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64 Cards in this Set
- Front
- Back
complications of cirrhosis
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portal htn
hepatocellular failure |
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2 most common causes of cirrhosis
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alcohol use
chronic hepatitis b and c |
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clinical features of portal htn
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bleeding from varices - most life threatening
hemorrhoids caput medusae |
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tx of portal htn
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tips (transjugular intrahepatic portal systemic shunt) to lower portal pressure
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what is the most common type of varices from portal htn
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esophageal (90%) gastric (10%)
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acute tx of varices
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hemodynamic stabilization (plus fluids)
ligation/banding endoscopy sclerotherapy octreotide |
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long-term treatment of varices
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beta blocker to prevent rebleeding
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etiologies of ascites
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increased portal htn (hydrostatic pressure increased)
decreased albumin concentration (decreases oncotic pressure) |
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how to differentiate the causes of ascites
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calculate the saag
if >1.1, then from portal htn, if <1.1, then from hypoalbumin state |
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tx for ascites
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bed rest, low sodium diet, and diuretics
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pathophys of hepatic encephalopahthy
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ammonia accumulates b/c the liver is unable to detoxify it
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clinical presentation of hepatic encephalopathy
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asterixis
fetor hepaticus |
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treatment of hepatic encephalopathy
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decreased protein diet
lactulose neomycin (last resort) to decrease bacteria that produce ammonia |
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pathophys of hepatorenal syndrome
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decreased renal perfusion b/c RAAS gets activated from decreased bp in splanchnic circulation, so there is peripheral vasoconstriction --> poor renal perfusion
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clinical features of hepatorenal syndrome
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azotemia
oliguria hyponatremia hypotension low urine sodium |
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tx for hepatorenal syndrome
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octreotide + midodrine: palliative
liver transplant is the only cure |
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pathophysiology of spontaneous bacterial peritonitis
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portal htn increases --> gut hypomotility, and bacterial overgrowth
bv become more permeable and bacteria enter mesenteric ln and then enter blood stream ascites fluid becomes infected |
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organisms usually involved with spontaneous bacterial peritonitis
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usually monomicrobial (e coli, klebsiela, strep pneumo)
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dx of spontaneous bacterial peritonitis
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pnml >250
ascites cx |
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tx of spontaneous bacterial peritonitis
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iv abx
|
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complications of spontaneous bacterial peritonitis
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hepatic abscess
hepatorenal syndrome intestinal obx |
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pathophys of wilson's disease
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copper is normally excreted by the liver, but in wilson's disease, there is a ceruloplasmin deficiency (required for excretion) so cu builds up
cu accumulates in hepatocytes, causing them to die and release cu into plasma and accumulate in kidney, cornea, and brain |
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clinical features of wilson's disease
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hepatitis
cirrhosis fulminant hepatic failure kayser'-fleischer rings extrapyramidal signs psych disturbances (depression, neurosis, psychosis, personality changes) |
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dx of wilson's disease
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elevated aminotransferases
low ceruloplasmin levels liver bx shows elevated cu |
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tx for wilson's disease
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chelating agents (penacillamidene - removes and detoxifies cu deposits)
zn (prevents dietary uptake of cu) liver transplant |
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pathophys of hemochromatosis
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excessive fe absorption in intestines --> fe accumulation
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organs affected by hemochromatosis
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liver
pancreas skin heart joints |
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clinical features of hemochromatosis
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liver dz
fatigue arthritis abdominal pain cardiac arrhythmias |
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complications of hemochromatosis
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cirrhossi
cmp arthritis dm bronzing of the skin |
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dx of hemochromatosis
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liver bx required for dx
|
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pathogenesis of appendicitis
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lumen of appendix is most commonly blocked by hyperplasia of lymphoid tissue or fecalith
obx --> stasis --> bacterial overgrowth and inflammation |
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pathogenesis of ruptured appendix
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distension of appendix can compromise blood supply and can lead to infarction or necrosis
necrosis --> perforation and peritonitis |
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imaging to dx appendicitis
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ct most sensitive and secific
u/s |
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pregnant woman with suspected appendicitis
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surgery despite risk of false positive b/c risks are too severe
|
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most common site for carcinoid tumor
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appendix
|
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location of carcinoid tumor if it is malignant
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ileal tumor
|
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pathogenesis of acute pancreatitis
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inflammation of pancreas from autodigestion of the pancreas
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causes of acute pancreatitis
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GET SMASHeD
Gallstones EtOH Trauma Steroids Mumps Autoimmune dz Scorpion Hypercalcemia, Hyperlipidemia Drugs |
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which is more specific in acute pancreatitis: amylase or lipase
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lipase
|
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what is the purpose of lfts in acute pancreatitis
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to ID cause (esp if related to gallstones)
|
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role of abdominal radiographs in acute pancreatitis
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used to r/o other dx
calcifications suggests chronic pancreatitis can sometimes see sentinel loop (air filled bowel in LUQ that demonstrates localized ileus) |
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role of u/s in acute pancreatitis
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to ID gallstones
can be used to follow pseudocyst or abscess |
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which is the test of choice for dx of acute pancreatitis
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ct
|
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indication for ercp in acute pancreatitis
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if it is from severe gallstone pancreatitis with biliary obx
to id uncommon causes of acute pancreatitis if dz is recurrent |
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pathogenesis of pancreatic pseudocyst
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localized collection of necrotic hemorrhagic material rich in pancreatic enzymes
it lacks and epithelial lining |
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complications of untreated pseudocysts
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rupture infx, gastric outlet obx, fisual, hemorrhage and pancreatic ascites
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dx of pancreatic pseudocyst
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ct
|
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tx of pancreatic pseudocyst
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<5cm, observation
>5cm, drain |
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complications of acute pancreatitis
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pancreatic necrosis
pancreatic pseudocyst hemorrhagic pancreatitis ARDS pancreatic ascites pleural effusion ascending cholangitis pancreatic abscess |
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tx of acute pancreatitis
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npo
ivf pain control |
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pathogenesis of chronic pancreatitis
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continuing inflammation of pancreas, with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic ducts --> irreversible destruction of pancreas
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most common cause of chronic pancreatitis
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chronic alcoholism
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presentation of chronic pancreatitis
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chronic epigastric pain + calcifications on plain abdominal films
steatorrhea, DM, and pancreatic calcifications |
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serum and amylase levels in chronic pancreatitis
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not elevated
|
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appearance of chronic pancreatitis on ct
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calcifications and pseudocysts an be seen
|
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appearance of chronic pancreatitis on ercp
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chain of lakes appearance from areas of stricture and duct dilation throughout the pancreatic ducts
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complications of chronic pancreatitis
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dm
narcotic addiction malabsorption/steatorrhea pseudocyst formation pancreatic ductal dilation b12 malabsorption pancreatic carcinoma |
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non surgical tx for chronic pancreatitis
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narcotics for pain
npo pancreatic enzymes + h2 blockers insulin alcohol abstinence frequent small low-fat meals |
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surgical tx for chronic pancreatitis
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pancreaticojejunostomy (drains the pancreatic ducts to decompress dilated ducts)
pancreatic resection |
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most common location for pancreatic cancer
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pancreatic head
|
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risk factors for pancreatic cancer
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cigarette smoking (most common)
chronic pancreatitis dm heavy etoh use exposure to benzidine and b-naphthylamine |
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purpose of h2 blockers + pancreatic enzymes in chronic pancreatitis
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pancreatic enzymes inhibit cck release and decrease pancreatic secretion after meals
h2 blockers inhibit gastric acid secretion, preventing degradation of pancreatic enzyme supplements by gastric acid |
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test for dx pancreatic ca
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ct
ercp |
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tumor markers for pancreatic ca
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ca 19-9
CEA |