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38 Cards in this Set

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hepatocellular jaundice
cong/uncong
increased urine br
nl/decr urine urobilinogen
obstructive jaundice
cong
increased urine br
decr unine urobilinogen
hemolytic jaundice
uncong
absent urine bilirubin
increased urine urobilinogen
Gilberts
mildy decreased UGT
incr uncong br without hemolysis, assoc with stress
Crigler Najjar I
absent UGT
die within a few years
Crigler Najjar II
less severe, responds to PHB which increases liver enzyme synthesis
Dubin Johnson
conjug hyperbr due to defective liver excretion
grossly black liver
benign
Rotors
similar to dubin johnson but milder and does not cause black liver
Primary sclerosing cholangitis
intra/extra hepatic; inflammation and fibrosis of bile ducts-->alternating strictures and dialtion with beading
assoc with UC; can lead to 2ndary biliary cirrhosis
triad: fever, jaundice, RUQ pain
tx: ersodiol, weight loss
men, 40 y/o
Primary biliary cirrhosis
intrahep, AI; severe obstructive jaundice, steatorrhea, pruritis, hypercholesterolemia, increased alk phos, increased AMA, assoc with scleroderma, CREST
secondary biliary cirrhosis
due to extrahep biliary obstruction; increased pressure in intrahep ducts-->injury-->fibrosis
often complicated by asc cholangitis, bile stasis, bile lakes
increased alk phos, increased cong br
HCC
increased risk with hep B/C, wilsons, hemochromatosis, alpha AT def, alcoholic cirrhosis, carcinogens (aflatoxin B1- asp fungus)
heme spread
sxs: hepatomegaly, ascites, polycythemia, hypoglycemia
increased AFP
cholesterol stones
radiolucent; assoc with obesity, Crohns, CF, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, NA origin
Mixed stones
radiolucent both cholesterol and pigment components; most common
Pigment stones
radioopaque seen in pts with chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection
tx of gallstones
estradiol
acute pancreatitis cauces
gallstones, ethanol, trauma, steroids, mumps, AI dz, scorpion sting, hyperCa/hyperlipidemia, drugs (sulfas, propofol, didanosine)
acute pancr
presents with epigastric ab pain radiating to back, anorexia, nausea
elevated amylase, lipase
can lead to DIC, ARDs, diffuse fat necrosis, hypoca, pseudocyst formation, hemorrhage, infection
panc adenocarc
prognosis 6 mos or less; very aggressive; usually already mets at presentation; tumors more common in pancr head (obstructive jaundice) painless
often presents with: ab pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable GB
carcinoid
tumor of endocrine cells; dense core bodies seen on EM; often produce 5HT; classic sxs: wheezing, right sided heart lesions, diarrhea, flushing
serotonin excess
hepatic angiosarcoma
vinyl chloride and arsenic
OCP, anabolic steroids
hepatic adenoma (benign)
H2 blockers
cimetidine, ranitidine, famotidine, nizatidine
block H secretion by parietal cells
used in peptic ulcer, mild GERD
can cause TCP
cimetidine
inhibits P450, antiandrogenic effects
can cross BBB
PPI
omeprazole, lansoprazole, pantroprazole
irreversibly inhibit H/K ATPase in stomach parietal cells
use: peptic ulcer, gastritis, eso reflux, ZES
bismuth, sucralfate
bind to ulcer base proving physical protection and allow bicarb secretion to reestablish pH
require acidic environment to work
used in ulcer healing, travellers diarrhea
misoprostol
PGE analog; increases production and secretion of gastric mucous barrier, decreases acid production
prevention of NSAID induced peptic ulcers; maintenance of PDA, induce labor
diarrhea, abortifactant
muscarinic antag
pirenzepine, propantheline
block MI receptors on ECL cells (decrease histamine secretion) and M3 receptors on parietal cells (decrease H secretion)
used for peptic ulcer
tox: tachycardia, dry mouth, difficulty focusing eyes
aluminum hydroxide overusse
constipation and hypophosphatemia, prox muscle weakness, osteodystrophy, seizures
mg OH
diarrhea, hyporeflexia, hypotenion, cardiac arrest
do not use with renal disease
calcium carbonate overuse
hypercalcemia, rebound acid increase (increases gastrin release)
infliximab
antibody to TNF-alpha; proinflammatory cytokine (must test for tb!)
use: crohns, RA
tox: resp infection, fever, hypotension
sulfasalazine
sulfa (AB) and mesalamine (antiinflam)(
activated by colonic bacteria
use: UC, Crohns
tox: malaise, nausea, sulfa tox, reversible oligospermia
ondansetron
5HT3 antag; powerful centrally acting antiemetic
control vomiting postop and in pts undergoing cancer chemo
tox: HA (vasodil), constipation
octreotide
decreases hormones, splanchnic circulation
PUD, eso varices, pancreatitis
cisapride
acts through serotonin receptors to increase Ach release at myenteric plexus
increases eso tone
increases contractility, improving transit time
NOT USED
metoclopramide
D2 antag; increases resting tone, contractility, LES tone, motility; does not increase transit time through colon
use: diabetic and post surgery gastroparesis
tox: increases parkinsonian effects, restlessness, drowsiness, fatigue, depression, nausea, constipation
DI: digoxin, diabetic agents
CI: SI obstruction
safe in preg
increase ACh, increase 5HT, decrease D2
chol ag, ACHE-I (neostigmine), metoclopramide, domperidone (decreases DA), cispride (increases 5HT), macrolides (stim SM motilin receptors), EES