The most common cause of intestinal obstruction is:
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - ANSWER-A- adhesion
A firm liver on physical exam is usually associated with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - ANSWER-B- Passive congestion
Differential diagnosis of lower GI Bleed - ANSWER--Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Goals of GI Bleed Resuscitation - ANSWER--Volume resuscitation (IV fluids, PRBCs)
-Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
What are the vitamin K dependent clotting factors synthesized by the liver? - ANSWER-Factor II, VII, IX, X
and proteins C and S
, How is the adequacy of vit. K dependent clotting factors estimated? - ANSWER-PT and INR.
Prolongated from impaired coagulation factor synthesis or Vitamin K deficiency. (If PT/INR normalize
after Vit K administration, this indicates Vit K deficiency).
AST and ALT enzymes - ANSWER-Elevations-->hepatocellular injury, necrosis. Marked elevations (>1000)
typically occur with acute hepatocellular injury (viral, drugs, ischemia). AST>2x ALT = alcohol. AST<1 ALT
= viral hepatitis
Alkaline phosphatase (ALP) enzyme - ANSWER-Elevations-->cholestatic (biliary obtruction, space-
occupying/infiltrative lesions of liver). ALP present in multiple tissues. An elevated GGT (enzyme)
establishes hepatic origin of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - ANSWER-Normal adult level: <10
Insensitive marker for hepatocellular carcinoma. Mild-moderate elevations in acute & chronic liver
inflammation.
Hypoalbuminemia - ANSWER-Frequently decreased in chronic liver disease. Also: chronic inflammation;
expanded plasma volume; GI or renal losses.
May be normal in acute liver disease because albumin 1/2 life is 20 days.
Normal value: 3.4 - 5
Bilirubin - ANSWER-Degradation product of hemoglobin. Total bili = conjugated + unconjugated
fractions. Normally bilirubin is processed by the liver and conjugated to a pigment secreted in the bile.
The more rapid destruction of RBCs-->higher bilirubin level. Mainly excreted in feces.
Causes of unconjugated hyperbilirubinemia: - ANSWER-Excessive bilirubin production: hemolysis and
hemolytic anemias, ineffective erythropoesis, resorption of hematomas
Causes of elevated total bilirubin: - ANSWER-Obstructive or hepatocellular origin of jaundice
Normal value: 0.2 - 1
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - ANSWER-A- adhesion
A firm liver on physical exam is usually associated with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - ANSWER-B- Passive congestion
Differential diagnosis of lower GI Bleed - ANSWER--Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Goals of GI Bleed Resuscitation - ANSWER--Volume resuscitation (IV fluids, PRBCs)
-Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
What are the vitamin K dependent clotting factors synthesized by the liver? - ANSWER-Factor II, VII, IX, X
and proteins C and S
, How is the adequacy of vit. K dependent clotting factors estimated? - ANSWER-PT and INR.
Prolongated from impaired coagulation factor synthesis or Vitamin K deficiency. (If PT/INR normalize
after Vit K administration, this indicates Vit K deficiency).
AST and ALT enzymes - ANSWER-Elevations-->hepatocellular injury, necrosis. Marked elevations (>1000)
typically occur with acute hepatocellular injury (viral, drugs, ischemia). AST>2x ALT = alcohol. AST<1 ALT
= viral hepatitis
Alkaline phosphatase (ALP) enzyme - ANSWER-Elevations-->cholestatic (biliary obtruction, space-
occupying/infiltrative lesions of liver). ALP present in multiple tissues. An elevated GGT (enzyme)
establishes hepatic origin of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - ANSWER-Normal adult level: <10
Insensitive marker for hepatocellular carcinoma. Mild-moderate elevations in acute & chronic liver
inflammation.
Hypoalbuminemia - ANSWER-Frequently decreased in chronic liver disease. Also: chronic inflammation;
expanded plasma volume; GI or renal losses.
May be normal in acute liver disease because albumin 1/2 life is 20 days.
Normal value: 3.4 - 5
Bilirubin - ANSWER-Degradation product of hemoglobin. Total bili = conjugated + unconjugated
fractions. Normally bilirubin is processed by the liver and conjugated to a pigment secreted in the bile.
The more rapid destruction of RBCs-->higher bilirubin level. Mainly excreted in feces.
Causes of unconjugated hyperbilirubinemia: - ANSWER-Excessive bilirubin production: hemolysis and
hemolytic anemias, ineffective erythropoesis, resorption of hematomas
Causes of elevated total bilirubin: - ANSWER-Obstructive or hepatocellular origin of jaundice
Normal value: 0.2 - 1
