Gi Liver Disease

Front 1

Liver failure, >PT, GI bleed; how do you treat?

Back 1

1. Vitamin K- treats coumadin OD (in fresh frozen plasma)

2. Beta Blocker

Front 2

Children with liver disease, especially if accompanied by pulmonary manisfestations (emphysema/COPD); what may be the cause?

Back 2

Alpha 1 anti-trypsin

Front 3

This vein is formed by the junction of the splenic & superior mesenteric veins

Back 3

The portal vein

Front 4

what is the Acini

Back 4

The acinus make up the primary functional unit of the portal tract; contains the portal triad (hepatic artery, portal vein, bile ducts)

Front 5

where are hepatocytes found and what do they contain?

Back 5

Found in the ascini
They contain glycogen

Front 6

Which clotting factors does the liver produce?

Back 6

Prothrombin

factors:
VII
IX
X

from vitamin K absorption

Front 7

what is the main functions of albumin?

Back 7

Carries molecules (drugs)
Osmotically active (prevents edema)

Front 8

T/F The liver produces fat-soluble vitamins, ADEK.

Back 8

False, the liver does not produce them, only stores them

Front 9

_______ bilirubin is transported in the plasma bound to albumin

Back 9

Unconjugated

Front 10

what are some cutaneous physical findings of liver disease

Back 10

spider angiomas
telangiectasias
palmar erythema
jaundice
xanthomas & xanthelasma

Front 11

GI bleed with liver problems are most likely due to?

Back 11

ruptured esophageal varices from portal HTN

Front 12

Name 3 causes of decreased albumin in the blood

Back 12

Liver disease- < production
Renal disease - albumin escapes into urine
Malnutrition

Front 13

Wernecke's encephalopathy symptoms

Back 13

Confusion
Ataxia
ophthalmoplegia

Front 14

what causes Wernecke's encephalopathy?

Back 14

Thiamine deficiency

Front 15

S/sx of Korsakoff encephalopathy

Back 15

confabulation
recent memory loss

Front 16

what test would you do to test for fluid in the abdomen?

Back 16

shifting dullness

Front 17

what is asterixis

Back 17

flapping of the hands when extended forward

caused by cerebellar or liver problems

Front 18

what is the most sensitive prognosticators of severe liver disease

Back 18

Prolongation of the PT

Front 19

what does the PT (prothrombin Time) test do?

Back 19

It measures clotting ability of factors I (fibrinogen), II (prothrombin), V, VII, and X

Front 20

name 2 things that can prolong the PT

Back 20

Vit K deficiency
Coumadin

Front 21

What is the normal PT range?

Back 21

11-15 seconds

Front 22

what is the normal value of INR?

Back 22

The normal value for the INR is 1.0

Front 23

what substance helps with the absoption of Vit K?

Back 23

Bile

Front 24

which liver enzyme would be elevated with tissue injuries like MI or muscle disorders?

Back 24

AST: found in liver, muscle, kidney, heart, and brain; released into serum if these organs are damaged

Front 25

This enzyme is mostly concentrated in the liver and is released in response to liver damage

Back 25

ALT; therefore it is a more specific test for liver injury

Front 26

what does a ratio of AST:ALT > 2:1 suggest?

Back 26

Alcoholic liver disease

Front 27

what does a ratio of AST:ALT < 1:1 suggest?

Back 27

viral hepatitis

Front 28

what conditions can give you very high levels of AST/ALT?

Back 28

disorders that cause extensive hepatic necrosis:

Viral Hep
Acetaminophen OD
Circulatory shock

Front 29

Since AST/ALT ratios and ALK Phos tests are not specific, what other test should you do?

Back 29

Isoenzymes

Front 30

where does Alk Phosphatase come from?

Back 30

liver
intestines
bones
Placenta

Front 31

when will Direct (conjugated) bilirubin be elevated?

Back 31

with Intra or Extra Hepatic obstruction

Ex: Choledocolithiasis

Front 32

when will Indirect bilirubin (Unconjugated, insoluble)be elevated?

Back 32

when hemolysis releases it from red blood cells

Ex: hemolytic anemia

Front 33

what is the normal bilirubin level?

Back 33

Normal Bilirubin ranges 0.5 to 1.0 mg/dl.

Front 34

at what levels is it considered to be clinically jaundiced?

Back 34

Levels >3.0 mg/dl

Front 35

which cells conjugate bilirubin?

Back 35

Kupffer cells of the liver; they make the bilirubin water-soluble (shows up in urine)

Front 36

what happens to bilirubin in the terminal ileum?

Back 36

it is converted to sterobilinogen and urobilinogen by natural bacteria

Front 37

what makes feces brown?

Back 37

stercobilin

Front 38

what can prevent production of urobiligen & stercobilinogen

Back 38

Obstruction of biliary system

Stool will be light and urine dark

Front 39

what causes dark urine?

Back 39

if excretion of conjugated bilirubin into the bile is hindered, it is excreted by the kidneys givin urine a dark color

Front 40

Name 3 causes of Unconjugated hyperbilirubinemia

Back 40

overproduction
decreased hepatic uptake
decreased conjugation of bilirubin

Front 41

MCC of jaundice?

Back 41

Neonatal jaundice

Front 42

what substance makes bilirubin water-soluble?

Back 42

UDPglucuronate

Front 43

what is Dubin-Johnson Syndrome?

Back 43

an autosomal recessive disease which presents shortly after birth with an increase of conjugated bilirubin without elevation of liver enzymes (ALT, AST).

Front 44

name some causes that impair conjugation of bilirubin

Back 44

Hepatocellular disease

drug inhibition: chloramphenicol
anabolic steroids

genetic disorders:
Gilbert’s syndrome
Crigler- Najjar syndrome (decreased UDP-glucuronyl transferases)

Front 45

what would lab results show with cholestatic jaundice?

Back 45

Increased alk phos to 3-4 times normal

Front 46

Hx of pale stools and pruritis

Back 46

Cholestasis

Front 47

10-15 fold increase in transaminases (AST/AlT)suggest?

Back 47

Liver disease

Front 48

Increased alk phos to 3-4 times normal suggest?

Back 48

biliary obstruction

Front 49

How do you Dx Cholestatic Jaundice?

Back 49

Ultrasound -stones
Bile duct dilation - ERCP
Liver Biopsy

Front 50

MC hereditary cause of increased bilirubin

Back 50

Gilbert's Syndrome

Front 51

MC manifestation of cholestatic jaundice

Back 51

Hypercholesterolemia

Front 52

Which Heps are fEcAl/orally transmitted?

Back 52

E & A

Front 53

name some symptoms of hepatitis

Back 53

DAMN VARF

Diarrhea
Anorexia
Malaise
Nausea

Vomiting
Arthralgia
Rash
Fatigue

Front 54

when is the PT,PTT elevated in liver disease?

Back 54

when destruction reaches ~55%

Front 55

what test is done for Mono?

Back 55

Monospot

Front 56

what do you NEVER give to treat a patient with Mono?

Back 56

Ampicillin or Omoxicillin, causes rash

Front 57

what are the key symptoms of Mono?

Back 57

Fever
Exudative Pharyngitis
Lymphadenopathy
Splenomegaly

Front 58

Name some complications of Mono

Back 58

Bacterial pharyngitis
Upper airway obstruction
Rupture Spleen
Bells palsy

Front 59

When lab testing, if the Mono test is negative, which test should you do next?

Back 59

CMV test

Front 60

which is the least dangerous of the viral hepatitis?

Back 60

Hep A

shortest incubation(2-6 wks)
h/o of eating clams, travel

Front 61

what's the incubation time for Hep B?

Back 61

1-6 months

Front 62

this serum marker is positive in acute HBV

Back 62

HBeAg: envelop antigen

Front 63

which serum marker is the first to show up in HBV infection?

Back 63

HBsAg surface antigen

Front 64

which serum marker will show up in late acute HBV and immunized people?

Back 64

Anti-HBs: anti surface

Front 65

this serum marker appears when antigen decreased

Back 65

HBeAb: envelop antibody

Front 66

what are the 2 HBcAb (core antibodies)

Back 66

IgM marker: for acute infection
IgG marker: chronic HBV & carrier

Front 67

what anti-serum marker would be dectectable 2 weeks after the appearance of HBsAG?

Back 67

Anti-HBc: IgM

It is indicative of an acute infection

Front 68

which Anti-HBc predominates after 6 months and generally persists indefinitely

Back 68

IgG

Front 69

This serum marker is considered to be a marker of active virus replication and infectivity

Back 69

HBeAG: envelope antigen

Front 70

Primary biliary cirrhosisis is manifested by?

Back 70

cholestasis