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44 Cards in this Set
- Front
- Back
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What is hemosiderosis?
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Deposit of iron (hemosiderin) - this causes hemochromatosis
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The traid of sx. are?
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micronodular cirrhosis, pancreatic fibrosis, and skin pigmentation ("bronze" diabetes)
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Possible complications include?
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CHF, increased risk of hepatocellular carcinoma
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What is primary form?
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inherited, Autosomal recessive
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What is secondary form due to?
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chronic transfusion therapy
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What are ferritin, iron, TIBC and transferrin saturation levels?
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Ferritin increased, iron increased, TIBC decreased => transferrin saturation is increased
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How much iron may the body contain?
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As much as 50g, enough to set off airport metal detectors
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How is this condition treated?
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Phlebotomy, deferoxamine
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bacteria convert conjugated bilirubin into what? what happens to some of this?
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urobilinogen --> some which is reabsorbed, some which is excreted. (urobilinogen that's reabsorbed is converted to urobilin= yellow pigment in urine)
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which is soluble in water/urine: conjugated or unconjugated bilirubin?
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conjugted of course!
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check out the 3 jaundice types: what are they? For each type: bilirubin type, urine bilirubin?, urine urobilinogen?
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heptocellular (conjugated/uncongugated; urine bilirubin inc; urnine urobilinogen normal) obstructive (conjugated; urine bilirubin increased; urine urobilinogen decreased); hemolytic (unconjugated; urine bilirubin absent; urine urobilinogen increased)
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What is the biochemical disorder in GILBERTS SYNDROME?
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mild ↓ in UDP-glucuronyl transferase (this is key enzyme in conjugation of bilirubin)
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what are the symptoms?
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asymptomatic
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what type of bilirubin is seen upon the lab findings in Gilbert's? Do you have do you have major hemolysis?
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unconjugated bilirubin is elevated w/o overt hemolysis
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What is the syndrome called when you have an ABSENCE of UDP-glc-ur-transferase?
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Crigler-Najjar (CN) syndrome type 1 (type 2 is LESS severe)
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when does it present in life? What is the prognosis?
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presents early in life: pts die in a few years.
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name 3 findings of Crigler Najjar syndrome?
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jaundice, kernicterus, ↑ unconjugated bilirubin
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type 2 is more sever or less severe? What do you treat it with?
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less severe than type 1; treat type 2 with phenobarbital.
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what do you treat type 1 with (name 2)?
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plasmapheresis + phototherapy (breaks down unconj. Bilirubin)
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What is Dubin Johnson syndrome?
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↑↑ hyperbilirubin (conjugated) due to defective liver EXCRETION
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what does the liver look on gross exam?
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black liver grossly
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what is the name of the less severe syndrome akin to Dubin Johnson?
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Rotor's syndrome: also no black liver.
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what is the pathophysiology of primary sclerosing cholangitis
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segmental inflammation and fibrosis of bile ducts: unaffected parts are dilated.
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what test do you do to see stricture/dilating/beading pattern in primary sclerosing cholangitis?
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ERCP
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what disease is primary sclerosing cholagitis associated with?
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Ulcerative Colitis
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What can prim. Scl. Cholangitis lead to?
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2° biliary cirrhosis/sclerosis
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what is the cause of Primary Biliary Sclerosis (PBS)? (compare the name/disease of PBS vs. PSC: primary sclerosing cholangitis)
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autoimmune disorder with antimitochondrial antibodies
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name 3 signs associated with PBS:
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1) severe obstructive jaundice 2) itching 3) hypercholesterolemia (xanthoma)
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What is the cause of SBS: secondary biliary sclerosis?
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EXTRA-hepatic biliary obstruction → ↑ pressure in INTRA-hepatic ducts → ↑ injury/sclerosis
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what is 2° biliary sclerosis associated with (name 3 things)?
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ascending cholangitis (bacterial infection), bile stasis, and bile lakes
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in liver cancers, is this common?
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yes, #1 most common!
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there is an ↑ incidence of hepatoma due to what diseases/exposures (name 7)
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1) hep B, 2) hep C, 3) Wilson's disease, 4) hemochromatosis, 5) a-antitrypsin def 6) EtOH cirrhosis 6) carcinogens (e.g. aflatoxin B1)
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How do hepatomas spread? How does this differ with renal cell ca. spread?
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They BOTH commonly spread hematogenously!
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What is major lab finding with hepatocelluar ca?
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↑ AFP (alpha fetoprotein)
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What is Reye's syndrome?
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Hepato-encephalopathy: fatal: occurs in childhood
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name 3 finding in Reye's:
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1) fatty liver w/ microvesicular fatty change 2) hypoglycemia, 3) coma
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is this associated with any outside factors/triggering factors?
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yes: 1) viral infection (esp. VZV or influenza B) 2) salicylates!!!
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if baby/child has fever what do you use in place of aspirin?
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use acetaminophen (but with caution): i.e. acetaminophen OD hepato-toxicity
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name 3 types of stones and tell me how they show up on CT scan:
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1) cholesterol stone (radiolucent but 10-20% opaque due to calcification) 2) mixed stone = cholesterol + pigment (radiolucent) 3) pigment stone (radio-opaque)
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Which is the most common type of gall stone?
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mixed stone
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name at least 5 out 9 risk factors for Cholesterol stones: is there a mnemonic?
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1) obesity 2) Crohn's D 3) Cystic fibrosis 4) elderly 5) clofibrate 6) estrogens 7) multiparity 8) rapid weight loss 9) native American origin mnemonic = 4 F's fat, female….
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name 4 risk factors for pigment stones:
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1) pts with chronic RBC hemolysis 2) alcoholic cirrhosis 3) elderly 4) biliary infection
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What is a good way to diagnosis stones?
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ultrasound
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What is CHARCOT'S TRIAD
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1) epigastric/RUQ pain 2)fever 3) jaundice. present in 70% of those with bacterial cholangitis
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