IM：肝膽胰

55 flashcards · Other · by Wanying Koh

  1. direct/total bil levels: <15% 35-45% 60-75% >85%

    hemolysis hepatocellular 肝: virus, alcohol mixed 肝膽: drug induced hepatitis obstructive 膽: stones, cholangiocarcinoma

  2. primary biliary cirrhosis more frequent in middle aged males or females? dx tx prednisolone? what other tx

    middle aged females dx: antimitochondrial antibody (AMA+) liver biopsy tx NO prednisolone give ursodeoxycholic acid URCA, liver transplant

  3. high direct/total bilirubin levels (85%) + high GGT & ALK-P indicative of what problems

    膽道疾病為主 obstructive jaundice cholestasis cholangioCa

  4. bilirubin in urine is conjugated or unconjugated?

    only conjugated bilirubin present in urine (unconjugated bil x albumin in blood, not filtered into urine)

  5. half-life of: unbounded bilirubin bilirubin x albumin

    2-4hr 2 weeks (half-life of albumin)

  6. low direct/total bilirubin level + normal LDH, hematocrit

    unconjugated bil + can r/o hemolysis => Gilbert / Crigler-Najjar (U G-C)

  7. Gilbert vs Crigler-Najjar

    Gilbert: 無其他不適, no kernictus C-N: kernictus

  8. s/s suspect what dz: tea-coloured urine clay-coloured stool Courvoisier sign RUQ pain

    hemolysis pancreatic ca cholangioca CBD stone

  9. Courvoisier sign definition

    enlarged, non-tender GB jaundice

  10. SAAG > 1.1g/dL (portal HTN related) what diseases 記得 > means portal related < means non-related

    pre-hepatic: portal v. thrombosis hepatic: cirrhosis post-hepatic: heart failure, Budd-Chiari syndrome [liver 製造ascites 所以 liver 最大 => SAAG 大 > 1.1]

  11. nephrotic syndrome SAAG ?

    SAAG <1.1g/dL non-portal HTN related 記得 > means portal related < means non-related

  12. low WBC, high RBC ascitic alb: 3.0g/dL serum alb: 3.5g/dL dx?

    SAAG < 1.1g/dL ascitic fluid total protein AFTP >2.5g/dL suspect: neoplasm, infection low WBC => r/o infection Dx: neoplasm

  13. AFTP <2.5g/dL

    SAAG < 1.1g/dL: nephrotic syndrome SAAG > 1.1g/dL: cirrhosis

  14. AFTP >2.5g/dL

    SAAG <1.1g/dL infections malignancy SAAG >1.1g/dL heart failure --> cardiac ascites Budd-Chiari syndrome

  15. hepatic hydrothorax 是什麼 通常發生在那一側

    pleural effusion (usually >500 mL) in a patient with cirrhosis who does not have other reasons to have a pleural effusion (eg, cardiac, pulmonary, or pleural disease) right side

  16. flapping tremor indicative of what dx tx

    hepatic encephalopathy tx lactulose：排便 --> 才能排出toxin ABx：rid of NH3 producing bacteria

  17. liver cirrhosis pts 不能用哪款ABx

    aminoglycosides：causes nephrotoxicity --> may worsen cirrhosis pts hepatorenal syndrome

  18. liver cirrhosis + fever + abd pain blood tests show PMN > 250 dx

    可能 SBP

  19. SBP most common bacteria

    GNR 70% (E. coli, Klebsiella) GPC 30% (S pneumoniae, Enterococcus)

  20. Bacteroides fragilis spontaneous or secondary peritonitis?

    anaerobic bacteria --> secondary bacterial peritonitis

  21. hep C treatment

    peg-IFN + ribavirin

  22. hep B treatment

    lamivudine LAM-B

  23. anti-HBc IgG(+) anti-HBc IgM(-) anti-HBe Ag(+) Dx

    HBc -- 曾經感染過 IgG(+) -- not active replication Dx： hep B carrier [IgM(+) 才是 active replication]

  24. can hep C be passed on to child by breastfeeding

    no (blood or body secretions only)

  25. hep A prevention procedure

    check for hep A antibody 抗體 (NOT antigen 抗原） if no AB, can receive hep A vaccine

  26. hep A immunoglobulin 什麼時候用

    post-exposure prophylaxis

  27. most common mode of transmission of hep B in taiwan

    vertical transmission

  28. endemic areas mode of transmission of hep b

    vertical, horizontal 都有

  29. liver transplant most common indication in taiwan other countries

    chronic hep B chronic hep C, alcoholic hepatitis

  30. which hep virus 跟 fatty liver 無關 hep B vs. hep C

    hep B 無關

  31. alcohol related to what hep virus

    hep C HCV infection is particularly common in alcoholics, and the disease course and rate of progression can be exacerbated by alcohol consumption

  32. acetaminophen overdose 會不會傷害 liver ？ kidney？ pathology？

    liver, kidney 都會被傷害 in liver: centrilobular necrosis

  33. fatty liver in u/s image

    hyperechoic (白) compared to kidney [normal: same echogenicity as kidney] [vs. cirrhosis: 後者 shrunken and lumpy] in CT, fatty liver hypodense (比 pancreas 暗 -- normal 肝比脾亮)

  34. mallory body pathology present dx?

    alcoholic hepatitis

  35. caput medusae (umbilicus 周遭有明顯血管) spleen dullness ascites indicative of what dx?

    spleen dullness => splenomegaly all symptoms of portal hypertension SAAG > 1.1

  36. esophageal varices tx

    non-selective B blocker regular band ligation

  37. precipitants of hepatic encephalopathy

    infection hypoK high protein diet

  38. hepatic encephalopathy pts can consume branched-chain aa (valine, isoleucine, leucine)?

    yes. enzyme needed to break down these aa found in other tissues, not liver

  39. Milan criteria define used for what

    define: used to determine whether pt is fit for liver transplant single tumor <5cm OR multiple (2-3) tumors <3cm AND NO vascular invasion, extrahepatic spread

  40. hepatic granulomas associated with which meds sulfonamides tetracycline isoniazid allopurinol

    all except tetracycline

  41. liver cirrhosis pts 容易得 what kind of GB stones

    pigment stones

  42. ursodeoxycholic acid 可 treat what kind of GB stones

    cholesterol stones (pigment stones 不行)

  43. post-cholecystectomy diarrhea treat w what

    cholestyramine

  44. RANSON criteria on admission first 48hr

    on admission: ASS 乳白 age, sugar, AST, LDH, WBC first 48hr: BUNny base sequester Ca, HCT, O2 BUN inc, base deficit, sequestration of fluid, dec Ca, HCT , PaO2

  45. hep C progressive factors

    male alcohol 40-55yo 中年 喝酒 男性 (HCV -> 4/5 chronic hepatitis -> 1/5 cirrhosis -> 1/4 HCC)

  46. can use morphine in sphincter of oddi spasm pts?

    NO. morphine causes sphincter of oddi contraction --> pancreatic pressure inc and worsens condition

  47. UDCA can be used to treat GB stones in what pts

    stone < 1.5cm cholesterol stones (pigment stones, calcified stones 不行) CBD no obstruction

  48. hep B disease severity related to subtype or genotype B genotype has lower HCC risk than C genotype

    genotype genotype C higher risk than genotype B hep B ---> 5% chronic hep B

  49. hep B tx nucleos/tide analogues can treat 重症 pts nucleos/tide analogues can change clinical course nucleos/tide analogues can decrease complications and mortality treat until?

    yes cannot change clinical course can dec complications and mortality rates HBsAg seroconversion post-3 mo, or HBeAg seroconversion post-6 mo

  50. HCC paraneoplastic syndrome % 包括 blood abnormalities

    30-40% pts hyper Ca, hypoglycemia, erythrocytosis, hypercholesterolemia 高 Ca, cholesterol, RBC // 低 glucose

  51. liver during pregnancy acute fatty liver of pregnancy occurs when ? 會有什麼pathology HELLP syndrome 主要立即生產為治療？ AST, ALT, ALP levels during pregnancy

    third trimester microvesicular fat 對 ALP inc, AST, ALT no change

  52. hepatic encephalopathy need to control protein intake? MgO as treatment? ammonia levels related to severity? causes

    NO need to control protein intake, unless all other tx options exhausted NO. use lactulose - maintain gut acidity unrelated

  53. cirrhosis with portal HTN cirrhosis 改變liver BV distribution - some areas hypodense, some areas hyperdense 亮亮 = blood vessels = varices caused by portal HTN from liver cirrhosis

  54. liver cirrhosis 數值

    LFTs AFT/ALT inc T bil inc PT/INR prolong Alb dec Hematology tests WBC, RBC, plt dec Chemistry hypoNa Fe/TIBC inc ferritin inc

  55. newest first line for hep C

    oral DAA ((direct acting antiviral agents) old - peg-IFN + ribavirin