Gi: Smith Liver And Gb Dysfunction

Front 1

Benign condition of increased unconjugated (indirect) bilirubinemia that affects 3 to 8% of the population

Back 1

Gilbert's Syndrome

Front 2

MCC of ascites

Back 2

Cirrhosis

Front 3

When does jaundice occur?

Back 3

Bilirubin exceeds 2-3 mg/dL

Front 4

High unconjugated bilirubinemia

Back 4

hemolysis or Gilber'ts

Front 5

High conjugated bilirubinemia

Back 5

liver disease or biliary tract obstruction

Front 6

MCC infant jaundice

Back 6

Physiologic, then congenital infections

Front 7

MCC adolescent jaundice

Back 7

Gilbert's, then Viral

Front 8

MCC jaundice in young adults

Back 8

Viral Hep, the Biliary tract

Front 9

MCC jaundice in the elderly

Back 9

Malignancy, then toxin/drug

Front 10

MCC jaundice in 1st and 2nd trimesters

Back 10

Viral hep, the cholestasis of preg

Front 11

MCC jaundice in 3rd trimester

Back 11

Preeclampsia and Cholestasis of preg

Front 12

Gilbert's is a defect in what?

Back 12

uptake and conjugation of bilirubin

Front 13

Name some indications for paracentesis for ascites

Back 13

new onset, admission, systemic signs (spontaneous bacterial peritonitis), renal dysfunction, unex enchephalopathy

Front 14

Clubbing is seen most often in pts with cirrhosis due to what?

Back 14

biliary causes, such as PBC

Front 15

Markers of hepatocellular injury

Back 15

AST, ALT

Front 16

Cholestatic markers

Back 16

Alkaline phosphatase, bilirubin, GGT

Front 17

Synthetic function of the liver (markers)

Back 17

Albumin, PT or INR

Front 18

Does the degree on enzyme elevation correlate with severity of liver disease?

Back 18

NO (just a clue to etiology)

Front 19

Alkaline phosphatase > 1000 mg/dl with a bili < 1mg/dl suggests what?

Back 19

granulomatous or infiltrative diseases of the liver (TB, sarcoidosis, fungal or lymphoma); more of a liver "stasis" enzyme

Front 20

The most common cause of abnormal liver tests in the pediatric and adult populations

Back 20

NAFLD

Front 21

strong assoc with metabolic syndrome (dyslipidemia, diabetes and obesity)

Back 21

NAFLD

Front 22

Intake of ___-___g/d of ETOH for men and ___-____ g/d for women for 10-12 years my lead to cirrhosis

Back 22

40-80 for men, 20-40 for women

Front 23

The leading cause of liver transplantation in this country

Back 23

Hep C

Front 24

Dose related hepatotoxin, leading cause of acute liver failure in the U.S.

Back 24

Acetamnophen

Front 25

Tx for Acetaminophen hepatotoxicity

Back 25

N-acetylcysteine which will > GSH (reduced glutathione)

Front 26

+ ANA and SMA; > ALT, AST, gamma globulins

Back 26

AIH

Front 27

Tx for AIH

Back 27

corticosteroids

Front 28

Serum Fe studies of %sat > ___ and ferritin > ____ suggest hemochromatosis

Back 28

%sat > 50% and ferritin >1000

Front 29

What would be indication that a pt is in trouble and should be managed in a facility that preforms liver transplantations? (in the context of acute liver failure)

Back 29

If the INR is elevated and increasing the patient is in trouble (acute = < 8 weeks)

Front 30

Type of Hepatic encephalopathy that is of rapid onset and frequently fatal. Main cause?

Back 30

Type A, MCC cerebral edema (Need liver transplant!)

Front 31

Type of Hepatic encephalopathy that is of gradual onset and rarely fatal. MCC?

Back 31

Type B, MCC is shunting/toxin/precipitant

Front 32

Most sensitive method to detect ascites

Back 32

US

Front 33

CT has greater sensitivity than US for what?

Back 33

Pancreatic cancer as a cause of jaundice, Mets to liver

Front 34

Test that can be dx for sclerosing cholangitis; useful for looking for CBD stones

Back 34

MRC (magnetic resonancing cholangiography)

Front 35

+ test for acute cholecystitis on Cholescintigraphy HIDA Scan

Back 35

Nonvisualization

Front 36

MC type of gallstone

Back 36

cholesterol

Front 37

Pigment stones C in pts with what?

Back 37

cirrhosis or hemolytic anemia

Front 38

Radiopaque (white) stones

Back 38

Pigment

Front 39

Inflammation of the CBD

Back 39

cholangitis

Front 40

cholecystitis

Back 40

inflammation of the GB

Front 41

Usually seen in hospitalized, critically ill patients after major surgery, trauma or severe burns
Often associated with gallbladder stasis and ischemia leading to inflammatory response

Back 41

Acalculous Cholecystitis

Front 42

Primary CBD stones are most popular in what population?

Back 42

Asians (clonorchiasis, fascioliasis, ascariasis)

Front 43

Choledocholithiasis

Back 43

presence of at least one stone in the common bile duct

Front 44

Charcot's triad

Back 44

Fever, Pain, Jaundice (cholangitis)

Front 45

Tx of Cholangitis

Back 45

with broad spectrum antibiotics and emergent bile duct decompression by ERCP if the patient is unstable or fragile

Front 46

Pts with what have a 7-15% > risk of developing cholangiocarcinoma?

Back 46

PSC