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24 Cards in this Set
- Front
- Back
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Describe the following for Jaundice pre-hepatic
a. occurs where? b. liver enzymes? c. bilirubin types found? |
a. Occurs prior to reaching the liver
b. Liver enzymes are normal c. Increased unconjugated bilirubin |
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Describe the following for Jaundice hepatic
a. occurs where? b. liver enzymes? c. bilirubin types found? d. other levels |
a. Affecting the liver
b. Elevation of liver enzymes (AST, ALT) c. Increased levels of unconjugated and conjugated bilirubin d. Alkaline phosphatase might be slightly elevated |
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Describe the following for Jaundice post- hepatic
a. occurs where? b. liver enzymes? c. bilirubin types found? d. other levels |
a. Occurs after clearance of the liver
b. Elevation of liver enzymes c. Increased levels of conjugated bilirubin d. Alkaline phosphatase greatly elevated |
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42 y/o obese WF presents with episodic severe epigastric and RUQ pain, vomiting and diaphoretic, +Murphy's sign.
Risk factors for cholelithiasis? (6 F's) Best test to diagnose cholelithiasis? |
cholelithiasis
female, forties, fat, fertile, flatulent, fair-skinned U/S |
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4 treatments for cholelithiasis?
Two complications of chronic cholecystitis? |
surgery, chemical dissolution, endoscopic removal (ERCP), lithotripsy
thickened, fibrotic GB, pancreatitis |
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Describe the symptomatic type of presentations with cholelithiasis?
If pain lasts more than 6 hrs what could it pain? what may also show with this? |
1. Biliary “colic” due to visceral pain, shows 1/3 time episodic, severe pain usually RUQ or epigastrium
2. cholecystitis- vomiting diaphoresis |
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Infection of the common bile duct:
Charcot's triad? Tx for cholangitis? |
cholangitis
RUQ pain, fever/chills, jaundice Abx, NPO, IVF |
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35 y/o M presents w/ elevated alkaline phosphatase, jaundice, enlarged liver, UC:
primary sclerosing cholangitis? secondary sclerosing cholangitis? |
sclerosing cholangitis
associated with inflammatory bowel, UC often occurs post surgery, trauma, chronic pancreatitis |
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What is cholecystitis?
What are most cases associated with? Why do some show this with jaundice? |
obstruction of cystic duct by gallstone with resultant acute inflammation of the gallbladder- 90% associated with stones
- inflammation of wall blocks bile |
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Pt presents with painless jaundice, dark urine, light stools, anorexia, N/V:
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cholangiosarcoma
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fecal-oral transmission, incubation 4 wks, replication limited to liver:
Has two Antigens, one early, one during infectious stage; percutaneous transmission, 4-12 weeks: |
Hep A
Hep B |
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Which Hep B Ab's are always present post infection?
Which IG shows up first, which one shows up later? When does Anti-HCV show up in serum? |
Anti-HBs, Anti-HBc
IGM, then IGG 30-90 d. post infection |
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Waterborne hepatitis, ID'ed in Asia, India, Africa, C. America, eneteric transmission, 5-6 weeks incubation:
S/S of hepatitis? |
Hep E
general, prodromal symptoms (anorexia, N/V, fatigue, photophobia, fever) then hepatomegaly, jaundice, raised AST/ALT, PT time elevated |
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Prognosis of:
1.Hep A? 2. Hep B? 3. Hep "C"? 4. Hep D |
1.Hep A - most recover fine
2. Hep B - 95% adults recover, 95% kids chronic infection 3. Hep C - Chronic infection 4. increases mortality |
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Which Ag's are elevated in acute and chronic infectious Hep B?
When do you see Anti-HBe? When do you see Anti-HBc? What do you get when receving the Hep B vaccination? Which IG appears with acute infection? chronic infection? |
HBsAG, HBeAg
chronic infectious, late chronic recovery stages Anti-HBs acute - IGM chronic - IGG |
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Most common causes of liver‐related
jaundice: |
– Toxins, Drugs
– Infections – Chronic liver Disease secondary to alcohol use |
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what is treatment is typical for viral hepatitis?
What is the key symptomatic finding that differs alcoholic hepatitis from viral? |
Supportive Care: Restrict physical activity, high calorie diet, Anti-emetics and pruritics
- spider angiomas (dilated blood vessels on the face) |
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Key to diagnosis of alcoholic hep vs viral hep?
Treatment of alcoholic hep |
AST/ALT 2:1 ratio
Vitamin Supplementation-Thiamine, Folate, Vit K, Rehab |
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Autosomal recessive disease with an abnormality in copper excretion from liver
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Wilson's disease
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Wilsons is a deficiency of ?
Manifestations usually after? |
Deficiency of plasma ceruloplasmin
• Clinical manifestations of copper excess are rare before age 6 yrs |
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For pre-hepatic (hemolysis) cause of jaundice
Unconjugated/conjugated bilirubin AST/ALT/ alk phosphat |
Pre-hepatic
• Find more unconjugated w/albumin • AST/ALT/Alk phos normal Hepatic • |
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For hepatic (hepatocellular jaundice) cause of jaundice
Unconjugated/conjugated bilirubin AST/ALT/ alk phosphatic |
Show conjugated high
• AST, ALT, high, • Alk phos- mildy higher |
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For post- hepatic (Obstructive jaundice) cause of jaundice
Unconjugated/conjugated bilirubin AST/ALT/ alk phosphatic Symptoms? |
Post hepatic-
• AST/ALT slightly elevted • Alk phos- VERY HIGH -•Urine may be darker it was deposited to the Kidneys •“Itching” due to bile salts going to the skins - Will not have bilirubin in feces so clay colored feces |
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What are differentials for pre-hepatic jaundice?
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1. Hemolytic Anemias (sickle cells)
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