Im Gi Liver Usmle 2

Front 1

What lab values in a patient are Very High w/ Obstructive liver disease?

Parenchymal liver disease?
(2)

Back 1

Obstructive:
Alk Phos

Parenchymal:
1. PT
2. ALT/AST

Front 2

Definition:
Chronic hepatic injury assoc w/ hepatic necrosis, fibrosis and nodular regeneration

Back 2

Cirrhosis

Front 3

A patient w/ alcoholic cirrhosis comes in vomiting blood. He is stabilized w/ fluid. What is the next step?

Back 3

Octreotide

Front 4

MCC of cirrhosis in USA?

worldwide?

Back 4

USA: Alcohol abuse

world: Hepatitis

Front 5

Dx:
spider nevi, gynecomastia, loss of sexual hair, asterixis, bleeding tendency, Dupuytren's contracture, encephalopathy, portal HTN, jaundice

Back 5

Cirrhosis of the Liver

Front 6

What are the causes in the following symptoms that are diagnostic of liver cirrhosis:
1. Bleeding
2. Encephalopathy
3. Ascites, melena, edema

Back 6

1. Decreased clotting factors made in the liver

2. Increased ammonia

3. Portal HTN

Front 7

Order of the (4) liver problems (Dx names) caused by increasing alcohol consumption

Back 7

Alcoholic Fatty Liver ->

Alcoholic Cirrhosis ->

Alcoholic Hepatitis ->

Necrosis

Front 8

Most sensitive serum marker for recent alcohol bingeing

Back 8

GGT

Front 9

Rx for the following Sx in Alcoholic liver cirrhosis:
1. Decrease inflammation (2)
2. Ascites
3. Hepatic encephalopathy (2)
4. Esophageal varices (2)

Back 9

1. Glucocorticoids and Colchicine

2. Spironolactone

3. Lactulose and Neomycin

4. Beta-blocker or IV somatostatin
(or banding or balloon tamponade)

Front 10

(3)* metabolic diseases that cause Liver Cirrhosis.

Name the test markers that would indicate the Dz as the cause

Back 10

Will Agitate Hepatocytes:

1. Wilson's Dz
(high serum Ceruloplasmin)

2. Alpha-1-antitrypsin deficiency
(serum electrophoresis w/ absence of alpha-globulin)

3. Hereditary Hemachromotosis
(Fasting Transferrin Saturation = high Ferritin and TIBC)

Hint 10

Will Agitate Hepatocytes

Front 11

Why would the BUN be lower in liver cirrhosis?

Back 11

Decreased protein production

Front 12

Test marker that indicates cirrhosis w/ hepatocellular CA

Back 12

Increased Alpha-fetoprotein

Front 13

Definition:
Autoimmune dz causing destruction of the intrahepatic ducts

Back 13

Primary Biliary Cirrhosis

Front 14

Dx:
40-yo woman w/ scleroderma is admitted w/ jaundice, pruritis and xanthomas

What is the serologic hallmark?

Back 14

Primary Biliary Cirrhosis

(Anti-mitochondrial Ab)

Front 15

(2) autoimmune disorders assoc w/ Primary Biliary Cirrhosis

Back 15

Scleroderma

Sjogren's syndrome

Front 16

What drug Tx will slow the progression of Primary Biliary Cirrhosis?

What is only cure?

Back 16

Ursodiol
(synthetic bile acid)

Cure:
Liver Transplant

Front 17

MCC of Portal HTN worldwide

Back 17

Schistosomiasis

Front 18

Signs of Portal HTN
(5)*

Back 18

CHASE:

Caput medusa;
Hemorrhoids;
Ascites;
Splenomegaly;
Esophageal Varices

Hint 18

CHASE

Front 19

Tx for Portal HTN
(4)

Back 19

Propranolol to reduce pressure;

Portosystemic shunt surgery;

TIPS - shunt b/t hepatic and portal veins;

Liver transplant

Front 20

Dx:
Liver disease, joint pain, Diabetes, cardiomyopathy, skin hyperpigmentation and infertility.

First test?

what is the confirmatory test?

Back 20

Hereditary Hemochromatosis


first test:
Fasting Transferrin saturation

Confirmatory:
HFE Gene and C282Y mutation
(eliminates the need for liver Bx in HH)

Front 21

GI functions of Somatostatin
(6)

Back 21

Inhibits:
- Visceral blood flow
- Gastric acid secretion
- Gastric motility
- Gallbladder emptying
- Pancreatic enzyme and bicarbonate secretion
- Intestinal absorption of glucose, water, AA, and triglycerides

Front 22

Hepatic encephalopathy is precipitated by what?
(3)*

Back 22

PIG:

Protein (dietary) increase;

Infection;

GI bleed

Hint 22

PIG

Front 23

Signs/Sx of Hepatic Encephalopathy
(3)

Back 23

Fetor Hepaticus (Corpse breath);

Asterixis;

Mental status change or coma

Front 24

In a patient w/ bleeding esophageal varices, after stabilizing IV fluids, what is the next step?

Back 24

Octreotide

Front 25

Tx for Hepatic encephalopathy
(3)

Back 25

Protein restriction;

Lactulose
(to change NH3 to NH4 so it cant cross BBB)

Neomycin
(for gut bacteria that make NH3)

Front 26

MCC of Spontaneous Bacterial Peritonitis (bug)

Back 26

E. coli

Front 27

Dx:
Patient w/ ascites, fever, chills, abdominal pain w/ rebound, may progress to sepsis

Back 27

Spontaneous Bacterial Peritonitis

Front 28

Dx test for Spontaneous Bacterial Peritonitis

Tx?

Back 28

Test: Paracentesis
(abdominal tap)

Tx: Gram-negative coverage
(Cefuroxime)

Front 29

Definition:
Systemic infection of the liver due to viral agents, toxins, or alcohol

Back 29

Hepatitis

Front 30

Mode of transmission of Hepatitis:
A, B, C, D, E, G

Back 30

Vowels from the Bowels:
A and E - fecal-oral route

Consonants from "Consumance":
B, C, D, G - sex and blood

Front 31

Which forms of hepatitis are associated w/:
1. IV drug use (2)
2. Unprotected sex
3. Overseas travel (2)

Back 31

1. HBV and HCV

2. HBV

3. HAV and HEV

Front 32

What (2) toxins cause hepatitis?

Back 32

Acetaminophen

Aflatoxin

Front 33

*Viral class for:
1. HAV
2. HBV
3. HCV
4. HDV
5. HEV

Which is the only DNA virus?

Back 33

Please Help Find Danielle's Cat:
1. Picorna
2. Hepadna
3. Flavi
4. Delta
5. Calici

HBV is DNA
(the rest are RNA)

Hint 33

Please Help Find Danielle's Cat

Front 34

Meaning of HAV antibodies
(2)

Back 34

HAV IgM = Acute infection

HAV IgG = Immunity from prior infection

Front 35

Prevention of HAV?

Tx of HAV?

Back 35

Prevention:
Anti-HAV Ig is 90% effective if given w/i (2) weeks of exposure

Tx:
symptomatic

Front 36

How is hepatotoxicity from Acetaminophen prevented if detected early?

Back 36

N-acetylcysteine

Front 37

Meaning of HBV antibodies in order of detection
(4)*

Which signifies the "window period"?
Which indicates immunity?

Back 37

SAGing BAG-E / Camels May / Spit and Gag:

HBsAg positive = infection is present

HBeAg = Chronic hepatitis

Anti-HBc IgM = infection is acute (window period)

Anti-HBs IgG = past infection or vaccine (indicates immunity)

Hint 37

SAGing BAG-E Camels May Spit and Gag

Front 38

Exposure scenarios:
What is Tx to a newborn exposed w/ Hepatitis B?

Adult infected blood exposure?

Back 38

Newborn: Give HBIG and vaccine

Other: Test for HBV, if negative give HBIG only

Front 39

Tx for HBV

What does HBV give patient a risk of developing?

Back 39

Lamivudine


Risk: Hepatocellular cancer

Front 40

Meaning of "HCV antibody"

Back 40

Anti-HCV IgG = indicates chronic or past infection

Front 41

Tx for HCV
(2)

Back 41

Interferon

Ribavirin

Front 42

What do 25% of the chronic HCV patients develop?
(2)

Back 42

Cirrhosis

and/or

Hepatocellular CA

Front 43

Dx:
Medical student develops fever, jaundice and fatigue 2 weeks after returning from a trip to India

Back 43

Hepatitis E

Front 44

A young female is diagnosed with liver disease, but does not drink, have inflammatory bowel disease or infectious hepatitis.

Next test?
if positive, what is the Dx?
What additional immune marker is assoc w/ it?

Back 44

Next test:
Anti-Smooth Muscle Ab (ASMA)

Dx:
Autoimmune Hepatitis

Additional immune marker:
Anti-Liver/Kidney Microsome type 1 Ab
(anti-LKM1 Ab)

Front 45

Indications for Liver transplantation
(5)

Back 45

Cirrhosis;

Primary Sclerosing Cholangitis;

Chronic Hepatitis;

Hepatocellular CA;

Hepatic Vein Thrombosis

Front 46

What must match w/ donor liver?
(2)

Back 46

Size and ABO

(not Rh or HLA)

Front 47

(3) medications for Immunosuppression of Liver recipients

Back 47

Cyclophosphamide;

OKT3;

Tacrolimus