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28 Cards in this Set
- Front
- Back
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Risk factors for gallstones |
4 F’s Forty Female Fertile Fat |
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What is acalculous cholecystitis? |
Due to gallbladder stasis, hypoperfusion or infection (CMV) Seen in critically ill patients |
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What is Murphy sign? |
Inspiratory arrest on RUQ palpation due to pain. Pain may radiate to right shoulder (due to irritation of phrenic nerve) |
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What is a Rokitanksy Achoff sinus? |
Herniation of gallbladder mucosa into the muscular wall. Occurs in chronic cholecystitis |
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What is a porcelain gallbladder? |
A shrunken, hard gallbladder due chronic inflammation, fibrosis & dystrophic calcification Late complication of chronic cholecystitis Tx - prophylactic cholecystectomy due to high rates of gallbladder carcinoma |
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What is Charcot’s triad of ascending cholangitis? |
Jaundice, fever & RUQ pain |
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What is Reynolds pentad? |
Occurs in ascending cholangitis Fever, jaundice, right upper quadrant pain (Charcot triad) + altered mental status and shock (hypotension) |
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What is gallstone ileus? |
A gallstone enters and obstructs the small bowel (ileocecal valve-narrowest part) Due to cholecystitis with a fistula formation between the gallbladder and the small bowel Can see air in the biliary tree (pneumobilia) |
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What is Gilbert syndrome? |
Due to mildly decreased UDP-glucuronosyltransferase leading to increased unconjugated bilirubin. Not clinically significant. Jaundice during stress Autosomal recessive |
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What is Crigler-Najjar syndrome? |
Type 1 is absent UDP-glucuronosyltransferase. Presents early in life, leads to kernicterus, patients die within a few years. Increased UCB Tx - plasmapheresis & phototherapy. Liver transplant is curative Autosomal recessive (Type II is less severe & responds to phenobarbital which inc liver enzyme synthesis) |
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What is Dubin-Johnson? |
Conjugated hyperbilirubinemia due to deficiency of bilirubin canalicular transport protein (defective liver excretion) Autosomal recessive Liver is dark. Not clinically significant |
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What is Rotor syndrome? |
Similar to Dubin-Johnson syndrome but milder without black liver Due to impaired hepatic uptake & excretion |
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What are the clinical features of liver cirrhosis? |
Portal hypertension leads to: Ascites, Congestive splenomegaly/hypersplenism, Portosystemic shunts, Hepatorenal syndrome Decreased detoxification leads to: Mental status changes, asterixis & eventual coma (due to increased serum ammonia) Gynecomastia, spider angioma, palmar erythema due to hyperestrinism Jaundice Decreased protein synthesis: Hypoalbuminemia with edema, coagulopathy |
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What is a Mallory-Denk body? |
A cytoplasmic inclusion found in hepatocytes (damaged intermediate filaments) Highly eosinophilic & classically found in the livers of people suffering from alcholic liver disease |
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What are the forms of alcoholic liver disease? |
Hepatic steatosis Alcoholic hepatitis Hepatic cirrhosis |
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What are possible complications of hemochromatosis? |
Classic triad - cirrhosis, secondary diabetes mellitus & skin pigmentation (“bronze diabetes”) Cardiac arrhythmia, restrictive and dilated cardiomyopathy, hypogonadism, arthropathy. HCC is a common cause of death |
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What cause primary hemochromatosis? |
Autosomal recessive C282Y mutation on the HFE gene on chromosome 6. Leads to abnormal iron sensing & increased intestinal absorption Associated HLA-A3 |
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What causes secondary hemochromatosis? |
Chronic transfusion therapy (eg, B-thalassemia major) |
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What can we use to treat Wilson disease? |
Chelation with penacillamine or trientine Oral zinc |
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What is Wilson disease? |
Autosomal recessive mutations in hepatocyte copper-transporting ATPase (ATP7B gene on chr 13) Leading to lack of copper transport into bile & lack of copper incorporation into apoceruloplasmin Copper accumulates esp in liver, brain, cornea, kidneys |
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What is primary biliary cirrhosis? |
Autoimmune granulomatous destruction of intrahepatic bile ducts Classically arises in middle aged wonen & is associated with other autoimmune diseases Etiology is unknown. Antimitochondrial antibody is seen |
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What is secondary biliary cirrhosis? |
Caused by extrahepatic biliary obstruction leading to increased pressure in intrahepatic ducts. This leads to injury/fibrosis & bile stasis. Can be caused by gallstones, biliary strictures, pancreatic carcinoma etc |
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What is primary sclerosing cholangitis? |
Inflammation & fibrosis of intrahepatic and extrahepatic bile ducts. Leads to periductal “onion skin” fibrosis -> alternating strictures & dilations with “beaded” appearance on ERCP & MRCP Unknown etiology Associated with ulcerative colitis Increased risk of cholangiocarcinoma |
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What is Reye syndrome? |
Rare, often fatal childhood hepatic encephalopathy. Seen in children with viral illness (VZV & influenza esp) who take aspirin. Reye of sunSHINE: Steatosis of liver/hepatocytes, Hypoglycemia/Hepatomegaly, Infection, Not awake (coma), Encephalopathy Plus nausea & vomiting |
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Risk factors for hepatocellular carcinoma |
Chronic hepatitis - HBV, HCV All causes of cirrhosis - alcoholic & nonalcoholic fatty liver disease, autoimmune disease, hemochromatosis, A1AT deficiency, Wilson disease Carcinogens like aflatoxin from Aspergillus |
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What serum marker is associated with HCC? |
alpha-fetoprotein (AFP) |
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Which cancers commonly metastasize to the liver? |
Colon, pancreas, lung, breast |
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What is an angiosarcoma (liver)? |
Malignant tumour of endothelial origin. Associated with exposure to arsenic & vinyl chloride |
