Week 4 (Exam 2) Flashcards
(266 cards)
1
Q
Who gets sinusoidal obstruction syndrome?
A
Stem cell transplant and chemo patients
People who drink exotic teas
2
Q
Auto-immune pancreatitis Type 1 vs Type 2
A
Type 1: systemic, IgG4 related from plasma cells
Type 2: pancreas only (except in UC), Mass lesion
3
Q
What is the classic presentation of a symptomatic, ruptured AAA?
A
Abdominal and/or flank pain
Hypotension
Shock / Pulsatile Abdominal Mass
4
Q
What lab values are more specific for actute vs chronic changes in liver function?
A
Acute: PT
Chronic: Albumin
5
Q
What are the black box warnings for Entecavir?
A
Severe acute Hep B exacerbations
Lactic Acidosis
Hepatomegaly
Esp those co-infected with HiV
6
Q
CPA1
A
Carboxypeptidase A1
Exopeptidase in regulating zymogen activation
7q32
7
Q
Palpable stool in abdomen, empty rectal vault, needing help to poop, failure to pass meconium in the first 1-2 days of life. What is the diagnostic test?
A
Rectal Bx for Hischprung
8
Q
Diagnostic Labs of Chronic Pancreatitis
A
Fecal Elastase down below 100
Glucose / HbA1c (development of DM)
Elevated IgG4
9
Q
Primary Sclerosing Cholangitis (PSC) Etiology
A
IBD (mostly UC)
Decreased risk with smoking and coffee
10
Q
Where does Liver regeneration occur?
A
Canals of Hering
11
Q
Pancreatic Intraepithelial Neoplasia (PanIN)
A
Non-invasive precursor lesion that leads to invasive pancreatic lesions
12
Q
Treatment of hepatic encephalopathy
A
Lactulose to make 2-3 soft stools/day
13
Q
How do you treat a Acetaminophen (Tylenol) overdose?
A
N-acetylcysteine (NAC) ideally within 8 hours of ingestion
14
Q
Budd Chiari imaging findings
A
Occluded Hepatic or IVC flow
Prominent Liver Caudate Lobe on Imaging
Caval / spider web hepatic veins on venography
Nutmeg Liver
15
Q
What 6 things developing within the first 48 hours indicate a worsening prognosis of acute pancreatitis?
A
Calcium less than 8 Hematocrit drop more than 10% O2 (arterial) less than 60 BUN rising above 5 Base deficit over 4 Sequestration of fluid over 6
16
Q
Clinical presentation of Gallstones
A
Asx, initiated by eating a fatty meal
RUQ or Epigastric Pain (6 hours, progressive)
Radiates to Right Shoulder or Back
17
Q
Presentation of Intrahepatic Cholestasis of Pregnancy
A
Benign, third trimester of pregnancy.
Itching, GI symptoms, Abnormal liver excretory tests
Cholestasis on bx
18
Q
Treatment of alpha-1 antitrypsin deficiency
A
Stop Smoking Liver Transplant (children)
19
Q
Acute Hepatitis Pattern
A
Acute Hepatitis PatterElevated Transaminase levels, various increases in other enzymes
20
Q
What is an Indirect Coombs test?
A
Tests fir Abs that could hypothetically bind certain RBCs (if mixing / transfusion were to occur)
21
Q
H&P of PBC
A
Hx of UTIs, smoking, hormone replacement, hair dye
Pruritus, Progressive Jaundice, Xanthelasma
22
Q
Large HBsAg
A
Viral Envelope glycoprotein associated with complete virions
23
Q
HBV Pol
A
DNA polymerase and Reverse Transcriptase activity
24
Q
Weight Loss, Anorexia, Malaise
A
Signs of advanced pancreatic carcinoma
25
What are the TRUE liver function tests?
```
PT/INR
Albumin
Cholesterol
Ammonia
(AST and ALT are only for liver damage)
```
26
PiZZ Mutation
Glu to Lys at 342
mut a1AT-Z polypeptide is abnormally folded and polym.
Leads to ER stress, Unfolded Protein Response, Apoptosis. PAS+
27
Vinyl Chloride
Historical association with Angiocarcinoma
28
Primary Biliary Cirrhosis most characteristic finding
Anti-Mitochondrial Abs against E2 component of Pyruvate Dehydrogenase Complex (PDC-E2)
29
Labs of Hep B
Markedly Elevated Aminotransferases early in course
30
Choledochal Cysts
Congential dilations of the common bile duct
31
What are the drug interactions associated with Elbasvir / Grazoprevir?
Co-Admonistration with moderate CYP3A inducers not recommended (decreases plasma concentration)
32
Associated conditions of PSC
UC, Pancreatitis, Idiopathic Fibrosing Disease, Males
33
#1 cause of Acute (Fulminant) Liver Failure
Acetaminophen
34
Alpha-1 Antitrypsin Deficiency Complications
Young age emphysema
| Micronodular Cirrhosis, risk of HCC
35
Diagnostics for Non-alcoholic fatty liver disease
```
Ultrasound elastography (liver stiffness for fibrosis)
Liver bx (diagnostic): polymorphonuclear neutrophil infiltration and Mallory Hyaline (same as alcoholic)
```
36
What is Murphys sign for?
Acute Cholecystitis
37
How does ARDS appear upon Xray?
Bilateral Diffuse Fluffly Infiltrates (white all over)
38
Treatment of Biliary Dyskinesia
Supportive
Low Fat Diet
Cholecystectomy
39
Morphology features of progressive chronic liver damage
scarring
40
Complications of Acute Pancreatitis
3rd Spacing
Pre-renal azotemia
Infected Necrosis
Acute Respiratory Distress Syndrome
41
Where is the narrowing of the esophagus that catches most orally ingested foreign bodies?
Upper Esophageal Sphincter: At the level of the aortic arch and diaphragmatic hiatus
42
What is the initial (non-surgical) tx for appendicitis?
NPO, IVF, Antiemetic, Pain Meds, maybe pre-op abx
43
Who is most at risk for Hep E?
Immunocompromised pts
| Transplant pt tx w/ Tacrolimus can show chronic progressing to cirrhosis
44
Wilsons Tx
Oral Penicillamine, Liver transplant
45
Caroli Disease
Multifocal cystic dilation of large intrahepatic bile ducts
46
What is the MOA of Telbivudine?
Nucleoside Analogue
47
Treatment options for HCC
Surgery / Transplant
Radiofrequency Ablation
Transcatheter Arterial Embolization
48
Complications of Chronic Pancreatitis
Brittle DM
Pancreatic Insufficiency (steatorrhea, malnutrition)
Pancreatic CA
49
Findings of alcoholic steatohepatitis
AST:ALT is 2:1
| Elevated Alk Phos
50
Single Large, hard, scirrhous tumor with fibrous bands and large polygonal cells with granular cytoplasm
Fibrolamellar Carcinoma (Hepatocellular carcinoma variant)
51
Presentation of Acute Pancreatitis
Epigastric pain boring straight through to the back
Cullen or Grey Turner's
ARDS (Crackles, difficulty breathing)
(+) Chovstek and Trousseau
52
Biliary Dyskinesia Diagnostics
RUQ pains
Normal Ultrasound
HIDA scan: radio-nucleotides, abnormal ejection fraction (less than 35 - 38% get a cholecystectomy)
53
Most common congenital gallbladder anomaly
Folded Fundus: creates a Phrygian Cap
54
Hep C family
Single Stranded RNA
55
Wilson Disease Dx
Low Ceruloplasmin
| High Serum Cu in liver, Basal ganglia, brainstem, cerebellum
56
Pancreas Wraps around C Loop of duodenum
Annular Pancreas
57
Small HBsAg
Viral Envelope glycoprotein released by infected hepatocytes free of viral core elements
58
Physical findings in Primary Sclerosing Cholangitis (PSC)
Prurutis, Jaundice
Fatigue
Osteoperosis
Can lead to ascending cholangitis (can be initial presentation)
59
Serous Cystic Neoplasm
Always Benign
| Common on Pancreatic Tail
60
What labs do you want to monitor to screen for HCC?
Alpha Fetoprotein and Ultrasound every 6 mos
61
Lab finding in Pancreatic Cancer
CA 19-9 above 100 without biliary causes
62
Cirrhosis Pattern
Decreased Albumin, Elevated Gamma Globulins, Elevated PT
63
Choice of imaging for Budd Chiari
Contrast Enhanced Ultrasound
| Color or Pulsed-Doppler Ultrasonography
64
Signs of Pancreatic Insufficiency
Steatorrhea
Fecal Elastase below 100
Detection of decreased fecal chymotrypsin
65
What are the 3 prognostic indicators for acute pancreatitis?
Ranson Criteria
BISAP
APACHE II
66
Single Best acute measure of hepatic synthesis function
Coagulation Factors
67
What is the most common location of intussusception?
Ilium into the coilon at the ileocecal junction
68
Peliosis
Efflux of hepatic blood is impeded
69
Lab findings in Alcoholic Liver Disease
```
AST 2x higher than ALT
Bilirubin above 10 mg/dL
Leukocytosis
Anemia (usually macrocytic)
Thromboctopenia, maybe
PT prolongation
```
70
Mucenous Cystic Neoplasm
Almost all in women
| Common on Pancreatic Tail
71
What are the Black Box warnings for Lamivudine?
Lactic Acidosis
Severe Hepatomegaly
Exacerbations of Hep B
Different Formulations
72
What do you use for serologic diagnosis of Hep B if the production of Anti-HBs is delayed?
IgM anti-HBc
73
Cavernous Hemangioma of the Liver
Most common benign neoplasm of liver
| Often mistaken for malignancy
74
Tx of PBC
Ursodeoxycholic Acid (Liver transplantation if fails)
75
Treatment of Secondary Peritonitis
Surgery to plug the flora leak
| Antibiotics (fluoroquinolone-esque abx + metronidazole)
76
Cullens and Gray Turners Sign
| Abdominal Pain
Pancreatitis
77
Most likely cause of elevated conjugated bilirubin in an infant?
Biliary Atresia
78
What are the drug interactions associated with Ledipasvir / Sofosbuvir?
Poly Glycoprotein Inducers may alter concentrations (St Johns Wort, etc)
79
What is the threshold for diagnosis of an abdominal aortic aneurism?
3.0 cm
80
What type of cell death is seen in acute toxic or ischemic injury?
Coagulative Necrosis
81
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
(this is eclampsia)
82
Radiological findings in Chronic Pancreatitis
Calcifications (tumefactive chronic pancreatitis)
83
Etiology of non-alcoholic fatty liver disease
Metaolic Syndrome (increases risk of CKD and colorectal CA)
84
Small portal vein obstruction cause 1
Schistosomiasis
85
Which is the Chovstek and which is the Troussseau sign?
Both are for hypocalcemia. Chovstek is a facial twitch, Trousseau is a hand posture upon blood pressure check
86
What is the MOA of Ledipasvir / Sofosbuvir?
Ledipasvir: Hep HCV NS5A inhibitor
Sofosbuvir: HCV Nucleotide Analog NS5B Polymerase Inhibitor
87
Wilson Disease H&P
Young: Hepatitis, Hemolytic Anemia, Neuro-Psych
Brownish Kayser Fleischer Ring around iris edge
ass'd with renal calculi, hemolytic anemia, subQ lipomas
88
What are the Indications of PEG IFN Alfa-2a?
Treating chronic hep C with compensated liver disease not previously treated with IFN-a.
Treating chronic Hep B in people with compensated liver disease and evidence of viral replication and liver inflammation
89
Trypsin Inhibitor
Kazal Type I (SPINK1)
90
MEN2A
Thyroid (elevated calcitonin)
Adrenal (elevated catecholamines)
Parathyroid (hypercalcemia)
91
Fibropolycystic disease of the liver lesion embryology
Ductal Plate malformation from persistent fetal periportal ductal plates
Increased risk of cholangiocarcinoma
92
What are the major risk factors of gallstones?
Family History, Fair, Fat, Female, Forty
93
Etiology of Biliary Dyskinesia
Unknown
94
Choledochal Cyst predisositions
Stone Formation
Stenosis and Stricture
Pancreatitis
Obstructive Biliary Complications within Liver
95
What family is Hep A in?
ssRNA
96
alpha 1 antitrypsin deficiency diagnostics
PiZ / PIZZ gene on chromosome 14
97
HCV characteristic histology
Portal tract expansion by a lymphoid follicle
98
What are the indications for Telbivudine?
Chronic Hep B patients with evidence of viral replication, persistent elevations in ALT or AST or histologically active disease
99
What is the best predictor of HBV chronicity?
Age at time of infection (younger more likely to be chronic)
100
How do you treat auto-immune hepatitis?
Prednisne
101
What is the MOA of Tenofovir?
Reverse Transcriptase inhibitor (remember HIV?)
102
HBx
Transcriptional Transactivator of viral genes
| Implicated in related Hepatocellular Carcinoma
103
What are the major Unconjugated / indirect Jaundices?
Hemolytic Syndrome
Gilbert Syndrome
Crigler Najjar Syndrome
104
Primary Biliary Cholangitis (PBC) Etiology
Autoimmune destruction of small bile ducts, cholestasis
Female / 50 y.o. Predominance
Asx isolated elevation in Alk Phos OR impaired bile excretion
105
PBC Diagnostics
```
Antimitochondrial Abs (AMA)
Increased Alk Phos and IgM
```
106
CCK functions
1. Smooth Muscle Contraction (release bile from GB)
| 2. Tell Spincter of Oddi to Relax
107
Labs for Hep D
HDV RNA on PCR
108
Etiology of Hemochromatosis
HFE gene mutation on chr 6
Increased Fe absorption in duodenum
Increased accumulation of hemosiderin in so many organs
109
Hepatoblasoma presentation
Pediatric Abdominal Swelling
| Sx related to liver dysfunction
110
What is the best way to measure the severity of GERD?
24-hour intra-esophageal pH
| Impedance monitoring
111
Hep D Labs
HDV RNA (PCR)
112
What is the duration of Hep A?
Incubation 2-3 weeks, up to 6
| Self-Limited
113
What are the main differences in physical presentation between HBV and HCV?
HBV: Polyarteritis Nodosa
HCV: Mixed Cryoglobulinemia
114
Associated conditions of PBC
Sjogrens, Scleroderma, Thyroid Disease, Females
115
What are the major adverse reactions of Telbivudine?
Increased Creatine Kinase
116
Hemochromatosis tx
Phlebotomy
PPI
Deferoxamine (chelating agent)
117
Clinical findings of Dubin-Johnson Syndrome
Benign, symptomatic. Liver Darkly Pigmented on gross examination. Excellent Px
118
What enzyme hasn't kicked in at birth, leading to physiologic jaundice of the newborn?
UGT1A1
119
Complications of Hemochromatosis
Infections of Yersinia Enterocolitica, vibrio vulnificus, listeria
120
Complications of Hep C
Cirrhosis
Hepatocelluar Carcinoma
HIV Co-Infection
pathogenic factor in Mixed Cryoglobulinemia
121
Charcot Triad
RUQ pain
Fever with Chills
Jaundice
(this is found in Ascending Cholangitis)
122
Multiple Nodules, looking like cirrhosis, but no fibrous septa
Nodular Regenerative Heyperplasia (in liver)
123
Risk factors for Hep D
HBsAg+, especially IV drug users (percutaneous)
124
Chronic Pancreatitis Sx
```
Abdominal and Back Pain
Calcifications
Pseudocyst
Pancreatic Exocrine Insufficiency
DM
```
125
How do you interpret SAAG results?
= ascites albumin - serum albumin
Greater than 1.1 think portal HTN
greater than 250 PMNs/mL think SBP
126
Treatment of Auto-immune Hepatitis
Glucocorticoids
127
What is the Black Box warning for Ribivarin?
Serious Disorders and birth defects
| DO NOT USE in pregnancy and for 6 most after treatment
128
What babies are most at risk for hyperbilirubinemia?
Born to moms who are Type O or Rh(-)
129
Findings of Intrahepatic Cholestasis of Pregnancy
```
Pruritis
Darkening of Urine
Light Stools
Jaundice
Total bilirubin usually below 5, do a bx for canalicular cholesasis
```
130
How do you treat SBP?
Ceftriaxone of Cefotaxime with IV albumin
131
Most common cause of jaundice in pregnancy
Viral Hepatitisw
132
Acute Liver Failure Treatment
Liver Failure
| N-Acetylcysteine in Acetaminophen OD
133
Clinical Features of Gilbert Syndrome
Benign hereditary jaundice
hyperbilirubinemia after 24 - 36hr fast
No treatment required
Reduced CVD mortality
134
What is GGT sensitive for?
Liver Disease
135
MEN2B
```
Marfanoid body
Medullary thyroid cancer
Pheocromocytomas
Neuromas on face structures
Often a new mutation: no family history
```
136
Define Acute Liver Failure
Liver disease associated with encephalopathy and coagulopathy that Occurs Within 26 Weeks of the Initial Liver Injury in the Absence of Pre-Existing Liver Disease
137
Portal Triad
```
Portal Vein (branch)
Hepatic Artery (branch)
Bile Duct (branch)
```
138
Single well-demarcated lesion with central scar
Focal Nodular Hyperplasia (in liver)
139
Diagnostic Radiography of Acute Pancreatitis
```
Sentinel Loop (air filled intestine, usually in LUQ)
Colon Cutoff Sign (gas-filled blunt ended transverse)
Rapid-Bolus intravenous Contrast-Enhanced CT:
(avoid when serum Cr > 1.5 mg/dL)
```
140
What is the MOA of Boceprevir?
NS3/4A protease inhibitor for Chronic Hep C
Combo with Peginterferon alfa and Ribavirin
Use when previous IFN and Ribavirin therapy fails
141
Associations of Hepatoblastoma
FAP
| Beckwith-Wiedemann Syndrome
142
Physical presentation of Preeclampsia and Eclampsia
Maternal Hypertension
Proteinuria
Peripheral Edema
Coagulation Abnormalities
143
Chronic Hepatitis Pattern
Acute (elevated transaminase) AND cirrhosis (decreased albumin, elevated gamma globulins, elevated PT) patterns
144
Autoimmune Hepatitis HLA alleles for Caucasians, Japanese, South Americans
Caucasians: DR3
Japanese: DR4
South Americans: DRB1
145
How do you interpret a Child Turcottte Pugh score vs a MELD/MELD-Na score?
CTP: A-C (C or above a "7" is worst)
MELD: Over 10 is bad, Over 14 you want a transplant
146
Minimal risk, mainly women, hepatocellular adenoma subtype.
HNF1-a
147
CASR
Calcium sensing Receptor
Senses Calcium and controls it. Mut activates Trypsin
3q13
148
Most common bugs of SBP
E Coli
| Klebsiella
149
Detection of intra vs extra hepatic adenocarcinoma
Intrahepatic: Incidental on imaging
Extrahepatic: Like biliary tree obstruction
150
What are the warnings associated with Velpatasvir / Sofosbuvir?
Can potentiate bradycardia with Amiodarone co-admin
| Caution those using b-Blockers or with underlying cardiac comorbitidies / Advanced liver disease
151
What is the transmission of Hep A?
Fecal Oral
152
Biliary Dyskinesia Physical Signs
RUQ Pain
Severe Pain
Nausea
153
Oral contraceptives and anabolic steroids, can cause pain from rapid growth, hemorrhage, rupture.
B-Catenin Hepatocellular Adenoma
154
Diagnostic Labs of Acute Pancreatits
Lipase 3x more than Upper Limit Normal
155
Fibropolysistic Disease of the liver findings
Von Meyenburn Complexes: hamartomas
Simple Multiple Biliary Cysts: Caroli Disease
Congenityal Hepatic Fibrosis: Caroli Syndrome
156
Physical signs of Pancreatic Cancer
Painless Jaundice
Trousseau Sign of Malignancy (red leg spiral)
Courvoisier Sign (palpable gallbladder)
157
What are the contraindications of Boceprevir?
All the same as PEG-IFN-alfa and Ribavirin (kills fetuses)
158
What is the MOA of Lamivudine?
Nucleoside Analogue for Hep B (also tx HIV)
159
PRSS1
Serine Protease 1
Cationic Trypsin. GOF mut prevents trypsin inactivation
7q34
40% chance of developing pancreatic cancer
160
Caroli Syndrome
Disease (multifocal cystic dilation of large bile ducts)
| + Congenital Hepatic Fibrosis
161
What is the MOA of Velpatasvir / Sofosbuvir?
Sofosbuvir: HCV nucleotide analog NS5B Pol. Inhibitor
Velpatasvir: HCV NS5A Inhibitor
162
Tests for Cholestatic function
Primary Alkaline Phosphatase and Bilirubin Elevated
| Jaundice and pruritus, bile can't reach duodenum
163
What is the MOA of Elbasvir/Grazoprevir?
Hep C NS5A inhibitor (Elbasvir)
| NS3/4A Protease Inhibitor (Grazoprevir)
164
What are the indications for Ribivarin?
Nucleoside analogue for HCV in combo with IFN Alfa-2a
| Ages 5+ with compensated liver disease (not previously treated with IFN Alfa-2a) and adults co-infected with HIV
165
MOA of Gilbert Syndrome
Reduced activity of Uridine Diphosphate Glucuronyl Transferase
166
What is Entecavir MOA?
Hep B nucleoside analogue reverse transcriptase
167
What are the Drug interactions associated with Velpatasvir / Sofosbuvir?
PGP inducers / CYP inducers
168
What is the major cell type involved in hepatic scarring?
Hepatic Stellate Cell (stores Vit A, Converted to fibrinogenic myofibroblast)
169
Precipitants of hepatic encephalopathy
GI bleeding
Constipation
Sepsis
170
What does an apoptotic cell look like?
Round / Oval mass of intensely eosinophilic cytoplasmic fragments of dense nuclear chromatin
171
What are the major precautions for Lamivudine?
Pancreatitis
172
Alcoholic Liver Disease Px
A Maddrey's: Poor starting at 32 and up
Glasgow good starting at 9 and up
MELD: Above 21 Is super bad
173
Asterixis
Flapping Tremor found in hepatic encephalopathy
174
Treatment for Chronic Pancreatitis
Supportive: Pain Control, Pancreatic Enzyme Supplement
| Treat associated DM
175
Hypertonia
Phase 3 of bilirubin toxicity in a neonate
176
Obstructive Liver Disease Pattern (cholestasis)
Elevated ALP and Bilirubin
177
Hyperbilirubinemia physical presentation
Icterus
Pruritus, xanthomas, ADEK deficiencies
Elevated GGT and Alk Phos
178
TIGAR-O
Chronic Pancreatitis: Toxic-Metabolic (alcoholic); Idiopathic (early onset); Genetic (CFTR); Autoimmune (IgG4); Recurrent; Obstructive
179
Complications of Budd Chiari
Hepatocellular Carcinoma
180
What are the major adverse reactions to adefovir?
Asthenia
| Increased Creatinine in pre and post transplantation
181
What are some warnings associated with Ledipasvir / Sofosbuvir?
Only use in combination with Ribavirin
182
Complications of Primary Sclerosing Cholangitis (PSC)
Increased risk of cholangiocarcinoma
183
Window Period of Hep B
Between HBsAg disappearing and HBsAb appearing
Considered Acute
Only detectable with HBcAb IgM
184
Ground-Glass Liver
Hepatocytes in chronic Hep B infection
| Accumulation of HBV surface Ag
185
Hemochromatosis Diagnostics
```
HFE gene mutation
Elevated plasma Fe with over 45% transferrin saturation
MRI and Ct for quantification
Liver bx for cirrhosis
Screen all first degree family members
```
186
Anti-HBe Ab
Signifies that acute Hep B has Peaked and is on the wane
187
What family is the Hep D virus in?
Defective RNA
188
Morphology features of chronic hepatitis
Increased portal chronic inflammation
189
What unique warning comes with Tenofovir?
New onset or worsening renal impairment
190
What are the two types of gallstones?
Cholesterol and Pigment (calcium bilirubinate)
191
What are the two main causes of Acute Pancreatitis?
Biliary Tract Gallstones
| Heavy Alcohol Use
192
Gallstone Ileus / Bouveret Syndrome Etiology
Large stone erodes directly into an adjacent loop of small bowel
193
How would you identify chronic liver failure in a patient?
Acute symptoms
Palmar Erythema, Spider Angiomata, Hypogonadism, Gynocomastia
Portal HTN
194
Lab Findings of Pancreatitis
```
Elevated Lipase (and amylase, less specific)
Maybe glycosuria and hypocalcemia from fat necrosis
```
195
What is the MOA of Adefovir?
Nucleotide Analogue for 12 y.o.+
196
How would you identify acute liver failure in a patient?
N/V, icterus, jaundice, elevated liver enzymes...
Coagulation Abnormalities
Hepatic Encephalopathy leading to Asterixis
197
Complications of acute cholecystitis
Gangrene of gallbadder
| Emphysematous cholecystitis
198
3 of what 5 tings indicate severe acute pancreatitis complicated by necrosis?
```
Age over 55
WBC over 16 x 10^3
Glucose over 200
Lactic Dehydrogenase over 350
Aspartate aminotransferase over 250
```
199
Most important test when assessing ascites
CBC w/ Diff to rule out SBP (PMN over 250)
200
Rotor Syndrome MOA
Reduced hepatic reuptake of bilirubin conjugates
201
Elevated vs Normal gamma glutamyl transferase (GGT) upon ALP fractionation
Elevated most commonly from Liver
| Normal consider Bone or Placenta
202
What are the black box warnings for Tenofovir Disoproxil?
Lactic Acidosis / Severe Hepatomegaly w/ Steatosis
| Post-Tx Exacerbation of Hep B
203
What is the main function of a-1 Antitrypsin
Inhibition of proteases (esp Elastase, Cathepsin G, Proteinase 3) that are normally released at inflammation sites by neutrophils
204
Diagnostics of HCC
Pt with known liver disease gets a bad ultrasound or has rising a fetoprotein
205
What would you order for a suspected duodenal injury?
CT with contrast
206
What are the indications for Velpatasvir / Sofosbuvir?
HCV without Cirrhosis (or at least compensated)
| Combine with Ribavirin when its decompensated
207
Primary Sclerosing Cholangitis (PSC) Diagnostics
Elevated Alkaline Phosphatase and Bilirubin
Beads on a string bile duct
"onion skin" periductal fibrosis on biopsy
208
Neoplasm on the head of the pancreas, connected to the ductal system. Mainly in men
Intraductal Papillary Mucinous Neoplasm
209
Defining histologic feature of chronic viral hepatitis
portal lymphocytic (or lymphoplasmacytic) inflammation with fibrosis
210
Most pancreatic cancers are ______ and incite _____
Adenocarcinomas
| Dense Desmoplastic reaction
211
Hypoperfusion + retrograde congestion =
centrilobular hemorrhagic necrosis
| from right sided cardiac decompensation
212
Hep E family
ssRNA
213
CTRC
Chymotrypsin C
Degrades Trypsin, Protecting the pancreas
1p36
214
Budd Chiari Etiology
```
Hepatic Vein Obstruction (or IVC)
Caval Webs, R Heart Failure (causing Nutmeg Liver)
Hypercoaguable State (like PV)
```
215
What is the diagnostic test for gallstones?
Ultrasonography, acoustic shadow cast
216
Classifications of Auto-Immune Hepatitis
```
Type I (classic): Anti-Smooth Muscle / Anti-Nuclear Abs
Type II: Anti-Liver / Kidney Microsomal Abs
```
217
Complications of Chronic Cholecystitis
Porcelain Gallbladder on Xray (calcified lesion)
| Increased risk of gallbladder cancer
218
What is the BISAP score for acute pancreatitis?
```
Bun over 25
Impaired mental status
SIRS of 2-4
Age over 60
Pleural Effusion
```
219
Rotor Syndrome Findings
Asymptomatic like DJ, except no pigmented liver
220
How do the numbers of complications in acute pancreatitis correlate to mortality rate?
0 - 2: 1%
3 - 4: 16%
5 - 6: 40%
7 - 8: 100%
221
Hepatocellular Adenoma associated with obesity and metabolic syndrome. Higher risk of malignant transformation
Inflammatory Adenomas
222
What are the major signs of acute cholecystitis?
Tea Colored Urine or Acholic Stools
Acute attack after large fatty meals
Murphy sign
223
Etiology of Chronic Pancreatitis
Usually from alcoholism
Recurrent episodes of acute pancreatitis
Malabsorption (exocrine insufficiency, steatorrhea)
DM (endocrine insufficiency)
224
What are the Black Box warnings of PEG IFN Alfa-2a?
Serious disorders and Ribavirin Ass'd Effects
| fetal death?
225
How much alcohol does it take to cause alcoholic liver disease?
Takes 10+ Years:
Males: over 80g /day
Females: over 30-40 g/day
226
What is the Hep B family?
Partially dsDNA
227
Hemochromatosis Mutation
HFE: C262Y
228
Treatment / Management of Acute Pancreatitis
1. IV fluid resuscitation
Treat the cause
Severe: Early surgical consult, ICU monitoring
229
Alcoholic Liver disease bx findings
Mallory-Denk Bodies (alcoholic hyaline)
230
Liver failure from heart failure Dx
Elevated Serum N-terminal-ProBNP or BNP
| Hallmark Shock Liver of aminotransferase levels (often above 5k units/L), early rapid rise in LDH
231
Hypochloremic, Hypokaelmic, Metabolic Alkalosis
Pyloric Stenosis
232
What are the major Conjugated / direct jaundices?
Dubin - Johnson
Rotor
Drug Reaction
Pregnancy
233
What is the transmission of Hep B?
Parenteral, Sexual, Perinatal (esp BHsAg+ mothers)
Percutaneous
Endemic to Southeast Asia and Sub Saharan Africa
234
Acute Liver Failure Diagnostics
Rapidly Rising Bilirubin Level
PT prolongation even as AST/ALT fall
Acetaminophen level via Rumack-Matthew Nanogram
235
Alpha 1 Anti-Trypsin Deficiency etiology
AR deficiency leads to Pulmonary Emphysema
Hepatocellular accumulation of misfiled proteins causes Liver Disease
Most Common Inherited hepatic disorder in pediatrics
236
What is a Direct Coombs Test?
Looks for Abs on a baby's RBCs.
when hyperbilirubinemia is maybe from hemolysis
(ABO incompatibility in newborns)
237
What are the major warnings indicated with Adefovir?
Nephrotoxicity (look for drug-drug interactions)
| Exacerbations of Hep B
238
Tests for Hepatocellular damage
Primary AST and ALT
239
You can get Emphysema with your pancreatitis. How would you treat it?
Surgical debridement and antibiotics
240
Hypertonia of muscles, opsithononus (ricin arching), retrocollis, maaaaaaybe fever
Phase 2 of bilirubin toxicity in a neonate
241
Diagnostics of Hepatic Encephalopathy
Clinical
| elevated ammonia levels
242
What are the black box warnings for Telbivudine?
Lactic Acidosis
Severe hepatomegaly with Steatosis
Severe Exacerbations of Hep B
243
Pseudocysts vs Congenital Pancreatic Cyst
Pseudocyst lacks epithelial lining
244
What are the major contraindications of Telbivudine?
Combination with PEGylated IFN alfa-2a increases risk of peripheral neuropathy
245
Wilson Disease Etiology
```
AR mut on Chr 13 at ATP7B
Impaired Copper excretion and incorporation
Accumulation in liver brain and eyes
Toxic to RBC: hemolytic Anemia
Neuropsychiatric disease in young adults
```
246
Hemochromatosis H&P
Tetrad: Cirrhosis w/ hepatomegaly, Abnormal Skin Pigmentation, DM, Cardiac Dysfxn
Later: Hypogonadism
247
Cholestatic Jaundice (conjugated), Hepatomegaly, Acholic Stools
Biliar Atresia
248
Poor Suck, High Pitched Cry, Listlessness, poor tone, yellow skin, maaaaaaybe seizure
Phase 1 of bilirubin toxicity in a neonate.
249
MEN1
Parathyroid (hypercalcemia, more PTH)
Pancreas (Gastrinoma, insuinoma / hypoglycemia)
Pituitary (Acromegaly, Cushing)
250
Physical presentation of Chronic Pancreatitis
Pain (cardinal symptom)
Steatorrhea
Unintentional Weight loss
Fatigue
251
Symptoms of Hep B
Fever, Enlarged Liver, Jaundice
| Polyarteritis Nodosa
252
Intrahepatic vs extra hepatic biliary tree adinocarcinomas
Intrahepatic: Intrahepatic Cholangiocarcinoma
Extrahepatic: Biliary Adenocarcinoma
253
HBcAg
Nucleocapsid protein
Role in Assembly of complete virions
Longer polypeptide transcript with precode and core region (HbeAg)
254
Reynold Pentad
Charcot Triad
Confusion
Hypotension
(acute suppurative cholangitis, Endoscopic Emergency)
255
MOA of Dubin-Johnson Syndrome
reduced hepatocyte excretory function
256
What are the contraindications of Ribivarin?
Pregnancy and Hemoglobinopathies
257
What imaging techniques would you use for children vs adults?
Adults: CT abdomen and pelvis w/ contrast
Children: Ultrasound RLQ first, then CT if (-)
Pregnant: MRI
258
What are the labs in Hep A?
Markedly elevated AST / ALT
Elevated bilirubin and Alk Phosphatase = Cholestasis
IgM anti-HAV
259
Prognosis of Chronic Pancreatitis
Pancreatic CA is main cause of death
260
Treatment of Primary Sclerosing Cholangitis (PSC)
None
261
Anti-HBs Ag
Rises after resolution of acute Hep B (may be delayed)
Persists for life, confers protection
Not in cases that become chronic
262
Hepatomegaly, Abdominal Pain, Ascites
Classic Triad of Hepatic Vein Thrombosis
263
What are the contraindications of Elbasvir / Grazoprevir?
Patients with moderate or severe Hepatic Impairement
| ALT elevations
264
Diagnostic labs of Acute Cholecystitis
Leukocytosis
Bilirubinemia
Increased ALP and GGT
265
How do you treat biliary cholangitis / cirrhosis?
Urodeoxycholic acid
266
Treatment of Alcoholic Liver Disease
Daily Multivitamin: Glucose, Thiamine to avoid Wernicke Korsakoff
Steroids and Pentoxifylline for severe cases
