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38 Cards in this Set
- Front
- Back
hepatocellular jaundice
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cong/uncong
increased urine br nl/decr urine urobilinogen |
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obstructive jaundice
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cong
increased urine br decr unine urobilinogen |
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hemolytic jaundice
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uncong
absent urine bilirubin increased urine urobilinogen |
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Gilberts
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mildy decreased UGT
incr uncong br without hemolysis, assoc with stress |
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Crigler Najjar I
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absent UGT
die within a few years |
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Crigler Najjar II
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less severe, responds to PHB which increases liver enzyme synthesis
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Dubin Johnson
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conjug hyperbr due to defective liver excretion
grossly black liver benign |
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Rotors
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similar to dubin johnson but milder and does not cause black liver
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Primary sclerosing cholangitis
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intra/extra hepatic; inflammation and fibrosis of bile ducts-->alternating strictures and dialtion with beading
assoc with UC; can lead to 2ndary biliary cirrhosis triad: fever, jaundice, RUQ pain tx: ersodiol, weight loss men, 40 y/o |
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Primary biliary cirrhosis
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intrahep, AI; severe obstructive jaundice, steatorrhea, pruritis, hypercholesterolemia, increased alk phos, increased AMA, assoc with scleroderma, CREST
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secondary biliary cirrhosis
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due to extrahep biliary obstruction; increased pressure in intrahep ducts-->injury-->fibrosis
often complicated by asc cholangitis, bile stasis, bile lakes increased alk phos, increased cong br |
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HCC
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increased risk with hep B/C, wilsons, hemochromatosis, alpha AT def, alcoholic cirrhosis, carcinogens (aflatoxin B1- asp fungus)
heme spread sxs: hepatomegaly, ascites, polycythemia, hypoglycemia increased AFP |
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cholesterol stones
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radiolucent; assoc with obesity, Crohns, CF, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, NA origin
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Mixed stones
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radiolucent both cholesterol and pigment components; most common
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Pigment stones
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radioopaque seen in pts with chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection
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tx of gallstones
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estradiol
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acute pancreatitis cauces
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gallstones, ethanol, trauma, steroids, mumps, AI dz, scorpion sting, hyperCa/hyperlipidemia, drugs (sulfas, propofol, didanosine)
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acute pancr
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presents with epigastric ab pain radiating to back, anorexia, nausea
elevated amylase, lipase can lead to DIC, ARDs, diffuse fat necrosis, hypoca, pseudocyst formation, hemorrhage, infection |
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panc adenocarc
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prognosis 6 mos or less; very aggressive; usually already mets at presentation; tumors more common in pancr head (obstructive jaundice) painless
often presents with: ab pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable GB |
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carcinoid
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tumor of endocrine cells; dense core bodies seen on EM; often produce 5HT; classic sxs: wheezing, right sided heart lesions, diarrhea, flushing
serotonin excess |
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hepatic angiosarcoma
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vinyl chloride and arsenic
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OCP, anabolic steroids
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hepatic adenoma (benign)
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H2 blockers
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cimetidine, ranitidine, famotidine, nizatidine
block H secretion by parietal cells used in peptic ulcer, mild GERD can cause TCP |
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cimetidine
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inhibits P450, antiandrogenic effects
can cross BBB |
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PPI
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omeprazole, lansoprazole, pantroprazole
irreversibly inhibit H/K ATPase in stomach parietal cells use: peptic ulcer, gastritis, eso reflux, ZES |
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bismuth, sucralfate
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bind to ulcer base proving physical protection and allow bicarb secretion to reestablish pH
require acidic environment to work used in ulcer healing, travellers diarrhea |
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misoprostol
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PGE analog; increases production and secretion of gastric mucous barrier, decreases acid production
prevention of NSAID induced peptic ulcers; maintenance of PDA, induce labor diarrhea, abortifactant |
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muscarinic antag
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pirenzepine, propantheline
block MI receptors on ECL cells (decrease histamine secretion) and M3 receptors on parietal cells (decrease H secretion) used for peptic ulcer tox: tachycardia, dry mouth, difficulty focusing eyes |
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aluminum hydroxide overusse
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constipation and hypophosphatemia, prox muscle weakness, osteodystrophy, seizures
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mg OH
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diarrhea, hyporeflexia, hypotenion, cardiac arrest
do not use with renal disease |
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calcium carbonate overuse
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hypercalcemia, rebound acid increase (increases gastrin release)
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infliximab
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antibody to TNF-alpha; proinflammatory cytokine (must test for tb!)
use: crohns, RA tox: resp infection, fever, hypotension |
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sulfasalazine
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sulfa (AB) and mesalamine (antiinflam)(
activated by colonic bacteria use: UC, Crohns tox: malaise, nausea, sulfa tox, reversible oligospermia |
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ondansetron
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5HT3 antag; powerful centrally acting antiemetic
control vomiting postop and in pts undergoing cancer chemo tox: HA (vasodil), constipation |
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octreotide
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decreases hormones, splanchnic circulation
PUD, eso varices, pancreatitis |
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cisapride
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acts through serotonin receptors to increase Ach release at myenteric plexus
increases eso tone increases contractility, improving transit time NOT USED |
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metoclopramide
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D2 antag; increases resting tone, contractility, LES tone, motility; does not increase transit time through colon
use: diabetic and post surgery gastroparesis tox: increases parkinsonian effects, restlessness, drowsiness, fatigue, depression, nausea, constipation DI: digoxin, diabetic agents CI: SI obstruction safe in preg |
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increase ACh, increase 5HT, decrease D2
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chol ag, ACHE-I (neostigmine), metoclopramide, domperidone (decreases DA), cispride (increases 5HT), macrolides (stim SM motilin receptors), EES
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