Imported: Gi_Johnson: Liver Disease I&ii

Front 1

when the liver is not articulating properly in the body, a pt will feel..

Back 1

tired

Front 2

what cells in the liver are responsible for making albumin, coag factors, hormones, and growth factors? What are some of the other things it makes?

Back 2

Hepatocytes

cholesterol, bile acids, lecithin, phospholipids

Front 3

these cells line the sinusoids of the liver and act as macrophages

Back 3

Kupffer cells

Largest group of fixed macrophages in the body

acts as a huge filter for the body

Front 4

these cells encircle the sinusoidal epithelium, store Vitamin, and in liver disease can produce collagen and lead to fibrosis

Back 4

Stellate (Ito) cells

Front 5

what type of hepatic disease is shown by liver injury, necrosis, inflammation. Examples include:
Viral hepatitis
Alcoholic liver disease

Back 5

Hepatocellular

Front 6

what type of hepatic disease is shown by inhibition of bile flow—primary injury is in the bile ducts
Gallstones
Malignant obstruction
Primary Biliary Cirrhosis
Some drug induced

Back 6

Cholestatic

Front 7

key to evaluation of hepatic disease

Back 7

HISTORY

you know who this card is for! :P

Front 8

person comes in and itches like crazy...you see no rash..what could it be due to?

Back 8

liver problem

bile is getting under the skin

Front 9

Asterixis

Back 9

extend hand, let it go, it flaps up and down

sign of liver disease

Front 10

What disease is associated with Kayser-Fleisher rings?

Back 10

Wilson's disease

inherited disorder in which there is too much copper in the body's tissues. The excess copper damages the liver and nervous system.

Front 11

AST/ALT are what? what can they show? what is the ratio seen in alcoholic liver disease

Back 11

aminotransferases

indicators of HEPATIC cellular necrosis

ALT more specific

In alcoholic liver disease, AST:ALT is at least 2:1 (note: ALT is normally > AST)

Front 12

PT can be prolonged with what?

***

Back 12

Vitamin K deficiency

(can be seen in alcoholics)

Front 13

if you see high levels of Alkaline Phosphatase, what should you be thinking

Back 13

Infiltrative diseases (tumors)

Front 14

GGT shows you what?

Back 14

if pt has high Alkaline phosphatase, you order this, it can tell you that your infiltratitve disease is in the liver

also can show if a pt is drinking (aka if they are lying to you)

Front 15

pt has a positive Anti-mitochondrial Antibody (AMA), what do they have?

Back 15

primary biliary cirrhosis

Front 16

if you want to take a look at the liver what should you order first? then?

Back 16

Ultrasound—detects dilated bile ducts if obstructed—is cheap and 95% sensitive

CT—may help in determining cause of obstruction

Front 17

progression of jaundice

Back 17

sclera

mucosa (in mouth especially)

skin

This is important because a pt might look yellow (from eating carrots) but they wont have jaundiced sclera...so not jaundice!

Front 18

Indirect bilirubin gives you what kind of bilirubin?

Back 18

Unconjugated

it is albumin bound

can cross BBB and cause kinecterus

Front 19

what type of bilirubin leads to kinecterus

Back 19

UNCONJUGATED

Front 20

Direct bilirubin shows you what kind of bilirubin?

Back 20

Conjugated

Front 21

Which bilirubin shows up in the urine?

Back 21

Conjugated (direct)

Front 22

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Increased RBC turnover (hemolytic anemias)

Back 22

Unconjugated (Indirect) Bilirubinemia

Front 23

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Physiologic (newborn babies)

Back 23

Unconjugated (Indirect) Bilirubinemia

Front 24

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Hereditary (Gilbert and Crigler-Najjar syndromes)

Back 24

Unconjugated (Indirect) Bilirubinemia

Front 25

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Biliary tract obstruction

Back 25

Conjugated (Direct) Bilirubinemia

Front 26

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Biliary tract disease (Primary biliary cirrhosis [PBC], Primary sclerosing cholangitis [PSC])

Back 26

Conjugated (Direct) Bilirubinemia

Front 27

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Hereditary (Dubin-Johnson and Rotor syndromes)

Back 27

Conjugated (Direct) Bilirubinemia

Front 28

is the following a unconjugated (indirect) bilirubinemia or conjugated (direct)?

Liver diseases (cirrhosis and hepatitis

Back 28

Conjugated (Direct) Bilirubinemia

Front 29

Male comes in, says he is stressed (physical, mental, drinking, etc.), has increased total bilirubin. What is this? What is the cause? What is the tx?

***TEST

Back 29

Gilberts Syndrome

problem is defiency in glucuronal transferase activity (that is what puts bilirubin with a heme)

Tx: normally will resolve on own (if stressor taken away), if bilirubin is over 10 give Phenobarbitol (antiseizure med) that will tx it. Note: this can cause seizures in pts that don't need it

Front 30

a female has an autoimmune disease and you find elevated AMA... they have elevated conjugated bilirubin, and alkaline phosphatase. They present with jaundice and fatigue..

Back 30

Primary Biliary Cirrhosis (PBC)

Front 31

Middle aged female, itching, increased alkaline phosphatase. What should your order? If it is positive what do you have?

**TEST

Back 31

AMA

if elevated you have Primary Biliary Cirrhosis (PBC)

Front 32

pts with Primary Sclerosing Cholangitis are at risk of?

Back 32

Cholangeal carcinoma

Front 33

MRCP or ERCP shows "string-of-beads" appearance on imaging, it shows narrowing of the bile duct...


**TEST

Back 33

Primary Sclerosing Cholangitis (PSC)

Front 34

pt has ALT>AST but both are elevated, also presents with malaise, anorexia, nausea, flu-like symptoms, better in AM (preicteric phase)..what do they have?

Back 34

Acute Viral Hepatitis

this would be early

later they will have their Prodrome followed by dark urine, light stool and jaundice, RUQ pain (icteric phase; Low-grade fever early, transient urticaria

Front 35

pt has massive necrosis of the liver associated with Hep B and D...the liver is shrinking about every hour. You also have hepatic encephalopathy (Altered mental status progressing to coma). What is this

Back 35

Fulminant Hepatic Failure

this is really fatal
Mortality 70-80%, varies by age (increases <10 yr, >40 yr) and degree of encephalopathy present
Cerebral edema
INR elevated, low grade DIC
50% develop GI bleeding (hard to stop)
Multi-organ failure
Severe acid-base and electrolyte abnormalities
+/- jaundice

Front 36

if you diagnose someone with hepatitis what must you do?

*

Back 36

report it!!!

Front 37

this virus is mild, never acute, doesn't cross placenta, can be from contaminated food, and is spread by the fecal oral route. What is this and what can be used to detect it?

Back 37

Hep A

IgM anti-HAV is detected during acute illness

Front 38

If someone wants an HAV immunization what do you have to do first?

TEST********

Back 38

MUST LOOK AT THERE IMMUNITY STATUS FIRST (to hep A)

they may already be immune so you don't need to give them a shot!!

Front 39

pregnant women in third trimester gets Hep E. what do you have to worry about?

*boards

Back 39

Fulminant Hepatic Failure can develop from this

Front 40

this virus is transmitted by blood and has a high risk of transfer by needle stick. It has an Insidious onset, may become chronic leading to increased risk of cirrhosis and hepatocellular carcinoma

Back 40

Hepatitis B

Front 41

THERE WAS SOME CDC REQUIREMENT FOR HEP B LEVELS AND IMMUNITY

Back 41

might want to get this from danielle

Front 42

active viral replication and infectivity, associated with a worse prognosis..marker in Hep B

Back 42

HBeAg

Front 43

what 2 things needed for diagnosis of hepatitis B?

Back 43

Hep B surface antigen and Anti-HBc

Front 44

what is the difference btw superinfection and coinfection with Hep B

Back 44

HDV May occur spontaneously in a known HBV carrier (superinfection)

HDV May be acquired at same time as acute HBV (co-infection)

Front 45

this is one of the most common liver diseases in the US, they have NO SYMPTOMS during the acute phase, is a huge reason for liver transplant.

Back 45

Hep C

Front 46

how do you diagnose HCV?

Back 46

Anti-HCV: detects presence of Ab to HCV.

HCV-RNA: identifies presence of virus in the blood. used to monitor treatment. Shows infectivity

Viral genotyping: 6 types known.

Front 47

when someone comes in with acute viral hepatitis what must you order?

****TEST

Back 47

When you suspect acute viral hepatitis you should obtain the following serologic tests:
IgM anti-HAV
IgM anti-HBc
HBsAg
Anti-HCV

Front 48

To check for immunity after HBV vaccine obtain anti-HBs—it should be....? if not then what do you do?

TEST!!!!!!!***********

Back 48

To check for immunity after HBV vaccine obtain anti-HBs—it should be

> 10 mlU/mL

if not then you have to repeat the titer series

Front 49

patient wants HAV vaccine..what do you do?

********TEEEEEEESSSSTTTTTT

Back 49

check the Total anti-HAV first—if pos they are immune

Front 50

what is the 4 question questionnaire for alcoholism?

(note: I am pretty confident that during my undergrad career I was positive for all 4)

Back 50

C = have ever felt you should Cut down on your drinking?
A = have people Annoyed you by criticizing your drinking?
G = Do you ever feel Guilty or bad about your drinking?
E = Do you need a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

One positive answer—indicates high risk for alcohol abuse and further evaluation is required

Two positive answers indicates a high probability of alcohol abuse or dependency

Front 51

pts are normally asymptomatic, but can have a 2 -4-fold ↑ ALT and AST
AST/ALT ratio < 1 in most
Serum AP sl ↑ in 1/3
Normal bilirubin, albumin and protime
↑ serum ferritin level

no history of drinking

********

Back 51

Nonalcoholic Fatty Liver Disease (NAFLD)

probably should have them lose weight

Front 52

treatment for Nonalcoholic Fatty Liver Disease (NAFLD)...

there will be some test question on this**********

Back 52

Weight loss
Exercise and diet
Control of Metabolic Syndrome
Antidiabetic/Insulin-sensitizing agents
Lipid-lowering agents
Bariatric surgery for morbid obesity
Avoidance of toxins

Front 53

Resembles alcohol-induced liver disease but in the absence of significant alcohol intake

A spectrum of liver disease includes:
Benign steatosis (fatty liver)
Nonalcoholic Steatohepatitis (NASH)
isolated portal fibrosis
Cirrhosis with resultant liver failure

there will be some test question on this**********

Back 53

Nonalcoholic Fatty Liver Disease (NAFLD)

Front 54

The final common pathway of many types of liver injury

Back 54

Cirrhosis

Defined as irreversible liver injury, fibrosis, necrosis, regenerative nodules, collapse of supporting reticular network, and vascular distortion
The results are loss of functioning hepatocellular mass and portal hypertension

Front 55

if a pt has a severely cirrhotic liver, what is one major treatment you can help to induce?

*

Back 55

STOP DRINKING BOOZE!

Front 56

most common cause of portal HTN?

Back 56

Cirrhosis

Front 57

most common complication of cirrhosis?

*

Back 57

Gastroesophageal varices with hemorrhage

Front 58

caput medusa, parotid enlargement, spider angiomata, esophageal varices are physical signs of what?

Back 58

Liver Ds

Front 59

Seen in patients with ascites due to a variety of reasons
Present with fever, chills, abdominal pain, altered mental status, elevated WBC, or no symptoms
Need to have a high clinical suspicion
Dx by paracentesis

Back 59

Spontaneous Bacterial Peritonitis

Front 60

Form of functional renal failure w/o renal pathology
Mechanism poorly understood
Characterized by worsening azotemia (high urea) with avid sodium retention and oliguria

most pts die soon after diagnosis

Back 60

Hepatorenal Syndrome

Front 61

pt with liver disease should not get what type of drugs

Back 61

aminoglycosides

Front 62

if you see neuro changes in a pt with liver problems what must you consider?

Back 62

Hepatic Encephalopathy

Front 63

this is a complication of cirrhosis, has a higher risk if a pt has Hep B and C....

***TEST

Back 63

Hepatocellular Carcinoma (HCC):

note: don't biopsy, can normally see on imaging

If caught early can increase survival by 1-2 yr
Once symptoms clinically apparent, life expectancy is 3-6 mo

Front 64

What will you see an increased level of in a pt with hepatocellular carcinoma?


*****TEST

Back 64

Alpha fetoprotein