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51 Cards in this Set
- Front
- Back
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Q600. Portal Hypertension - History/PE
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A600. History – jaundice, ascites, esophageal varices, hemorrhoids, caput medusa, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction; PE - icteric sclerae, abdominal fluid wave, shifting dullness, splenomegaly, easy bruising, spider angioma, caput medusa, palmar erythema, gynecomastia, testicular atophy
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Q601. Portal Hypertension - Dx
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A601. LFTs; alkaline phosphatase; bilirubin; albumin; PT/PTT; serum ferritin; ceruloplasmin; a1-antitrypsin; US; increased indirect hepatic vein wedge pressure; SAAG
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Q602. Portal Hypertension; What is SAAG; SAAG > 1.1; SAAG < 1.1
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A602. serum-ascites albumin gradient: serum albumin-ascitic albumin; SAAG > 1.1: portal HTN - increased pressure in portal v., chronic liver dis., hepatic mets; SAAG < 1.1: noNPOrtal HTN - nephrotic syndrome, TB, malignancy
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Q603. Portal Hypertension - Tx for ascites
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A603. restrict Na; diuretics; rule out infection & neoplasms; paracentesis - to get SAAG, CBC, cultures; tx underlying liver disease
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Q604. Portal Hypertension; Tx for spontaneous; bacterial peritonitis
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A604. Indolent infection of ascitic fluid; pos. if > 250 PMNs/ml or > 500 WBC, Culture and gram stain usually neg., IV 3rd gen. cephalosporin (covers Enterococcus, E. Coli or Klebsiella)
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Q605. Portal Hypertension - Tx for hepatorenal syndrome
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A605. Dx of exclusion; Hard to tx; Often requires dialysis
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Q606. Portal Hypertension - Tx for hepatic encephalopathy
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A606. Decreased protein consumption; lactulose; metronidazole
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Q607. Portal Hypertension - Tx for esophageal varices
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A607. Monitor for GI bleeding; B blockers; band ligation; sclerotherapy; or portocaval shunt
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Q608. Hepatocellular Ca - Risk factors for primary
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A608. US - cirrhosis; chronic HBV or HCV; worldwide - HBV, HCV, aflatoxin
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Q609. Hepatocellular Ca - History/PE
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A609. RUQ tenderness; abdominal distention; hepatomegaly; signs of chronic liver dis. – jaundice, easy bruisability, coagulopathy, nodular cirrhotic liver
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Q610. Hepatocellular Ca - Dx
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A610. US; CT; increased LFTs; significantly increased AFP; Biopsy - definitive Dx
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Q611. Hepatocellular Ca - Tx
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A611. early detection – resection or orthotopic liver transplant; neoadjuvant therapy - chemo and radiation to shrink large tumor before surgery; serial AFP - monitor recurrence
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Q612. Hemochromatosis - What is it
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A612. increased in int. iron absorption => too much deposited, accums in skin, pancreas, liver, heart, joints, kidney, pituitary, gonads, adrenals; primary - auto recessive; secondary - chronic transfusions, alcoholics
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Q613. Hemochromatosis - History/PE
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A613. DM; hypogonadism; arthritis; CHF; restrictive cardiomyopathy; cirrhosis; adrenal insufficiency; hypothyroidism, hypoparathyr. abdominal pain
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Q614. Hemochromatosis - Dx
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A614. Increased serum iron; increased % iron saturation; increased ferritin; decreased serum transferrin; fasting transferrin saturation > 45%; glucose intolerance; increased AST; increased alkaline phosphatase; liver Biopsy; MRI; C282Y mutation; hepatic iron index > 2.0
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Q615. Hemochromatosis - Tx
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A615. weekly phlebotomy (1-2 yrs.), then maintenance phlebotomy, every 2-4 months; deferoxamine (maintenance); liver transplant cures
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Q616. Hemochromatosis - Complications
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A616. cirrhosis; hepatocellular ca; cardiomegaly; CHF; DM; impotence; arthropathy; hypopituitarism
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Q617. Wilson's Disease - What is it
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A617. Hepatolenticular degeneration; Decreased synthesis of ceruloplasmin => too much copper deposited in liver, brain, cornea; auto recessive (chrom 13); usually presents 15-25 y/o
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Q618. Wilson's Disease - History
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A618. ABCD; asterixis; basal ganglia degenerates; ceruloplasmin decreased; copper deposited; cirrhosis => hepatocellular ca; choreiform movements (tremor); corneal deposits; dementia; 1st sign - neuro or psych; kayser-fleischer rings always accompany neuro or psych
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Q619. Wilson's Disease - PE
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A619. Kayser-Fleischer rings - copper in Descemet's membrane; jaundice; hepatomegaly; asterixis; choreiform movements
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Q620. Wilson's Disease - Dx
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A620. decreased serum ceruloplasmin; increased urinary copper excretion; elevated hepatic copper
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Q621. Wilson's Disease - Tx
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A621. dietary copper restriction; no shellfish, liver, legume; penicillamine (urine excretes); oral zinc (fecal excretion); cured by liver transplant
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Q622. Acute Pancreatitis - What is it
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A622. Leakage of pancreatic enzymes into pancreatic and peripancreatic tissue.
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Q623. Acute Pancreatitis - Risk factors
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A623. GET SMASHeD; gallstones; ethanol; trauma; steroids; mumps; autoimmune dis. scorpion sting; hyperlipidemia; hypercalcemia; drugs (thiazide)
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Q624. Acute Pancreatitis - History/PE
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A624. Severe epigastric pain; radiates to the back; cullen's (periumbilical); grey-turner (flank)
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Q625. Acute Pancreatitis - Dx
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A625. Increased amylase - but amylase can read normal if hypertriglyceridemia; increased lipase - more specific; decreased calcium (fat necrosis); "sentinel loop" on AXR; "colon cutoff" on AXR; US or CT - enlarged pancreas, pseudocysts, abscess, hemorrhage, necrosis
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Q626. Acute Pancreatitis - Tx
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A626. IV fluids; electolyte replacement; analgesia; NPO; NG suction; nutritional support; O2; if necrotizing - IV Antibiotics, respiratory support, surgical debridement; ERCP - if stone in COMMON BILIARY DUCT; debridement - if necrosis; CT-guided drainage – abscess, pseudocyst > 5cm lasts > 1 mo.
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Q627. Acute Pancreatitis - Complications
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A627. pseudocyst; fistulas; hypocalcemia; renal failure; pleural effusion; sepsis; chronic pancreatitis; splenic vein thrombosis; mortality - Ranson's criteria
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Q628. Acute Pancreatitis - Ranson's Criteria
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A628. GA LAW - On Admission:; Glucose > 200 mg/dl; Age > 55 yrs. LDH > 350 IU/L; AST > 250 IU/dl; WBC > 16,000/ml C HOBBS - After 48 hours:; Ca2+ < 8.0 mg/dl; Hct decreased by > 10%; O2 PaO2 < 60 mmHg; Base excess > 4 mEq/l; BUN increased > 5 mg/dl; Sequestered fluid > 6L; Mortality risk - 20% with 3-4 signs, 40% with 5-6 signs, 100% with > 7 signs
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Q629. Chronic Pancreatitis - What is it
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A629. recurrent attacks of acute => irreversible destruction => pancreatic dysfunction
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Q630. Chronic Pancreatitis - Risk factors
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A630. alcoholism (90%); gallstones; hyperparathyroidism; idiopathic; congenital - pancreas divisum, CF
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Q631. Chronic Pancreatitis - History/PE
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A631. recurrent episodes of :; persistent epigastric pain; steatorrhea; weight loss; nausea; diabetes
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Q632. Chronic Pancreatitis - Dx
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A632. Abdominal XR - calcifications; low trypsin; amylase and lipase - normal; secretin stimulation test - most sensitive; glycosuria; mild ileus on AXR and CT ("chain of lakes")
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Q633. Chronic Pancreatitis - Tx
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A633. Pancreatic enzymes replaced; med-chain triglycerides in diet; decreased fat intake; vitamins; analgesics; Puestow procedure; stop alcohol; celiac nerve block; surgery for -, intractable pain, structural causes
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Q634. Chronic Pancreatitis - Complications
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A634. chronic pain; pancreatic cancer
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Q635. Pancreatic Cancer - What is it
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A635. pancreatic head adenocarcinoma; prognosis 6 mos. or less; usually metastasis at presentation
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Q636. Pancreatic Cancer - Risk factors
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A636. smoking; chronic pancreatitis; high-fat diet; long-standing DM
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Q637. Pancreatic Cancer - History/PE
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A637. abdominal pain radiates to back; painless jaundice; loss of appetite; n/v; weight loss; Courvoisier's sign - palpable NT gallbladder; Trousseau's sign - migratory thrombophlebitis
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Q638. Pancreatic Cancer - Dx
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A638. CT; US; ERCP
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Q639. Pancreatic Cancer - Tx
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A639. Palliative; Whipple – pancreaticoduodenectomy, if no evidence of mets (10-20%); chemo - 5-FU, gemcitabine
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Q640. Jaundice; What is it; Causes
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A640. excess bilirubin in blood; pathological in adults from overload, damage to liver, inability to excrete causes; congenital (Gilbert's, Dubin-Johnson, Crigler-Najjar); hemolytic anemia; hepatitis; alcoholic cirrhosis; obstruction; pancreatic ca
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Q641. Hepatitis - History/PE
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A641. Acute Viral:; incubation period - virus multiplies & spreads, no Symptoms; prodromal period – anorexia, malaise, n/v, fever, RUQ pain, joint pain (occasionally), 3-10 days- urine darkens; icteric phase – jaundice, systemic Symptoms regress, patient feels better despite worsening jaundice, liver enlarged and tender, jaundice peaks 1-2 wks, then fades; acute usu resolves spontan in 4-8 weeks Chronic hepatitis: lasts > 6 mos. many patients asymp - esp. HCV; malaise, anorexia; jaundice - usu absent, scleral icterus; tender hepatomegaly, splenomegaly, lymphadenopathy, spider nevi, palmar erythema; autoimmune - can involve any body sys
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Q642. Chronic Hepatitis - Etiologies
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A642. HCV (80% with HCV progress); HBV (10%, cum or sin HDV prog); autoimmune hepatitis; alcoholic hepatitis; nonalcoholic steatohepatitis; right-sided heart failure; Wilson's; hemochromatosis; a1-antitrypsin deficiency; neoplasm; drug-induced disease – INH, methyldopa, acetaminophen, nitrofurantoin
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Q643. Hepatitis - Dx
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A643. WBC - normal count, relative leukocytosis; very high ALT and AST; high bilirubin; high alkaline phosphatase; hypoalbuminemia (chronic); hepatitis serology; severe cases - PT prolonged (all clotting factors except factor VIII made by liver); Biopsy; autoimmune – ANA, anti-LKM1 antibody, anti-smooth muscle antibody, antimitochondrial antibody
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Q644. Hepatitis - Tx
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A644. Etiology specific; monitor for resolution of Symptom; severe alcoholic - steroids; autoimmune -, steroids, azathioprine; chronic HBV - IFN-a, lamivudine (3TC), adefovir; chronic HCV – peginterferon, IFN-B, ribavirin; end-stage liver failure - liver transplant; fulminant hepatic failure – ICU, emergent transplant
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Q645. Hepatitis - Complications
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A645. Cirrhosis; liver failure; hepatocellular ca; mortality in 5 yrs (50%)
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Q646. Hepatitis - IgM HAVAb
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A646. IgM Ab to HAV - best test to detect active hepatitis A
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Q647. Hepatitis - HBsAg
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A647. Ag on surface of HBV; continued presence indicates carrier state
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Q648. Hepatitis - HBsAb
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A648. Ab to HBsAg; provides immunity to hep B
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Q649. Hepatitis - HBcAg
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A649. Ag associated with the core of HBV
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Q650. Hepatitis - HBcAb
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A650. Ab to HBcAg; positive during window period; indicator of recent disease
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