Trigger - LIver 1

Question 1

what is the result of accumulation of bile salts in liver disease

Answer 1

pruritus

Question 2

what is the result of the excess estrogen seen in liver disease

Answer 2

spider nevi and palmar erythema

also menstrual irregularities in women

Question 3

impaired cholesterol synthesis seen in liver disease results in what

Answer 3

testicular atrophy and gynecomastia in males

Question 4

symptoms include confusion, tremor, coma

Answer 4

hepatic encephalopathy d/t build up of ammonia

Question 5

AST>ALT OF >2

Answer 5

Chronic alcoholic liver disease

Question 6

AST>ALT of 1-1.99

Answer 6

chronic NASH/ non alcoholic cirrhosis

Question 7

ALP>4x UNL

Answer 7

hepatic cholestasis

less than 4x is non hepatic/non cholestatic cause

Question 8

elevated ALP and GGT

Answer 8

hepatobilliary obstruction

Question 9

first enzyme to rise in obstructive billiary disease

Answer 9

ALP

Question 10

elevated GGT but normal ALP

Answer 10

alcohol/medication

Question 11

elevated AST/ALT compared to ALP
elevated total billirubin
elevated direct billirubin
normal GGT

Answer 11

hepatocellular damage

Question 12

elevated ALP compared to AST/ALT
elevated GGT
elevated or normal total bilirubin
elevated direct bilirubin

Answer 12

obstructive disease of the liver

Question 13

albumin and PT are markers of what

Answer 13

synthetic hepatic function

Question 14

elevated serum globulin levels

Answer 14

autoimmune hepatitis

Question 15

MC in young to middle aged women

Answer 15

autoimmune hepatitis

Question 16

insidious onset of fulminant hepatitis after viral illness, drug exposure or postpartum

Answer 16

autoimmune hepatitis

• otherwise healthy person w spider nevi, cutaneous striae, acne and hepatomegaly
• may have arthritis/thyroiditis or other auto conditions

Question 17

otherwise healthy person w spider nevi, cutaneous striae, acne and hepatomegaly

Answer 17

autoimmune hepatitis

• insidious onset of fulminant hepatitis after viral illness, drug exposure or postpartum
• may have arthritis/thyroiditis or other auto conditions

Question 18

AST/ALTRR elevations of 1.5x-50x ULN
elevated total bilirubin

Answer 18

autoimmune hepatitis

also see:
Elevated ANA
PANCA
Anti-SLA

Question 19

occasionally co-exists w primary biliary cirrhosis or sclerosing choalngitis

Answer 19

autoimmune hepatitis

Question 20

Tx w prednisone +/- azothiaprine

Answer 20

autoimmune hepatitis

liver transplant is last resort

Question 21

NV, diaphoresis, pallor, lethargy and malaise w normal lab findings

Answer 21

stage 1 of acetaminophen induced hepatitis

Question 22

RUQ pain w hepatomegaly and tenderness.
ALT>AST elevation.
PT elevated
Bilirubin elevated

Answer 22

stage 2 acetaminophen induced hepatitis

Question 23

AST/ALT > 10k
Prolong PT/INR
Hyperammonemia
Hypoglycemia

Answer 23

stage 3 acetaminophen induced hepatitis.

also see reappearance of stage 1 s/s with hepatic encephalopathy. acute renal failure, multi organ failure and death can occur

Question 24

NV, diaphoresis, pallor, lethargy and malaise w proolonged PT/INR, AST/ALT >10 and hypoglycemia

Answer 24

stage 3 acetaminophen induced hepatitis

also see hyperammonemia
acute renal failre
death

Question 25

treat with N-acetylcysteine or activated charcoal

Answer 25

acetaminophen induced hepatitis

Question 26

macrocytic anemia

Answer 26

steatohepatitis also see mild AST/ALT elevations

Question 27

AST/ALT elevations hypoalbuminemia anemia

Answer 27

alcoholic cirrhosis also see: - elevated total bilirubin >10 - PT/INR prolongation - later on see lyte abnorm and elevated BUN Cr

Question 28

Biopsy showing macrovesicular fat and PMN infiltration with hepatic necrosis

Answer 28

definitive diagnosis for alcoholic liver disease

Question 29

Treat with methylprednisolone

Answer 29

alcoholic hepatitis if severe can use pentoxifyline

Question 30

tx with pentoxifylline

Answer 30

alcoholic hepatitis (severe) normal tx w methylprednisolone

Question 31

MC risk factor is obesity

Answer 31

NA fatty liver disease

Question 32

tx includes Vit E and TZDs

Answer 32

Non alcoholic fatty liver disease also use metformin and weight loss agents

Question 33

tx inludes metformin and weight loss agents

Answer 33

non alcoholic fatty liver disease also includes Vit E and TZDs

Question 34

liver w fibrosis and nodules

Answer 34

cirrhosis

Question 35

ascities with Worsening abd pain, Fever and Leukocytosis

Answer 35

bacterial peritonitis (caused by e coli)

Question 36

tx w cefotaxime

Answer 36

bacterial peritonitis | treat prophylactically w FQs

Question 37

treat with oral flouroquinolones

Answer 37

prophylaxis of bacterial peritonitis | tx for bacterial peritonitis is cefotaxime ( caused by ecoli)

Question 38

tx includes dereasing protein and taking lactulose

Answer 38

hepatic encephalotpathy also take abx such as rifamixin or metro

Question 39

tx includes rifaximin or metro

Answer 39

hepatic encephalopathy also: eat less protein take lactulose to metabolize ammonia | refiaxiMIN because you MINIMIZE ammonia build up

Question 40

coffee, tea and statins

Answer 40

reduce risk of rapid decompensation from cirrrhosis

Question 41

didnt do the last like 10 cards