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44 Cards in this Set

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if the biliary system is obstructed, production of urobiligen and stercobilinogen is prevented causing...?
stool is light and urine is dark showing bilirubin
increased serum unconjugated bilirubin, impaired hepatic uptake + jaundice in stress, benign is indicitive of?
gilbert's & certain drugs; rifampin
increase in serum unconjugated serum bilirubin, genetic + impaired conjugation
gilbert's or crigler-Najjar syndrome, drug inhibitions: anabolic steroids
increased alk phos x 3 or x 4 normal values is indicitive of ??
cholestatic jaundice
hx of pale stools + pruritis + nausea is indicitive of...
gallstones= biliary obstruction
5-10 fold increase of transaminases (ast/alt) and > 2-3x normal alk phos is indicitive labs of???
biliary obstruction
> 10-15 fold increase in transaminases (ALT/AST) and < 2-3x normal alk phos is indicitive of???
hepatocellular disease
what is the diagnostic procedure of choice to determine extra hepatic obstruction?
CT or US: stone or dilitation
what is the diagnostic procedure of choice to manage and treat bile duct dilitation?
ERCP: endoscopic retrograde cholangiography
what are the 3 main complications with hepatitis?
1.massive hepatic necrosis
2.chronic hepatitis
3.cholestatic hepatitis syndr.
what is the MC cause of hepatitis?
virus
22 y/o female presents with fever, malaise, N/V, (exudative)sore throat and lymphadenopathy, HA what is the most likely dx?
mono. after R/O preg
what medication is never given to a mono patient?
AMPICILLIN: causes maculopular rash
what are the 4 hallmark signs of MONO?
fever
exudative pharyngitis
lymphadenopathy
splenomegaly
what are some additional complications with MONO?
bacterial pharyngitis
upper airway obstruction
Bells Palsy
ruptured spleen
what virus presents similarly to MONO with out pharyngitis or respiratory symptoms, more common in transplant or AIDS patients?
cytomegalic virus CMV
if mono test is neg in a patient you suspect to be pos, what will you do next?
CMV titer
patient presents with malaise, fever and abdominal pain. you notice jaundice and palpate hepatosplenomegaly. patient just returned from a foreign country where she was eating clams every day...what is high on your diff dx?
Hep A
what is the first virologic marker detectable in serum in acute HBV infection?
HBsAg
which serological marker is not detectable in serum?
HBcAg
what serious manifestation are patients dx with Hep B more likely to develop?
hepatocellular carcinoma
which viral hepatitis is associated with blood transfusions 85% of the time?
hep c
a finding of a liver biopsy, common in alcoholics that is an accumulation of iron in the lungs?
hemosiderosis
Mainly a disease of young women
Most have hypergamaglobulinemia & ANA positive
chronic autoimmune hepatitis
Consider any young female with elevated liver function studies without course with hepatitis for greater than 6 months
Positive ANA
Elevated GG =means chronic
Liver biopsy showing chronic inflammation to have what disease????
chronic/autoimmune hepatitis
what is the most reliable indicator of active viral replication?
HBV DNA
this serological test results signifies that the virus is actively replicating, it is the most acute phase, most likely to be transmitted?
the envelope= HBeAg
after replication, when the virus is in the system indefinetely, it will show on serological testing as what?
Anti HBe
the triad of necrosis, regenerating nodules and fibrosis is indicitive of?
cirrhosis
a metabolic disorder that affects the basal ganglia, eyes and kidney. there is an abnormal accumulation of copper in the hepatocytes. serum ceruloplasm is low and therefore cu cannot be carried?
wilson's disease
a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. It is the main iron overload disorder.
haemochromatosis
this syndrome is seen in the pediatric age group associated with the flu, and asa...increasing drowsiness, belly pains.
reye's syndrome
in teenages and adults, this is a progressive liver disease with pulmonary manifestations, due to the deficiency of a potent protease inhibitor found in the serum, body fluids and tissues
alpha 1- antitrypsin deficiency
acute severe impairment of liver function with encephalopathy and coma in patients who have had liver disease for less than 8 weeks and causes liver failure
fulminant liver failure
what physical manifestations are seen on a patient with liver failure (chronic) esp on the arms?
CLAPS:
Clubbing
Leukonychia
Asterixis
Palmar Erythema
Stretch marks
what are some precipitating factors for hepatic encephalopathy?
HEPATICS:
Hemorrhage in GIT/Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/Anemia
Trauma
Infection
Colon Sx
Sedatives
a metabolic disorder of the CNS and neuromuscular system with slight changes in the brain (edema) with clinical manifestations such as confusion, asterixis, drowsiness and coma --> death CAUSED by elevated levels of NH3?
hepatic encephalopathy
Kayser-Fleischer ring
Wilson's Disease
an obese 48 Y/O patient who has had multiple incidences of vaginitis, presents with a global darkening of her skin color. the patient was previously on Atkins diet, but denies any abnormal eating habits now. what do you recc?
patient has Bronze diabetes or primary hemochromatosis.
this requires early phlebotomy to improve survival...primary tx is INSULIN
classic triad indicating liver disease?
1. skin pigmentation
2. cirrhosis
3, DM
an uncommon condition induced by thrombotic or nonthrombotic obstruction to hepatic venous outflow?
budd-chiari syndrome
what are some causes of hepatic cirrhosis?
HEPATIC
Hemochromocytosis
Enzyme Deficiency (alpha 1 anti-trypsin)
Post hepatic (infection+drug)
Alcoholic
Tyrosinosis
Indian childhood (galactosemia)
Cardiac/Cholestatic(biliary)/ Cancer/Copper (wilson's)
common causes of cirrhosis?
ABC
alcohol
B (hep)
C (hep)
very rare causes of cirrhosis?
ABC!!
autoimmune
biliary cirrhosis
copper (wilson's)