Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

G2F > Liver Diseases CIS > Flashcards

Liver Diseases CIS Flashcards

(69 cards)

Start Studying
1
Q

hepatocellular- labs

A

-ALT and AST

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

cholestasis

A

-ALK phos

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

IgM and IgG

A
  • IgM- acute

- IgG- chronic

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

liver fxn tests

A

PT and serum albumin

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

ascites- caused by? risk factors?

A
  • portal HTN from chron liver dz

- ETOH, transfusions, tattoos, IVDU, viral hepatitis

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

fatty liver (hepatic steatosis)- caused by

A
  • NAFLD
  • alcoholic related fatty liver dz
  • vinyl chloride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NAFLD- sx, etiology

A
  • usually asymptomatic- RUQ pain, hepatoemgaly
  • obesity, DM, hypertriglyceridemia, metabolcic syndrome
  • coffee reduces risk of fibrosis and cirrhosis
  • protective- physical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NAFLD- histology

A
  • macrovesicular steatosis

- NASH (nonalcoholic steatohepatitis)- macrovesicular steatosis and focal infiltration by PMN’s and Mallory hylain

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

NAFLD- imaging, tx

A
  • US- can see macrovascular steatosis
  • liver bx- diagnostic
  • tx- weight loss, dietary fat restriction, exercise, vit E, gastric bypass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

do what test for ascites?

A

-US

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

if abd pain, ascites, and fever- must rule out what? via?

A

spontaneous bacterial peritonitis

  • via Paracentesis!!- run WBC count with differential!
  • if malnourished- run adenosine deaminase- for tb!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

spontaneous bacterial peritonitis- caused by? presentation?

A
  • ascitic fluid infection w/o an apparent source
  • translocation of gut bacteria- gram neg (E coli or Klebsiella) or gram + (strep pneumo, viridans, enterococcus)
  • 10-20% of known cirrhotic pts- present with decompensation- encephalopathy, fever, abd pain, worsening renal fxn!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

spontaneous bacterial peritonitis- lab test

A
  • paracentesis- WBC count with diff
  • PMN > 250 with 75% of all white cells!!!- highly suggestive
  • if elevated WBC count and lymphocyte predominance- think TB or peritoneal carcinomatosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

calculate SAAG

A
  • serum albumin - ascitic fluid albumin
  • > 1.1 = a portal HTN cause
  • <1.1= non portal HTN cause!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes for ascites

A 
Portal HTN (SAAG >1.1)- most common
-hepatic congestion
-liver dz
-portal v occlusion
Hypoalbuminemia (SAAG <1.1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

alcoholic- follow up for?

A

EGD- esophageal varices

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

Hepatitis A- Dx, Tx

A
  • RNA hepatovirus
  • acute
  • inc aminotransferases- inc Alk phos and bilirubin
  • fecal-oral transmission- international travel is a risk factor!!
  • Dx- IgM anti-HAV
  • Tx- self limited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Had Hep A but not anymore

A

-Anti-HAV IgG

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

Had Hep C but not anymore

A

-Anti-HCV with neg HCV RNA

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

acute HBV infection- window period

A
  • b/w HBsAg disappearing and HBsAb appearing
  • ACUTE HBV!!
  • only detectable with HBcAb IgM
  • important for screening blood donations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hepatitis B

A
  • acute or chronic
  • dsDNA genome
  • inc aminotransferases- elevated Alk phos and billirubin
  • transmitted- infected blood, sexual contract, mother to baby at delivery!!- asia!
  • HBV vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Acute HBV- presentation

A
  • variable
  • asymptomatic-> fulminant dz and death (<1%)
  • aminotransferase levels > HAV
  • can become chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HBV- window period- lab

A

-Anti-HBc IgM +

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

HBV-Acute Infx- lab

A
  • HBsAg +
  • HBeAg +
  • Anti-HBc IgM +
  • HBV DNA +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
HBV- prior infection- lab
-Anti-HBs +!!!! -Anti-Bc IgG + -Anti-Hbe +/- (ASIA- maternal transmission)
26
HBV- chronic infection- lab
- HBsAg + - HBeAg + - Anti-HBc IgM + - Anti-HBc IgG + - Anti-HBe +/- - HBV DNA +
27
HBV- immunization- lab
-Anti-HBs +
28
Chronic HBV- where?
Asia! - 90% of infants with maternal transmission - risk of HCC and cirrhosis
29
HDV (delta agent)
- acute or chronic - only in assoc with HBsAg - percutaneous exposure - immigrants from endemic areas
30
HDV- dx
- anti-HDV - HDAg - HDV RNA
31
HCV
- ssRNA - 50% by IV drug use - risk factors- body piercing, tattoos, hemodialysis - sexual and maternal-fetal transmission is LOW - 80% chronic - no vaccine!!
32
HCV- dx
- enzyme immunoassay for Anti-HCV - confirmed by HCV RNA - +anti-HCV in serum but neg HCV RNA = recovery from past infection
33
HCV complications
- mixed cryoglobulinemia - membranoproliferative GN - lichen planus, autoimmune thyroiditis, idiopathic pulm fibrosis - inc risk for Non-Hodgkin lymphoma! - HCV genotype 3- hepatic steatosis - dec in serum chol and LDL - cirrhosis and HCC
34
HCV- recommendations
- screen ppl born b/w 1945-1965 - vaccinate against HAV and HBV - check for co infection with HBV and HIV - safe sex practice - CURABLE
35
Chronic HCV- cirrhosis progression inc in?
- after 20 yrs of dz - men - drink > 50g of ETOH daily - acquire infx after 40 yo - immunocompromised - tobacco and cannabis smoking * Af Am- higher rate of chronic HCV but lower fibrosis - coffee- slows progression - risk of cirrhosis and HCC - HCV is curable!
36
HEV- in who? dx?
- acute hepatitis in Asia, Africa - waterborne- pets, swine - self-limited - transplant recipients- those treated with tacrolimus!!! - Dx- IgM anti-HEV
37
Acute Liver Failure- causes
- Acetaminophen - idosyncratic drug rxn * risk inc with DM, outcome worse in the obese
38
acute liver failure- sx
- fulminant = hepatic encephalopathy within 8 wks and coagulopathy - labs= severe hepatocellular damage! - acetaminophen toxicity- AST/ALT > 5000 - ammonia level elevated- encephalopathy and intracranial HTN
39
Tylenol OD
- treat with NAC if in toxicity area - get a 4 hr acetaminophen level!! - empiric treatment if ingestion is unknown- acetylcysteine
40
Autoimmune hepatitis- who? labs?
- young-mid age women - +ANA and/or smooth m AB (type I) - Anti-LKM1 (type II) - AST/ALT can be >1000 - inc risk of cirrhosis and HCC
41
Autoimmune hepatitis- tx
steroids +/- azathioprine
42
alcoholics- what vit def?
-thiamine (B1)- wernicke korsakoff syndrome
43
wernicke encepalopathy
- encephalopathy- confusion, ataxia, involuntary abnormal eye movements - syndrome- memory issues, confabulate/make up stories
44
Alcoholic Liver Disease- labs
- AST 2x > ALT | - when total bili > 10 and PTT > 6 sec = severe alk hep with 50% mortality; susceptible to infections
45
Alcoholic Liver Disease- effects
- dec platelets- direct effect on megakaryocytes prod or hypersplenism - inc hepatic iron stores - reversible! - most common precursor to cirrhosis in US! - risk of HCC
46
Alcoholic Liver Disease- Bx, Tx
- polymorphonuclear infiltration with hepatic necrosis (Mallory bodies) and perivenular/perisinusoidal fibrosis - abstinence from alcohol!! - nutritional support for anorectic pts- glucose admin increases the thiamine requirement!! - 6 month abstinence before liver transplant
47
Risk of alcoholic cirrhosis
->50 grams daily for over 10 yrs
48
Maddrey Discriminant function- used for?
- disease severity and mortality risk in pts with alcoholic hepatitis - >32 = high short-term mortality- may benefit from tx with glucocorticoids!!
49
Glascow alcoholic hepatitis score (GAH)
- predicts mortality in alcoholic hepatitis - >9 who received glucocorticoids- higher survival rates than those who didnt receive glucocorticoids!! - no survival benefit with glucocorticoids <9
50
Cirrhosis- who? caused by? risk factors?
- fibrosis and regenerative nodules - Mex Ams and Af Ams > whites - causes- alcohol, chronic HCV, HBV, NAFLD, hemochromatosis - risk factors- heavy alcohol use, obesity, iron overload - coffee and tea consumption reduces risk - methotrexate and vit A assoc with fibrosis and cirrhosis
51
Cirrhosis- signs/sx
- asymptomatic for a long time - fatigue, disturbed sleep, m cramps, weight loss - portal HTN - others- gynecomastia, spider telangiectasias, palmar erythema, dupuytren contractures, asterixis
52
Cirrhosis- effects
- portal HTN- varices, ascites, hyperdynamic circulatory state - liver insufficiency- cant syn albumin, coag factors, and cant excrete bilirubin - portosystemic shunts
53
Cirrhosis- labs
- macrocytic anemia- folic acid def, hemolysis (hypersplenism) - dec WBC (hypersplenism) - inc infection - thrombocytopenia- marrow suppression, sepsis - prolongation of prothrombin time - elevation of AST, Alk phos, T bilirubin - dec in albumin - inc risk of DM!! - vit D def
54
Cirrhosis- imaging
- US- liver size, ascites, nodules - contrasted CT- nodules- biopsy - fibrosure- low/high excludes/predicts advanced fibrosis - liver bx - EGD - detect varices or causes of bleeding in esophagus, stomach, duodenum
55
Cirrhosis- complications
- Upper Gi bleeding- portal HTN gastropathy, gastroduodenal ulcer, varices - liver failure - hepatic encephalopathy - SBP (spontaneous bacterial peritonitis) - hepatorenal syndrome - coagulopathy - HCC - osteoporosis
56
Ascites- caused by?
- secondary to portal HTN! - found in 50% of pts with cirrhosis - 1/3 will develop upper GI bleeding - upper endoscopy- dx!
57
Child Pugh score
estimates cirrhosis severity! - ascites, encephalopathy, bilirubin, albumin, PT time - Class A- 5-6 - class B- 7-9 - Class C- 10-15
58
MELD score
(model for end-stage liver dz) - predict survival in pts with cirrhosis - serum bilirubin, creatinine, INR - inc of 2 in first wk- predict in-hospital mortality
59
PBC (primary biliary cholangitis)- lab, assoc with? risk factors? tx
- autoimmune destruction of small intrahepatic bile ducts and cholestasis - W>M - isolated elevated Alk phos!!! - antimitochondrial ab!!! - IgM elevated, inc chol - assoc HLA DRB1 and DQB1 - asoc with Sjogren, autoimmune thyroid, raynaud, scleroderma, celiac - risk factors- smoking - TX- ursodeoxycholic acid
60
Absorption- colon, duodenum, ileum
- colon- water - duodenum- iron - ileum- vit B12, bile salts
61
Hemochromatosis- caused by?
- autosomal recessive - HFE mutation- C282Y - iron accum- liver, pancreas, heart, adrenals, testes, pituitary, kidneys
62
Hemochromatosis- sx
- usually not until fifth decade!! | - cirrhosis, HF, hypogonadism, arthritis, skin pigmentation, DM
63
hemochromatosis- tx?
- avoid food rich in iron (Red meat), alcohol, vit C, raw shellfish, supplemental iron - phelbotomies - PPI- reduces intestinal iron abs - Deferoxamine- chelating agent
64
Wilson disease- sx, tx
(hepatolenticular degeneration) - autosomal recessive, <40 - N european - copper deposition- brain, kidney, liver - neuropyschiatric disease - kayser-fleischer rings - tx- oral penicillamine, liver transplant
65
Wilson dz- lab findings
- serum ceruloplasmin- low - urinary excretion of copper- high - hepatic copper- high
66
Budd-Chiari
- RUQ pain, painful hepatic enlargement, ascites, HSCM, jaundice - occlusion of hepatic v or ICV - hypercoagulable state!! - complicated by HCC!
67
Budd-Chiari- Dx
- prominent caudate lobe!! - screening- Doppler ultrasonography - direct venography- "spider web" pattern! - Bx- centrilobular congestion! (nutmeg liver)
68
assoc with oral contraception
-hepatocellular adenoma
69
Alpha-1 antritrypsin def
- autosomal recessive - defective alpha1-AT accum in hepatocytes - chrom 14- PIZZ - micronodular cirrhosis- risk of HCC - panacinar emphysema - TX- smoking abstinence, liver transplant

G2F (17 decks)

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