October 15, 2015 - Abdominal Pain and Fever

Question 1

Xanthelasma

Answer 1

Yellow deposits near the eyes. Usually indicates high cholesterol if there is no family history of it.

Question 2

Next Test After Cholestatic Liver Enzymes

Answer 2

Abdominal ultrasound to look at the bile ducts for dilation.

*Note* ducts may not dilate in PSC.

Question 3

Primary Sclerosing Cholangitis

Answer 3

A disease of the bile ducts that causes inflammation and obliterative fibrosis of the bile ducts inside and/or outside the liver. This impedes the flow of bile to the intestines and can ultimately lead to cirrhosis of the liver, liver failure, and other complications such as bile duct cancer, liver cancer, and colon cancer.

75% of those who have PSC have IBD.

Question 4

Signs and Symptoms of PSC

Answer 4

Intese pruritis

Severe fatigue

Jaundice

Episodes of acute cholangitis

Dark urine

Steatorrhea (poor fat digestion)

Cirrhosis

Question 5

Primary Biliary Cholangitis

Answer 5

An autoimmune disease of the liver. It is marked by the slow progressive destruction of the small bile ducts of the liver, with the intralobular ducts and intrahepatic ductules affected early in the disease. When these ducts are damaged, bile and other toxins build up in the liver and causes liver damage over time. This can lead to scarring, fibrosis, and cirrhosis.

Tested for with AMA

Question 6

AMA Test

Answer 6

Used to test for PBC

Question 7

Types of PSC

Answer 7

Large duct (95%) and small duct (5%)

Question 8

Route for Liver Biopsy

Answer 8

Can go through the side into the liver, or can go through the jugular in the neck.

If the patient has low platelets or a high INR, you must go through the neck. Risks of a liver biopsy are bleeding, infection, and pain.

Question 9

Ursodeoxycholic Acid (UDCA)

Answer 9

Is effective for PBC

May not be good for PSC, but may be as well…

Makes bile more water soluble so it flows out easier. Makes it harder to absorb fat too, so you need to put them on Vitamin ADEK.

Used to treat PBC. The drug reduces cholesterol absorption and is used to dissolve cholesterol gallstones in patients who want an alternative to surgery.

Question 10

Septic Shock

Answer 10

A medical condition as a result of severe infection and sepsis. It can cause multiple organ dysfunction and death.

Presents with hypotension, tachypnea, elevated or low WBC count, tachycardia, and altered body temperature.

Question 11

Sepsis

Answer 11

Is a whole-body inflammatory response to an infection. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.

Question 12

Lab Signs of DIC

Answer 12

INR increased

PTT increased

Fibrinogen decreased

Creatinine normal/increased

Liver tests normal

Blood pressure low/normal

Question 13

TTP

Answer 13

Caused by a defect or absence of ADAMTS13.

vWF multimers cannot be cleaved, which results in increased platelet adhesion to endothelial injuries, particularly at ateriole-capullary junctions.

Question 14

Complications of PSC

Answer 14

Cholangiocarcinoma

Colon cancer

Gall bladder cancer (often removed)

Cirrhosis

Fat-soluble vitamin deficiencies

Metabolic bone disease