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82 Cards in this Set
- Front
- Back
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__ refers to the yellow discoloration of the skin resulting from elevated bilirubin levels.
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jaundice
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Clinically, jaundice is usually detectable when bilirubin levels are more than __ umol/l.
-10 -25 -50 -100 |
50 umol/l
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The causes of jaundice are broken up into what 3 classes?
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prehepatic
hepatic posthepatic |
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Pre-hepatic causes result in __ hyperbilirubinemia.
-unconjugated -mixed -conjugated |
unconjugated
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Post-hepatic causes result in __ hyperbilirubinemia.
-unconjugated -mixed -conjugated |
conjugated
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Pale stools and dark urine are indicative of __ jaundice.
-pre-hepatic -hepatic -post-hepatic |
post-hepatic
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Abdomial pain can occur with gallbladder stones or any cause of acute __.
-cirrhosis -hepatitis |
hepatitis
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Rigors and night sweats may indicate __.
-cholecystitis -cholangitis -hepatits |
cholangitis
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Ingestion of herbal meds or fava beans may be associated with __ and jaundice.
-nausea -hemolysis -diarrhea |
hemolysis
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A pt. with a history of blood transfusions may have __ hepatitis.
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acquired
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Elevated alanine and AST suggest a __ origin of jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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Alk. Phos levels are elevated in __ cholestasis.
-pre hepatic -hepatic -post hepatic |
post hepatic
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GGT levels are elevated in __ causes as well as alcoholic liver disease.
-pre hepatic -hepatic -post hepatic |
post hepatic
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Disproportionately elevated levels of unconjugated bili would suggest a __ cause.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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Serum __ is low in pt's with impaired synthetic function of the liver.
-amylase -albumin -lipase -alk phos |
albumin
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Dark urine suggests a cholestatic cause; dipstick urine testing may reveal __.
-protein -bilirubin -urobilinogen -proteins |
urobilinogen
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what is the initial testing to detect extra-hepatic causes such as stones or masses?
-ct -u/s -mri |
u/s
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liver cirrhosis, hepatitis, viruses, etoh, autoimmune, and heart failure are __ causes of jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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Biliary obstruction, stones, biliary strictures, and primary sclerosis cholangits are all causes of __ jaundice.
-pre hepatic -hepatic -post hepatic |
post hepatic
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Increased bili production, hemolytic anemia, reduced hepatic uptake, and resorption from a hematoma are all __ causes of jaudice.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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A dilated biliary tree strongly suggests a __ cause of jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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__ is a multisystem disorder that results in encephalopathy and coagulopathy following a massive insult to the liver.
-hepatitis -acute liver failure -chronic liver failure -cirrhosis |
acute liver failure
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The most common cause of ALF is ?
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tylenol overdose
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t/f
the liver profile is of great use during the classification of severity of liver failure. |
false; the liver profile is of limited use
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The __ is prolonged in acute liver failure.
-PT -INR -PTT -bleeding time |
PT
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If renal failure accompanies liver failure what lab value will be elevated?
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serum creatinine
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What is the most important aspect to treating acute liver failure?
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treating the underlying cause
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__ is inflammation of the liver parenchyma.
-ALF -hepatitis -cirrhosis -ascites |
hepatitis
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What are the 3 types of hepatitis?
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acute, chronic, subclinical
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t/f
Rarely, hepatitis can lead to hepatic failure and death. |
true
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Acute hepatitis refers to liver inflammation of less than _ months.
1 3 6 12 |
less than 6 months
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T/F
Most cases of hepatitis can be managed as an outpatient-as it usually resolves spontaneously. |
true
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__ refers to continued inflammation and necrosis of the liver parenchyma.
-acute hepatitis -chronic hepatitis -cirrhosis |
chronic hepatitis
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How is the diagnosis of hepatitis made?
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histologically, characterized by parenchymal, portal and periportal inflammation.
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Chronic hepatitis can progress to __?
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cirrhosis
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When doing a hepatitis history on a pt, you must ask about recent travel, food intake or social habits as they may indicate a __ cause.
-viral -bacterial -amebic |
viral
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Pt's may be asymptomatic, as in many cases of hepatitis _ and _.
-a -b -c -d |
A & C
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Chronic hepatitis is often _ and detected on routine lab work.
-symptomatic -asymptomatic |
asymptomatic
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What are some common complaints of hepatitis patients?
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lethargy
arthralgia h/a fever ruq pain anorexia wt. loss pruritis |
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__ is a test of liver synthetic function, and may be low.
-ALP -GGT -serum albumin -bilirubin |
serum albumin
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In pt's with severe liver disease, blood sugars may be __.
Low High Normal |
Low
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What 2 sites are common for the development of varices?
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GE junction
Rectum |
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The risk of variceal bleeding is increased if the pressure gradient between the portal and hepatic veins is greater than __ mmHg.
10 20 40 50 |
10
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The mortality associated with bleeding esophageal varices is __%
10 25 50 100 |
50%
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__ are often used as a last resort to reduce the portal pressure.
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surgical shunting
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__, a nonselective beta blocker, can be used successfully to reduce portal pressures to reduce the risk of further bleeding.
-naldolol -atenolol -propranolol |
propranolol
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__ is the accumulation of fluid in the peritoneal cavity in which liver disease is the most common cause.
-ascites -cirrhosis -hepatitis -wilson's disease |
ascites
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What investigation is usually needed to determine ascites?
-u/s -PE -ct -mri |
physical exam is usually enough
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t/f
a diagnostic paracentesis should be taken in all cases of ascites. |
true
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A bloody tap suggests _ or _.
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malignancy or bleeding
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The evaluation of ascitic fluid must be assessed for __, which will be significantly elevated in pancreatitis.
-amylase -bilirubin -protein/albumin |
amylase
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A serum-ascites albumin gradient (serum albumin to ascitic albumin level) of more than __g/L suggests portal hypertension.
9 10 11 12 |
11g/L
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t/f
cytological evaluation of ascitic fluid will definitively diagnosis malignancy. |
false; cytology only sees about 10% of pt's with malignancy, thus a negative cytology does NOT rule out malignancy
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A WBC count on ascitic fluid of >__ indicates spontaneous bacterial peritonitis.
50 100 250 500 |
>250/mm3
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What is the most important aspect in the tx of ascites?
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find and tx the underlying cause
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What type of diet should you put your pt's on with ascites d/t liver disease?
-low protein -high protein -low sodium -low fat |
low sodium; by reducing intake and increasing excretion
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What is the tx of Ascites? Meds, therapies, treatments, surgeries?
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sodium restriction, fluid restriction, diuretics-spironolactone is DOC, paracentesis, TIPS, and liver transplant
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The rapid correction of hyponatremia may cause what 2 severe conditions?
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seizures
central pontine myelinosis |
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What IV fluid is preferred in the tx of ascites?
NS D5 D5NS |
D5
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Which is the DOC in the tx of ascites? And why?
-lasix -spirinolactone -bumex |
Spirinolactone antagonizes the renin-angiotensin-aldosterone system.
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What treatment is next in the case of refractory ascites after diuretic therapy?
-abdominal u/s guided liver biopsy -paracentesis -thoracentesis |
paracentesis
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With paracentesis what treatment is imperative to prevent renal impairment and CV comprimise.
-hyperventilation -IV hydration with D5 -Albumin replacement -Nitrates to dilate arterioles |
Albumin replacement
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For continuous/repeated need of paracentesis d/t ascites what surgical procedure is done?
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TIPS-creates an artificial bypass between the portal and systemic bld flow.
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What is the only tx for end stage liver disease?
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liver transplant
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t/f
Ascites is assoc. with liver dx carries a poor prognosis. |
true; the 5-year survival rate is usually less than 30%
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__ is a spectrum of neuropsychiatric disturbances associated with liver dysfunction.
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Hepatic Encephalopathy
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Which of the following toxins can cause hepatic encephalopathy?
-GABA -endogenous opiates -ammonia -none -all of the above |
all of the above
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__ is the loss of the detoxification fcn of the liver d/t acute liver failure or from the shunting of bld in chr. liver failure can lead to the accumulation of toxins that interfere with normal cerebral function.
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hepatic encephalopathy
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What are the 3 forms of encephalopathy?
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subclinical, acute and chronic
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Chronic encephalopathy is greater than _ weeks duration.
2 4 6 12 |
>4 weeks
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What are the physical exam findings you may see in someone with encephalopathy?
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asterixis (flapping tremor)
hyper-reflexia + Babinski sign possible Parkinsonian signs |
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What upper GI precipitant is known of encephalopathy?
-Mallory Weiss tear -esophageal varices -gastric adenocarcinoma |
varices
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What is the reason for prescribing enemas and lactulose to pt's with encephalopathy?
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to decrease bowel transit time (at least 3 BM's qd) to reduce the amt of ammonia produced from gut fermentation available for reabsorption.
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Which of the following parenteral vitamins should a encephalopathy pt receive and why?
-vit a -vit b -vit c -thiamine -folate |
Vit B and C as well as thiamine as Wernicke's encephalopathy.
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__ results from bacterial infection of ascitic fluid in pt's with cirrhosis.
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Spontaneous bacterial peritonitis
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t/f
SBP is a common condition. |
true affects up to 33% of with ascites d/t bacterial translocation from the gut to the bld stream (bacteremia) and into the ascitic fluid.
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All of the following EXCEPT which are common pathogens associated with SBP?
-Staph A -E. Coli -enterococcus -klebsiella |
staph A
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You will see a _ ascitic total protein and low serum complement levels.
-low -high |
low <10g/L
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As ascitic neutrophil count of more than __ cells/mm is a sensitive indicator for bacterial peritonitis.
50 100 250 500 |
250
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Is SBP usually .....
an individual organism polymicrobial |
usually a single organism, if polymicrobial suggests a secondary peritonitis
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Which of the following are the antibiotics are used for empiric therapy in SBP?
-Flagyl -Cipro -Cefotaxime -Rocephin |
cipro and cefotaxime
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How should you manage albumin replacement in the SBP pt?
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20% albumin at 1.5g/kg reducing to 1g/kg by day 3 to reduce the risk of renal impairment and death
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