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63 Cards in this Set
- Front
- Back
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Viral hepatitis vs alcoholic hepatitis ALT/AST levels
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Viral: ALT > AST
Alcohol: AST > ALT |
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Alkaline phosphatase raise in
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Obstructive liver, bone, bile duct diseases
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GGT raised in
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Liver, biliary disease
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Amylase raised in
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Acute pancreatitis, MUMPS
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Lipase raised in
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Acute pancreatitis
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Ceruloplasmin decreased in
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Wilson's disease
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Reye's syndrome
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Childhood hepatoencephalopathy with aspirin use in viral illness; aspirin metabolites affect hepatic mitochondrial enzymes
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Reye's syndrome clinical findings
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Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma
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Hepatic steatosis
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Short-term change with moderate drinking; reversible
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Alcoholic hepatitis
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Swollen, necrotic hepatocytes, neutrophilic infiltration, Mallory bodies (eosinophilic cytoplasmic inclusions); heavy, chronic drinking
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Alcoholic cirrhosis
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Irreversible fibrotic, shrunken liver, "hobnail" appearance; sclerosis around central vein (zone III)
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Hepatocellular carinoma associations
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HBC, HCV, Wilson's disease, hemochromatosis, a1-antitrypsin deficiency, alcohol, aflatoxin (Aspergillus)
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HCC lab marker
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Increased alpha-fetoprotein
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Cavernous hemangioma
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Common, benign liver tumour, 30-50 yo; biopsy contraindicated b/c hemorrhage
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Hepatic adenoma
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Benign liver tumour, OCP and steroid use
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Hepatic angiosarcoma
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Malignant endothelial-origin tumour; arsenic, polyvinyl chloride exposure
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Nutmeg liver
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Liver appearance with right-sided heart failure, Budd-Chiari syndrome
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Budd-Chiari syndrome
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Occlusion of IVC, hepatic veins --> congestive liver disease
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Budd-Chiari syndrome seen in
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Thrombotic states, polycythemia vera, pregnancy, HCC
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a1-antitrypsin liver findings
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Cirrhosis with PAS-positive globules in liver (misfolded protein aggregates in ER)
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Unconjugated hyperbilirubinemia causes
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Increased bilirubin production (eg. hemolysis), impaired conjugation (eg. liver disease)
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Unconjugated hyperbilirubinemia urine findings
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Urine bilirubin: ABSENT
Urine urobilinogen: INCREASED (increased UCB prod) or NORMAL (decreased UCB uptake) |
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Conjugated hyperbilirubinemia causes
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Reduced hepatic excretion, impaired bile flow
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Conjugated hyperbilirubinemia urine findings
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Urine bilirubin: INCREASED
Urine urobilinogen: DECREASED |
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Neonatal jaundice
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UDP-glucuronyltransferase deficiency --> unconjugated hyperbilirubinemia; jaundice, kernicterus. Treat with UV light
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Gilbert's syndrome
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Impaired UCB uptake by hepatocytes; unconjugated hyperbilirubinemia, fasting and stress
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Crigler-Najjar, Type 1
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Absent UDP-glucuronyl transferase, presents early, short lifespan
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Crigler-Najjar, Type 1 clinical features & treatment
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Jaundice, kernicterus, increased UCB. Treat with plasmapheresis, phototherapy
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Crigler-Najjar, Type 2
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UDP-glucuronyl transferase deficiency, less severe than type 1; responds to phenobarbital
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Dubin-Johnson syndrome
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Impaired CB excretion; conguated hyperbilirubinemia; grossly black liver; benign
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Rotor's syndrome
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Impaired CB excretion, milder than Dubin-Johnson, no black liver
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Wilson's disease
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Defective hepatic copper excretion; copper accumulation in liver, brain, cornea, kidneys, joints
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Wilson's disease clinical features
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Low ceruloplasmin (circulating copper), cirrhosis, corneal deposits (Kayser-Fleischer), HCC, hemolytic anemia, "wing-beat" tremors, asterixis, dementia, dysarthria, parkinsonism
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Hemochromatosis
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Hemosiderin (iron) deposits; cirrhosis + diabetes mellitus + skin pigmentation: "bronze diabetes"
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Hemochromatosis clinical features
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High ferritin, high Fe, low TIBC
CHF, testicular atrophy, HCC |
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Hemochromatosis 1o and 2o causes
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1o: HFE gene mutation
2o: chronic transfusion therapy |
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Hemochromatosis HLA association
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HLA-A3
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Wilson's disease treatment
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Penicillamine (chelator)
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Hemochromatosis treatment
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Phlebotomy, Fe chelators (deferasirox, deferoxamine)
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Primary biliary cirrhosis
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Autoimmune biliary destruction, lymphocytes + granulomas
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Biliary cirrhosis clinical features
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Pruritus, jaundice, dark urine, pale stools, hepatosplenomegaly
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Primary biliary cirrhosis lab findings
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Conjugated bilirubin, alk phos, anti-mitochondrial antibodies (IgM)
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Primary biliary cirrhosis associated conditions
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CREST/scleroderma, RA, celiac disease
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Secondary biliary cirrhosis
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Extrahepatic biliary obstruction --> injury/fibrosis, bile stasis; ascending cholangitis
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Secondary biliary cirrhosis lab findings
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Conjugated bilirubin, alk phos, cholesterol
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Primary sclerosing cholangitis
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"Onion skin" bile duct fibrosis, alternating strictures and dilations - "beading"; UC, 2o biliary cirrhosis
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Primary sclerosing cholangitis lab findings
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Hypergammaglobulinemia (IgM), conjugated bilirubin, cholesterol, alk phos
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Cholesterol stones features and risk factors
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Radiolucent, 80% of all stones; obesity, Crohn's, CF, eldery, clofibrate, estrogens, multiparity, rapid weight loss, Native American
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Pigment stones features and risk factors
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Radiopaque, black - hemolysis, brown - infection; chronic hemolysis, alcohol, age, biliary infection
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Gallstones cause
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Cholecystitis, ascending cholangitis, acute pancreatitis, bile stasis, biliary colic, gallbladder-intestinal fistula
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Risk factors for gallstones
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Female, Fat, Fertile, Forty
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Cholecystitis
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Gallbladder inflammation, gallstones, ischemia, CMV infection
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Acute pancreatitis causes (GET SMASHED)
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Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpions, Hypercalcemia, ERCP, Drugs
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Acute pancreatitis lab findings
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Elevated amylase, lipase (more specific)
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Acute pancreatitis complications
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DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multiorgan failure
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Chronic pancreatitis
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Chronic inflammation, atrophy, calcification of pancreas; alcohol abuse and idiopathic
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Chronic pancreatitis complications
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Pancreatic insufficiency - steatorrhea, fat-soluble vitamin deficiency, DM, pancreatic ADC
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Pancreatic ADC
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Aggressive tumour in ducts, prognosis 6 months; common in pancreatic head - obstructive jaundice
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Pancreatic ADC lab marker
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CA-19-9
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Pancreatic ADC risk factors
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Smoking, chronic pancreatitis, age > 50 years, Jewish, blacks
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Pancreatic ADC clinical presentation
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Abdo pain radiating to back, weight loss, migratory thrombophlebitis (Trousseau's sign), Courvoisier's sign (obstructive jaundice, palpable, non-tender gallbladder)
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Courvoisier's sign
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Obstructive jaundice with palpable, non-tender gallbladder; pancreatic ADC
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Trousseau's sign
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Migratory thrombophlebitis - redness and tenderness on palpation; pancreatic ADC
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