©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
NURS 5462 BILIARY TRACT Exam Study
Guide.
Jaundice - Answers✔Bilirubin formed by the breakdown of Hbg. in RBCs,Most bile excreted in
stool Normal 0.1-1 mg/dL or 5.1-17 mmol/L
seen in liver disease, biliary obstruction, hemolytic anemias, Gilbert syndrome [Gilbert
Syndrome]
Elevated Unconjugated Bilirubin - Answers✔Stool/urine WNL Mild jaundice Indirect bilirubin
elevated No bilirubin in urine Splenomegaly Hemolytic anemias
Elevated Conjugated Bilirubin - Answers✔Hereditary cholestatic syndromes Hepatocellular
disease Dark urine Hepatomegaly Palmar erythema Gynecomastia Asterixis
Biliary Obstruction - Answers✔Colicky RUQ pain Pain may be intermittent Occult blood
Weight loss Fever/Chills [cholangitis]
Diagnostics - Answers✔US CT ERCP or PTC to locate obstruction
Autoimmune Hepatitis - Answers✔More common in young women Infected people often + for
HLA-B8, HLA-DR3 or HLA-DR4 [older people] Usual gradual onset; some episodes follow
viral illness or use of a certain drug [Nitrofurantoin] Bilirubin elevated, but 20% are anicteriC
On exam - Answers✔healthy appearing young woman with spider nevi, hepatomegaly,
cutaneous striae Other signs/symptoms Thyroiditis Nephritis Ulcerative colitis
Autoimmune Hepatitis: Presentations - Answers✔Type I ANA +/- SMA present Serum GGT
elevated and serum antibody for HCV may be falsely +
Type II More common in Europe Anti-LKM1 without positive SMA or ANA
Autoimmune Hepatitis Therapy - Answers✔Prednisone 30 mg daily with Imuran or
Mercaptopurine 50 mg/d until symptoms decrease and bilirubin, transaminases and GGT
normalize Prednisone then decreased to 20 mg/d; then after 2- 3 weeks, 15 mg/d; maintenance
dose of 10 mg/d Complete resolution usual in 18-24 month
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Alcoholic Hepatitis - Answers✔Acute or chronic inflammation and parenchymal necrosis from
ETOH use
Alcoholic Hepatitis: Lab Findings - Answers✔Macrocytic anemia Leukopenia
Thrombocytopenia Elevated AST [usually not >300 units/L; AST >ALT, sometimes by as much
as **twice or more], Elevated bilirubin [can be 10 mg/dL or more] Prolonged PT [>6 seconds]
GGT, MCV and transferrin elevated Low albumin
low ALB, Hight ptt, high bili=bad signs
Alcoholic Hepatitis Treatment - Answers✔Abstinence Good nutritious diet Supplemental diet
Drugs Methylprednisolone 32 mg/d for 30 days can sometimes help in alcoholic hepatitis
Alcoholic Hepatitis: Prognosis - Answers✔PT <3 seconds: 1 year mortality rate is 07% PT >3
seconds: 1 year mortality rate is 18% PT >6 seconds: 1 year mortality rate is 42%
Cirrhosis - Answers✔Chronic degenerative disease of the liver in which lobes are covered with
fibrous tissue, degeneration of parenchyma and lobules infiltrated with fat; Blood flow thru liver
is obstructed, resulting in back pressure that causes portal hypertension and esophageal varices
Macronodular Cirrhosis - Answers✔Large lobules with their own blood supply Seen in
hepatocellular carcinoma
Micronodular Cirrhosis - Answers✔Laennec's cirrhosis Regenerated lobules are not larger than
original lobules Seen in alcoholism
Cirrhosis: Symptoms - Answers✔Varied- asymptomatic and gradual or sudden Hematemesis
[15-25%] Splenomegaly [35-50%] Anorexia and weight loss Decreased libido, amenorrhea,
gynecomastia [men] Hepatomegaly [70%] Spider nevi, palmar erythema Ascites and lower
extremity edema are late signs
Hepatotoxic Drugs and Toxins - Answers✔Environmental Toxins Arsenic Fluorine
Trichloroethylene Copper Vinyl chloride Toluene
Drugs INH Sodium valproate Quinolones Acetaminophen Phenothiazines Ketoconazole
Cirrhosis Rx - Answers✔Abstinence from all ETOH Adequate diet; restrict Na Spironolactone
100 mg/d up to 400 mg/d Paracentesis for ascites and respiratory distress TIPS for recurrent
bleeds and refractory ascites Liver transplant
Esophageal Varices - Answers✔Arise from obstruction of portal system that causes portal
hypertension, Portal hypertension occurs when elevated hydrostatic pressure within portal
venous circulation occurs as a result of inflammation and/or obstruction of blood flow
Bleeding occurs - Answers✔portal hypertension gradient is >/= 12 mm Hg
ALL RIGHTS RESERVED.
NURS 5462 BILIARY TRACT Exam Study
Guide.
Jaundice - Answers✔Bilirubin formed by the breakdown of Hbg. in RBCs,Most bile excreted in
stool Normal 0.1-1 mg/dL or 5.1-17 mmol/L
seen in liver disease, biliary obstruction, hemolytic anemias, Gilbert syndrome [Gilbert
Syndrome]
Elevated Unconjugated Bilirubin - Answers✔Stool/urine WNL Mild jaundice Indirect bilirubin
elevated No bilirubin in urine Splenomegaly Hemolytic anemias
Elevated Conjugated Bilirubin - Answers✔Hereditary cholestatic syndromes Hepatocellular
disease Dark urine Hepatomegaly Palmar erythema Gynecomastia Asterixis
Biliary Obstruction - Answers✔Colicky RUQ pain Pain may be intermittent Occult blood
Weight loss Fever/Chills [cholangitis]
Diagnostics - Answers✔US CT ERCP or PTC to locate obstruction
Autoimmune Hepatitis - Answers✔More common in young women Infected people often + for
HLA-B8, HLA-DR3 or HLA-DR4 [older people] Usual gradual onset; some episodes follow
viral illness or use of a certain drug [Nitrofurantoin] Bilirubin elevated, but 20% are anicteriC
On exam - Answers✔healthy appearing young woman with spider nevi, hepatomegaly,
cutaneous striae Other signs/symptoms Thyroiditis Nephritis Ulcerative colitis
Autoimmune Hepatitis: Presentations - Answers✔Type I ANA +/- SMA present Serum GGT
elevated and serum antibody for HCV may be falsely +
Type II More common in Europe Anti-LKM1 without positive SMA or ANA
Autoimmune Hepatitis Therapy - Answers✔Prednisone 30 mg daily with Imuran or
Mercaptopurine 50 mg/d until symptoms decrease and bilirubin, transaminases and GGT
normalize Prednisone then decreased to 20 mg/d; then after 2- 3 weeks, 15 mg/d; maintenance
dose of 10 mg/d Complete resolution usual in 18-24 month
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Alcoholic Hepatitis - Answers✔Acute or chronic inflammation and parenchymal necrosis from
ETOH use
Alcoholic Hepatitis: Lab Findings - Answers✔Macrocytic anemia Leukopenia
Thrombocytopenia Elevated AST [usually not >300 units/L; AST >ALT, sometimes by as much
as **twice or more], Elevated bilirubin [can be 10 mg/dL or more] Prolonged PT [>6 seconds]
GGT, MCV and transferrin elevated Low albumin
low ALB, Hight ptt, high bili=bad signs
Alcoholic Hepatitis Treatment - Answers✔Abstinence Good nutritious diet Supplemental diet
Drugs Methylprednisolone 32 mg/d for 30 days can sometimes help in alcoholic hepatitis
Alcoholic Hepatitis: Prognosis - Answers✔PT <3 seconds: 1 year mortality rate is 07% PT >3
seconds: 1 year mortality rate is 18% PT >6 seconds: 1 year mortality rate is 42%
Cirrhosis - Answers✔Chronic degenerative disease of the liver in which lobes are covered with
fibrous tissue, degeneration of parenchyma and lobules infiltrated with fat; Blood flow thru liver
is obstructed, resulting in back pressure that causes portal hypertension and esophageal varices
Macronodular Cirrhosis - Answers✔Large lobules with their own blood supply Seen in
hepatocellular carcinoma
Micronodular Cirrhosis - Answers✔Laennec's cirrhosis Regenerated lobules are not larger than
original lobules Seen in alcoholism
Cirrhosis: Symptoms - Answers✔Varied- asymptomatic and gradual or sudden Hematemesis
[15-25%] Splenomegaly [35-50%] Anorexia and weight loss Decreased libido, amenorrhea,
gynecomastia [men] Hepatomegaly [70%] Spider nevi, palmar erythema Ascites and lower
extremity edema are late signs
Hepatotoxic Drugs and Toxins - Answers✔Environmental Toxins Arsenic Fluorine
Trichloroethylene Copper Vinyl chloride Toluene
Drugs INH Sodium valproate Quinolones Acetaminophen Phenothiazines Ketoconazole
Cirrhosis Rx - Answers✔Abstinence from all ETOH Adequate diet; restrict Na Spironolactone
100 mg/d up to 400 mg/d Paracentesis for ascites and respiratory distress TIPS for recurrent
bleeds and refractory ascites Liver transplant
Esophageal Varices - Answers✔Arise from obstruction of portal system that causes portal
hypertension, Portal hypertension occurs when elevated hydrostatic pressure within portal
venous circulation occurs as a result of inflammation and/or obstruction of blood flow
Bleeding occurs - Answers✔portal hypertension gradient is >/= 12 mm Hg
