Liver Dysfunction: Gallbladder Disease

Question 1

AST and ALT suggest inflammation in what organ?

How about ALK Phos?

Answer 1

Da Liva, yo

Gallbladder

Question 2

What other tests can evalutate liver function?

Answer 2

PTT
Albumin
also, bilirubin

Question 3

Biggest cause of jaundice in:
infants
adolescents
adults
elderly

Answer 3

infants - physiologic
adolescents - gilbert’s, then viral
adults - viral. then autoimmune, alcohol and biliary tract
elderly - malignacny. then drugs and toxins

Question 4

unconjugated bili is raised in what

Answer 4

hemolysis, gilbert’s (becuase it can’t get in the cell), medications

Question 5

conjugated bili is raised in what

Answer 5

obstruction, intrinsic liver disease, meds, sepsis

Question 6

tell me, son, about fetor hepaticus.

Answer 6

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

Question 7

do you know what asterixis is?

Answer 7

hand flappy tremor when you have hepatic encephalopathy

Question 8

What’s TIPPS

Answer 8

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

Question 9

How does lactulose work to get rid of ammonia

Answer 9

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

Question 10

Most common type of gallstone

Answer 10

Cholesterol with calcium bilirubinate

Question 11

What causes gallstones, usually.

Answer 11

Biliary stasis

Question 12

What type of stone is more common with hemolysis

Answer 12

Pigment stones, also can be from cirrhosis.

There are also brown stone, which are in asianz more often .

Question 13

Treatment for gallstone

Answer 13

ursodeoxycholic acid. Stones are usually mixed composition and this helps reduce cholesterol absorption

Question 14

Best test to find gall stones

Answer 14

Transabdominal ultrasound

Question 15

Test to determine cause of ascites

Answer 15

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

Question 16

typical presentation of gallstone

Answer 16

colicy pain, RUQ, minutes to hours. after eating. N/V.

Question 17

Acute cholecystitis is from stone. do an ultrasound.

Chronic with no stone seen, what test do you do?

Answer 17

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

Question 18

What is murphy’s sign?

Answer 18

RUQ tenderness with inhale. can mean acute cholecystitis

Question 19

Labs with acute cholescytitis

Answer 19

normal liver stuff
WBC usually up
Bilirubin normalish
amylase, lipase up a little

Question 20

What is charcot’s triad?

Answer 20

Fever, pain and jaundice. You probz have a gallstone

Question 21

sepsis - conjugated or uncongugated bili

Answer 21

conjugated

may have something to do with gram negative rod sepsis, LPS may effect ability of conj bili to leave the canaliculi

Question 22

Tx for spontaneous bacterial peritonitis

Answer 22

cephalosporin, ciprofloxacin

Question 23

what type of beta blocker do you use for portal hypertension

why

Answer 23

non-selective

dilates the splanchnic system and decreases portal pressures

Question 24

milky ascites =

Answer 24

high triglycerides, usually from lymph obstruction due to retroperitoneal fibrosis, thoracic duct obstruction, lymphoma

Question 25

most “likely” med to cause a cholesterol stone in the gall bladder

Answer 25

octreotide (somatostatin analog - can be used to treat acromegaly in pituitary adenomas, gastrinoma, esophageal varices) - blocks histamine release

Question 26

acalculous cholecystitis

Answer 26

gallbladder wall gets thick, infected

no stones

typically in ICU population

Question 27

why do you see ALT and AST elevated in cholecystitis

Answer 27

simply because the gall bladder is next to the liver. it gets inflamed and the liver does by proxy

Question 28

most common type of gallbladder cancer

Answer 28

adenocarcinoma

people don’t do well

Question 29

tumor marker for pancreatic adenocarcinoma and cholangiocarcinoma

Answer 29

CA 19-9

Question 30

how to screen for hepatocellular carcinoma

Answer 30

alpha fetoprotein

people with hep b, cirrhosis, hemochromatosis get screened every 6 months