is hemoglobin broken down into

A

heme and globin
heme converted to biliviridin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what bilivurdin

A

converted heme that becomes unconjugated bilirubin (bound to albumin - fat soluble)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the four phases of bilirubin metabolism

A

production of bilirubin
uptake via liver cells
conjucation with glucuronic acid
transport via bile/urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is hyperbilirubinemia

A

impairment or dysfunction of any of the phases of bilirubin metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the accumulation of bilirubin in the body clinically

A

jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is normal total bilirubin (indirect and direct)

A

0.2 - 1.2 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is normal newborn total bilirubin

A

1.0-12.0mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the lab values that jaundice is apparent around

A

2.5 - 3 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is unconjugated (indirect) hyperbilirubinemia

A

overproduction from hemolysis
impaired uptake secondary to certain drugs
impaired conjugation by glucoronyl transferse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is overproduction from hemolysis

A

increased supply of unconjugated bilirubin overwhelms the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the clinical presentation of overproduction of hemolysis

A

sickle cell, hereditary spherocytosis, Rh incompatabiliy, transfusion reaction
normal stool color; urine color normal
increased indirect/unconjugated bilirubin
+ splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are impaired conjugation

A

physiological neonatal jaundice
gilbert syndrome
Crigler-najjar syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is impaired uptake

A

primarily a result of certain drugs
rifampin, chlecystographic contrast agents
? gilbert syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the clinical presentation of impaired uptake

A

light to normal stool; normal to dark urine color
elevated indirect/unconjugated bilirubin
no bilirubin in urine
resolvves with removal of drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the clinical presentations of impaired conjugation

A

light to normal stool; normal to dark urine
elevated indirect/unconjugated bilirubin
no bilirubin in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is physiologica neonatal jaundice

A

fetal bilirubin cleared by mom
immature GT in newborns
develosp around days 2-5 of life in most newborns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what makes unconjugated bilirubin water soluble in physiological neonatal jaundice

A

UV light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is Gilbert syndrome

A

hereditary disorder
reduced function of GT
episodic jaundice and hyperbilirubinemia
lifelong problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Crigler-Najjar syndrome

A

autosomal recessive inherited GT disorder
partial to complete loss of GT - complete loss - type1, partial loss - type 2
primarily identified in neonates, persists throughout life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is conjugated (direct) hyperbilirubinemia

A

decreased excretion of bilirubin
primarily a result of obstruction or hepatocellular dysfunction
-hard to differentiate on labs - elevated Alk Phos, elevated AST/ALT with hepatocellular problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are examples of hepatocellular dysfunction

A

hepatitis
cirrhosis
biliary cirrhosis
sepsis/infection
post-operative
cholangitis
sarcoidosis
lymphomas
toxns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are obstructiosn

A

choledocholithiasis
biliary atresia
carcinoma of biliary duct
sclerosis cholantitis
pancreatitis
pancreastic neoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does liver function testing typically inclued

A

serum bilirubin
serum albumin
ALK phos
ALT/AST
INR (prothrombin time)
+/- urine bilirubin
+/- GGT (gamma-glutamyl tranferase)
+/- 5’-nucleotidase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the most common cause of AST/ALT elevation

A

NAFLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
when is AST > ALT
Alcohol-related liver injury and cirrhosis
26
what releases alkaline phosphate
gallbladder
27
what is low serum albumin typically reflective of
chronic liver disease/cirrhosis
28
what is elevated PT/INR reflective of
poor hepatocyte function
29
what are the vitamin K dependent clotting factors
10, 9, 7, 2
30
what is the definitive study for determining cause and severity of liver disorders
liver biopsy
31
when does acute liver failure occur
without pre-existing liver disease
32
what is fulminant ALF
development of hepatic encephalopathy within 8 weeks
33
what is subfulminant ALF
hepatic encephalopathy 8 weeks to 6 months after onset
34
what are the causes of Acute liver failure
acetaminophen (APAP) toxicity idiosyncratic drug reactions
35
what is the presentation of acute liver failure
jaundice bleeding disorders encephalopathy / AMS
36
what are late complications of acute liver failure
systemic inflammatory response syndrome (SIRS) - from death of hepatocytes Multisystem organ dysfunction
37
what are LFT findings with ALF
significant LFT dysfunction APA - AST/ALT increase (>5000) Serum amylase elevated ammonia (NH3) level elevated PT-INR
38
what is the treatment for ALF
admit to ICU for management of multiorgan failure culture transplant team
39
what determines liver transport priority
MELD score (age >12)
40
what is progressive hepatocyte dysfunction and accumulation of fatty tissue
non-alcohol related liver disease - exists on a continuum
41
what is the continuum of liver disease
Normal liver - NAFLD - NASH - cirrhosis
42
What is NAFLD
common hepatic accumulation of fat absent of significant ETOH consumption M>W Hispanic > caucaasian > black
43
what is NAFLD strongly correlated with
insulin resistance
44
what is NAFLD commonly associated with
Metabolic syndrome Obesity (BMI >30) T2DM Dyslipidemia
45
what is the presentation of NAFLD
primarily asymptomatic +/- RUQ discomfort non-specific constitutional symptoms +/- isolated hepatomegaly
46
how is NAFLD diagnosed
diagnosis of exclusion so must r/o ETOH liver disease
47
what is the treatment of NAFLD
no reliable treatments except lifestyle modifications GRADUAL weight loss anti-diabetic agents tx of dyslipidemias
48
What is NASH
NAFLD + inflammation and fibrosis 2nd hit hypothesis: NAFLD + secondary insult also reversible
49
what are risk factors for progression of NASH
obesity older age non-AA ethnicity female DM HTN higher AST, ALT, or AST: ALT worse US
50
what is cirrhosis
end stage fibrosis and hepatocyte death
51
what causes cirrhosis
viral hepatitis (C&B) Alcohol NAFLD drug toxicity autoimmune metabolic liver disorder
52
what are the three stages of cirrhosis
compensated compensated with varices decompensated - ascites, variceal bleeding, encephalopathy, jaundice
53
what are the initial symptoms of cirhosis
fatigue disturbed sleep muscle cramps weight loss
54
what are the later symptoms of cirrhosis
anorexia, N/v reduced muscle strength, reduced exercise capacity abdominal pain menstrual irregularities (amenorrhea) ED, loss of libido sterility gynecomastia hematemesis skin manifestations, vitamin deficiencies, weight loss, chronic wasting, jaundice, FIRM, PALPABLE, NODULAR LIVER
55
what is seen on labs with cirrhosis
macrocytic anemia thrombocytopenia prolonged PT-INR AST and ALT elevations Elevated bilirubin low albumin renal dysfunction elevated BNP/ventricular dysfunction low cortison other hormone dysfunction
56
what imaging studies can be used to identify cirrhosis
US to asses liver size, for ascites, assess for hepatocellular carcinoma doppler US to assess patency of hepatic, splenic and portal veins CT/MRI with contrast to define any nodules liver biopsy for cirrhotic histology EGD for varices or UGI bleeding
57
what is the treatment of cirrhosis
abstain from ETOH, adequate caloric intake with increased proteins, sodium restriction for fluid retention, vitamin supplementations HAV, HBV and pnumoccocal vaccines yearly influenza Liver transplant is curative
58
what is ascites
portal hypertension - third spacing peritoneal fluid buildup
59
what is diagnostic and therapeutic for ascites
paracentesis - lights criteria
60
what are complications of paracentesis
bleeding infection bowel performation
61
what is lights criteria
determines if something is transudative or exudative looks at serum protein, serum LDH and pleural fluid LDH
62
what is the treatment of ascites
sodium restriction (<2,000mg/day) spironolactone + furosemide Large volume paracentesis (5L) transjugular intrhepatic portosystemic hunt (TIPS)
63
what is spontaneous bacterial peritonitis
infection of peritoneal fluid causes abdominal pain, icnreasing ascited, fever and progressive encephalopathy
64
how do you diagnose spontaneous bacterial peritonitis
culture of ascitic fluid with paracentesis
65
what is the treatment of spontaneous bacterial peritonitis
cefotaxime 2g
66
what is hepatorenal syndrome
characterized by Azotemia, macroscopic evidence of kidney injury, shock, see oliguria, hyponatremia, low urinary sodium
67
what is the treatment of hepatorenal syndrome
dialysis (modified protocol) and TIPS
68
what is hepatic encephalopathy
altered CNS function from toxin buildup - ammonia spectrum: day-night reversal - coma
69
what is hepatic encephalopathy precipitated by
constipation, opioids, hyovolemia, infection
70
what is the characteristic sign of hepatic encephalopathy
asterixis
71
what is the treatment of hepatic encephalopathy
lactulose or rifamixin to reduce ammonia (excreted in feces)
72
what is esophageal varices
dilated submucosal veins secondary to portal HTN occurs in about 50% of pts with cirrhosis high mortality rate with acute bleed
73
what are the signs and symptoms of acute UGI bleeding
hematemesis or "coffee ground" emesis melena
74
what is the treatment of esophageal varices
fluid resuscitation and blood transfusion FFP or platelet transfusions adjunctive vitamin K prophylactic abx: fluoroquinolones octreotide for acute bleeding control endoscopy portal decompression BBlockers
75
What is hepatocellular carcinoma (HCC)
85% of HCC associated with cirrhosis hepatitis and ETOH cirrhosis at greatest risk for converstion
76
what are risk factors for hepatocellular carcinoma
male age>55 asian or hispanic ethnicity +FH overweight/obese tobacco use DM hypothyroid
77
what is the presentation of hepatocellular carcinoma
cachexia, weihgt loss, weakness suden development of ascites enlarging liver with palpable amss
78
what is the diagnostic test of choice for HCC
biopsy
79
what is the definitive treatment of cirrhosis and complications
TRANSPLANT
80
what are absolute contraindications of liver transplant
malignancy (except small HCC) advanced cardiopulmonary disease (except heaptopulmonary syndrome) sepsis
81
what is the MELD score
transplant patients prioritized
82
are HIV and Hepatitis contraindications for liver transplants
NO
83
What is the AUDIT - C
scoring for alcohol use disorder identification
84
what is the spectrum for Alcohol related liver disease
alcohol related steatosis - alcohol-related heapatitis -cirrhosis
85
what are risk factors for alcohol-related liver disease
genetics gender (F>M) concurrent APAP use concurrent obestiy concurrent DM concurrent HCV
86
what is alcohol related liver steosis
reversible with ETOH dicontinuation presensation similar to NAFLD fatigue, anorexia, nausea and RUQ abdominal discomfort
87
what are the later lab findings with alchol related liver disease
AST: ALT > 2:1 (HIGH SUSPICION if >3:1) AST rarely above 300, ALT often normal elevated GGT helps differentiate from other causes of liver dz elevated alk phos (<3xnml) thrombocytopenia due to direct toxic effect of ETOH and hypersplenism
88
what imagine is used for diagnosis of Alcohol related liver disease
US to evaluate for steatosis CT or MRI with contrast to rule out other causes biopsy
89
what is the treatment for fatty liver
abstinence from ETOH -mental health/detox/rehab, psychosocial interventions -naltrexone -disulfram (anatbuse) - improve nutrition -treat vitamin deficiencies
90
what is the treatment of cirrhosis
abstinence from ETOH mental health, detox/rehab, psychosocial intervention Naltrexone (avoid disulfram) slows or halts progression -improve nutrition, vitamin deficiencies, sodium restriction, regular exercise to prevent muscle wasting
91
what is the definitive treatment of cirrhosis
transplant
92
What is alcohol-related hepatitis
hepatocyte injury characterized by: acute or chronic inflammation, fibrosis, parenchymal necrosis
93
what is the presentation of alcohol related hepatitis
recent period of heavy drinking followed by: jaundice, fever, nausea, anorexia, generalized edema, RUQ abdominal pain, tender hepatosplenomegaly
94
what is seen on labs with alcohol related hepatitis
same as other alcohol related liver disease AST:ALT >2:1 (HIGH SUSPICION IF >3:1) elevated serum bilirubin leukocytosis with left shift elevated alk phos, GGT
95
what is the treatment of alcohol related hepatitis
abstinence from ETOH ??corticosteroids if severe alternative: pentoxifylline (PDE inhibitor)

Clin Med - GI (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions