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when at least ............ of liver function has been lost, the synthetic capacity
of the liver is diminished
70 to 80%
The most common cause of cirrhosis in the United States is
alcohol
the most common
reason to need a liver transplantation is
chronic hepatitis C
The features common to all forms of cirrhosis, despite the etiology, are
a low albumin level,
portal hypertension, esophageal varices, ascites, peripheral edema, an elevated prothrombin
time, spider angiomata, palmar erythema, asterixis, and sometimes, encephalopathy.
asterixis,
Asterixis (also called the flapping tremor, or liver flap) is a tremor of the wrist when the wrist is extended (dorsiflexion), sometimes said to resemble a bird flapping its wings.
(All of the clotting factors are made
in the liver, with the exception of factor --------------
VIII and Von Willebrand factor,
VIII and Von Willebrand factor, which are made in the
-------------
vascular endothelial cells.
Spontaneous bacterial peritonitis (SBP) is an ..............
idiopathic infection of ascites.
The Gram stain is
rarely positive because .....
the density of microorganisms is so low.
Although 111111 of the fluid is
the most specific test 222222
1culture
2we cannot wait for the results of the culture to make a decision as to
whether to give antibiotics.
the criteria to determine the presence of infection
A total white cell count of >500/mm3 or the presence of >250/mm3
neutrophils are
------------------
are the drugs of choice for SBP .
Cefotaxime and ceftriaxone
---------------------- infusion decreases risk of hepatorenal syndrome
albumin
Normally, the ascitic fluid albumin level is always--------- than the serum level.
less
e serum-ascites albumin gradient, or SAAG
The difference
between them
When this gradient, or SAAG, is > 1.1,
portal hypertension, as from cirrhosis, is generally
the cause.
Cancer and
infections generally give a SAAG
<1.1.
When the SAAG is < 1.1, it means
the ascitic fluid albumin level is high.
is There specific therapy to reverse cirrhosis.
no
Edema and fluid overload in third spaces, such as ascites, are managed with -----------
diuretics.
The
diuretic most useful in cirrhosis is
spironolactone.
This is because
cirrhotics have intravascular
volume depletion, which results in a high aldosterone state.
Portal hypertension and varices are managed with ------------to prevent bleeding.
propranolol
Encephalopathy is managed with
neomycin or lactulose,
lactulose
a nonabsorbed disaccharide that
bacteria metabolize in the colon, making it more acidic.
making it more acidic. This
converts the NH3 to NH4
+ , or
ammonia to ammonium.
Ammonium is not absorbed very well,
and this leads to an overall
increased excretion of ammonia from the body.
Although vitamin K is often given because of the elevated prothrombin time, it is not effective
because
the liver is not able to synthesize clotting factors, no matter how much vitamin K is
present.
Primary biliary cirrhosis is an idiopathic autoimmune disorder that occurs more
often in
middle-aged women.
Bilirubin levels do not elevate until the disease is extremely far
advanced, which is usually after ---------
5 to 10 years.
The
diuretic most useful in cirrhosis is
spironolactone.
This is because
cirrhotics have intravascular
volume depletion, which results in a high aldosterone state.
Portal hypertension and varices are managed with ------------to prevent bleeding.
propranolol
Encephalopathy is managed with
neomycin or lactulose,
lactulose
a nonabsorbed disaccharide that
bacteria metabolize in the colon, making it more acidic.
making it more acidic. This
converts the NH3 to NH4
+ , or
ammonia to ammonium.
Ammonium is not absorbed very well,
and this leads to an overall
increased excretion of ammonia from the body.
Although vitamin K is often given because of the elevated prothrombin time, it is not effective
because
the liver is not able to synthesize clotting factors, no matter how much vitamin K is
present.
Primary biliary cirrhosis is an idiopathic autoimmune disorder that occurs more
often in
middle-aged women.
Bilirubin levels do not elevate until the disease is extremely far
advanced, which is usually after ---------
5 to 10 years.
xxxxxxxxx levels do not elevate until the disease is extremely far
advanced, which is usually after 5 to 10 years
Bilirubin
Primary biliary cirrhosis has a strong association with
other autoimmune diseases, such as xxxxxxx
Sjogren syndrome, rheumatoid arthritis, and scleroderma.
The most common symptoms of Primary biliary cirrhosis are xxxxxx
fatigue and pruritus.
xxxxxxxxxx s is found in 20 to 30% of patients.
Osteoporosi
Primary biliary cirrhosis Diagnosis. The 111111 are often normal. The most common abnormality is an elevation
of 2222222222
1 transaminases
2alkaline phosphatase and gamma glutamyl transpeptidase (GGTP).
Total Ig33 levels are also
elevated.
3 M
The most specific blood test is the
antimitochondrial antibody.
xxxxxxx is always the best way to diagnose liver disease. It is the only test more specific than
antimitochondrial antibodies.
Biopsy
There is no specific therapy for primary biliary cirrhosis. Steroids will not help.
Bile acid-binding medication, such as xxxxxxxxx , are used with
variable success. yyyyyy is recommended to treat the pruritus.
x)ursodeoxycholic acid and cholestyramine
y)Ultraviolet light
liver transplant
for late stage PBC may also be considered.
xxxxxxxxxx is
the only chronic liver disease
in which a liver biopsy is not
the most accurate test.
Primary sclerosis cholangitis
Primary Sclerosis Cholangitis
Pathogenesis. This is an idiopathic disorder of the biliary system most commonly associated
withxxxxxxxxxx
inflammatory bowel disease (IBD).
Although it is more often found with 11111111
it can also occur with 222222.
1 ulcerative colitis,
2 Crohn disease
xx of the biliary system can develop in 15% of patients
from the chronic inflammation.
Cancer
The most specific test for primary sclerosis cholangitis is an xxxx
ERCP or transhepatic
cholangiogram.
Primary sclerosis cholangitis Treatment. Therapy is the same as for
primary biliary cirrhosis
Hemochromatosis Clinical Presentation. xxxxx is the most common finding.
Cirrhosis
Hemochromatosis xxxxx cancer develops in
15 to 20% of patients.
Hepatocellular
Hemochromatosis Clinical Presentation.
Restrictive cardiomyopathy Arthralgias, skin hyperpigmentation, diabetes, and hypogonadism
Hemochromatosis xxxxx infections occur with increased frequency because of their avidity for iron.
Vibrio vulnificus
and Yersinia
Hemochromatosis Treatment.
Phlebotomy
A patient presenting with
choreoathetoid movements
and psychosis gives the clue to
perform the xxxxx
slit-lamp
examination. Kayser-Fleischer
rings are then found,
confirming the diagnosis of
Wilson disease.
Wilson disease is an autosomal xxxx disorder leading to the diminished
ability to excrete copper from the body.
recessive
Copper builds up in the xxx yy zzz
liver, brain, and cornea
xxxxx dysfunction
contributes to the movement disorder that develops.
Basal ganglia
xxxxxxxx yyyyyyy develop
because of copper deposition in the kidney.
Fanconi syndrome and type II proximal renal tubular acidosis
The most specific blood test is a low
ceruloplasmin level.
Chronic hepatitis B is treated with
interferon, lamivudine, or adefovir.
Chronic hepatitis C is
treated with the combination of xxxx
pegylated interferon and ribavirin.