Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
|
i. What are the hallmarks of hepatocellular liver disease?
|
1. Liver injury
2. Inflammation 3. Necrosis |
|
|
ii. What are some types of hepatocellular liver disease?
|
1. Viral hepatitis
2. Alcoholic liver disease |
|
|
i. What is the mechanism of cholestatic liver disease?
|
1. Inhibition of bile flow
|
|
|
ii. What are some examples of cholestatic liver disease?
|
1. Gallstones
2. Malignant obstruction 3. PBC, PSC |
|
|
i. What type of liver disease causes the most severe destruction?
|
1. Mixed disease
|
|
|
ii. What are some examples of mixed liver disease?
|
1. Drug induced hepatitis
2. Some viral hepatitis |
|
|
d. What is the general presentation of liver disease?
|
i. Jaundice
ii. Fatigue iii. Itching iv. RUQ pain v. Abdominal distension vi. Intestinal bleeding |
|
|
a. What are some of the most important elements to ask about in a social history with regards to liver disease?
|
i. Alcohol use
ii. Medications iii. Sexual activity iv. Travel v. Injected drug use |
|
|
b. What are some childhood liver diseases that could indicate risk for future liver disease in a family member?
|
i. Familial intrahepatic cholestasis
ii. Benign recurrent intrahepatic cholestasis iii. Alagille syndrome iv. Wilson’s disease |
|
|
c. What are some adult liver diseases that could indicate risk for future liver disease in a family member?
|
i. Hemochromatosis
ii. Wilson’s disease |
|
|
d. What questions about medications should you ask a patient with suspected liver disease in an H&P?
|
i. What medications do you take?
ii. When did you start them? iii. Any change in doses? iv. OTC meds? v. Herbals? |
|
|
i. What would you be looking for on a physical exam with acute liver disease?
|
1. Icterus
2. Hepatomegaly 3. Hepatic tenderness 4. Splenomegaly 5. Spider angiomata 6. Palmar erythema 7. Excoriations |
|
|
ii. What would you be looking for on a physical exam with advanced liver disease?
|
1. Muscle wasting
2. Ascites 3. Edema 4. Dilated abdominal veins 5. Hepatic fteor 6. Asterixis 7. Mental confusion 8. Coma 9. Hyperestrogenemia |
|
|
iii. What is an angiomata?
|
1. Dilation of the veins in the skin
|
|
|
iv. What is Dupuytren contracture?
|
1. Fixed flexion of the hand due to palmar fibromatosis
|
|
|
i. What are the characteristics of unconjugated bilirubin?
|
1. Heme breakdown
2. Not water soluble 3. Binds to albumin 4. AKA: indirect bilirubin |
|
|
ii. What are the characteristics of conjugated bilirubin?
|
1. Hepatocyte conversion
2. Water soluble 3. Excreted through urine 4. AKA: direct bilirubin |
|
|
1. What will cause unconjugated bilirubin to be in the blood?
|
a. Hemolysis
b. Defects in hepatic uptake/conjugation |
|
|
2. What are some possible causes of hemolysis?
|
a. Trauma
b. Poor erythropoiesis c. Drugs d. Hematoma absorption |
|
|
3. What will cause conjugated bilirubin to be excreted in the urine?
|
a. Biliary obstruction
b. Liver disease |
|
|
4. What can cause defects in hepatic uptake and conjugation?
|
a. Gilbert syndrome
b. Crigler-Najjar syndrome |
|
|
5. What is Gilbert syndrome?
|
a. Autosomal dominant
b. Decreased glucuronyl transferase c. Decreased bilirubin uptake d. Mild increase in bilirubin |
|
|
6. What is type I Crigler-Najjar syndrome?
|
a. Autosomal recessive
b. Absence of glucuronyl transferase c. Drastic increase in bilirubin |
|
|
7. What is type II Crigler-Najjar syndrome?
|
a. Autosomal dominant
b. Decrease in glucuronyl transferase c. Not as severe as type I |
|
|
8. Which form of bilirubin is water soluble?
|
a. Conjugated
|
|
|
9. Which form of bilirubin is alcohol soluble?
|
a. Both
|
|
|
10. Which form of bilirubin is present in bile?
|
a. Conjugated
|
|
|
11. Which form of bilirubin is absent in urine?
|
a. Unconjugated
|
|
|
12. Which form of bilirubin is absorbed in the gut?
|
a. Unconjugated
|
|
|
13. Which form of bilirubin is doesn’t diffuse into the tissues?
|
a. Conjugated
|
|
|
14. Where is ammonia produced?
|
a. Ammonia metabolism
b. By intestinal bacteria in colon |
|
|
15. Where is ammonia converted into urea?
|
a. Liver
|
|
|
16. How does advanced liver disease cause hyperammonemia?
|
a. Liver won’t break down ammonia
b. Ammonia goes straight to blood c. Symptom is muscle wasting |
|
|
17. What are blood ammonia levels useful for?
|
a. Detecting hepatic encephalopathy or hepatic synthetic function
|
|
|
18. What will cytoplasmic AST indicate?
|
a. Mild degree of injury
|
|
|
19. What will mitochondrial AST indicate?
|
a. Severe injury
|
|
|
20. Where is AST found?
|
a. Liver
b. Cardiac muscles c. Skeletal muscle d. Kidneys |
|
|
21. How useful is AST in diagnosing liver disease?
|
a. AST not specific for liver disease
|
|
|
22. How can you dx alcoholic liver disease?
|
a. 2:1 AST:ALT is suggestive
b. 3:1 is absolute |
|
|
23. Where is ALT found?
|
a. Primarily in the liver
|
|
|
24. 300U/L ALT indicates….
|
a. ….. nonspecific; any type of liver disorder
|
|
|
25. >1000U/L of ALT indicates…..
|
a. Extensive hepatocellular damage
|
|
|
26. What is an indication of acute hepatocellular disease?
|
a. ALT>AST
|
|
|
27. Where are isoenzymes for ALP found?
|
a. Liver, bone, intestine
b. Placenta |
|
|
28. What can an isolated rise of ALP indicate?
|
a. Hodgkins lymphoma
b. Diabetes c. Hyperthyroidism d. CHF e. Amyloidosis f. IBD |
|
|
29. What can give an isolated rise in ALP that will make you think liver damage but isn’t?
|
a. Growing kids→ bone growth
b. Pregnant women→ fetal growth c. Fractured bone |
|
|
30. What will elevated ALP + PSA indicate?
|
a. Metastasis of prostate cancer
|
|
|
31. What will an ALP <3 times normal indicate?
|
a. Viral hepatitis
b. Alcoholic hepatitis c. Hepatocellular carcinoma |
|
|
32. What will an ALP >4 times normal indicate?
|
a. Cholestatic liver disease
b. Infiltrative liver disease c. Bone disease with rapid bone turnover |
|
|
33. At what stage in life is high ALP expected?
|
a. Young children
b. Youth nearing puberty |
|
|
34. When will GGT show a moderate rise?
|
a. Infectious hepatitis
b. Prostate cancer |
|
|
35. When will GGT show a high rise?
|
a. Alcoholism
b. Obstructive jaundice c. Neoplasms of liver |
|
|
36. When will GGT be raised when other LFT are normal?
|
a. Alcoholics
|
|
|
37. When will GGT be slightly higher than normal?
|
a. Males with prostate cancer
|
|
|
38. What will a moderately elevated 5’ nucleotidase indicate?
|
a. Hepatitis
|
|
|
39. What will a highly elevated 5’nucleotidase indicate?
|
a. Biliary obstruction
|
|
|
40. How does 5’ nucleotidase differ from ALP?
|
a. Level is unaffected by bone disease
|
|
|
41. What is used for testing the true function of the liver?
|
a. Albumin
|
|
|
42. What produces albumin?
|
a. Hepatocytes
|
|
|
43. What is the serum level of albumin in hepatitis? What is an alternate dx with this level?
|
a. <3 g/dL
b. Possible chronic liver disease c. Ascites d. Protein malnutrition |
|
|
44. What are the PT coagulation factors important for the liver?
|
a. II
b. VII c. IX d. X |
|
|
45. What will a prolonged PT indicate?
|
a. Hepatitis
b. Cirrhosis c. Vitamin K deficiency |
|
|
1. What will drop first in acute parenchymal liver disease?
|
a. PT factors
|
|
|
1. What is 1st line method to image an obstruction?
|
a. Ultrasound
|
|
|
2. When should you do an ultrasound?
|
a. Increased ALP
b. Mild increase in ALT/AST |
|
|
3. What is an ERCP?
|
a. Scope to ampulla vader
b. Injects dye to visualize stones |
|
|
4. What is a liver bx useful for?
|
a. Assess severity
b. Stage-- most accurate method of determining the stage |
