Liver Dysfunction: Gallbladder Disease Flashcards
(30 cards)
AST and ALT suggest inflammation in what organ?
How about ALK Phos?
Da Liva, yo
Gallbladder
What other tests can evalutate liver function?
PTT
Albumin
also, bilirubin
Biggest cause of jaundice in: infants adolescents adults elderly
infants - physiologic
adolescents - gilbert’s, then viral
adults - viral. then autoimmune, alcohol and biliary tract
elderly - malignacny. then drugs and toxins
unconjugated bili is raised in what
hemolysis, gilbert’s (becuase it can’t get in the cell), medications
conjugated bili is raised in what
obstruction, intrinsic liver disease, meds, sepsis
tell me, son, about fetor hepaticus.
It’s also called breath of the death.
you have portal hypertension, so blood gets shunted to the lungs without going through liver and doesn’t get detoxified. You breath out sulfery, thiol-ly things that smell
do you know what asterixis is?
hand flappy tremor when you have hepatic encephalopathy
What’s TIPPS
you make portal blood go to the hepatic vein, then to the vena cava to bypass the liver and stop portal hypertension. but then toxified blood is going to the brain, so it can cause encephalopathy
How does lactulose work to get rid of ammonia
in the gut it gets turned to lactic acid, acidifying your poo, reducing the ammonia (NH3) into ammonium (NH4+) and trapping it there
causes diarrhea too, getting rid of bacteria that make ammonia
Most common type of gallstone
Cholesterol with calcium bilirubinate
What causes gallstones, usually.
Biliary stasis
What type of stone is more common with hemolysis
Pigment stones, also can be from cirrhosis.
There are also brown stone, which are in asianz more often .
Treatment for gallstone
ursodeoxycholic acid. Stones are usually mixed composition and this helps reduce cholesterol absorption
Best test to find gall stones
Transabdominal ultrasound
Test to determine cause of ascites
SAAG (serum ascites albumin gradient)
albumin in serum vs ascites fluid. if over 1.1 = portal hypertension. (its a transudate, low about of protein in the ascites fluid)
less than 1.1 = malignacy, infection, TB
typical presentation of gallstone
colicy pain, RUQ, minutes to hours. after eating. N/V.
Acute cholecystitis is from stone. do an ultrasound.
Chronic with no stone seen, what test do you do?
HIDA scan (hepatobiliary iminodiacetic acid scan) - give radiolabeled stuff and watch where it goes when you eat. You can see ejection fraction of the gallbladder
What is murphy’s sign?
RUQ tenderness with inhale. can mean acute cholecystitis
Labs with acute cholescytitis
normal liver stuff
WBC usually up
Bilirubin normalish
amylase, lipase up a little
What is charcot’s triad?
Fever, pain and jaundice. You probz have a gallstone
sepsis - conjugated or uncongugated bili
conjugated
may have something to do with gram negative rod sepsis, LPS may effect ability of conj bili to leave the canaliculi
Tx for spontaneous bacterial peritonitis
cephalosporin, ciprofloxacin
what type of beta blocker do you use for portal hypertension
why
non-selective
dilates the splanchnic system and decreases portal pressures
milky ascites =
high triglycerides, usually from lymph obstruction due to retroperitoneal fibrosis, thoracic duct obstruction, lymphoma
