52.2 📚 國考版醫垫國考 / PGY OSCE

52.2.0.1 📌 Cram Sheet

52.2.0.1.1 🔥 高 yield 10
  1. 3 分類pre / hepatic / post-hepatic
  2. Unconjugated: hemolysis / Gilbert / Crigler-Najjar
  3. Conjugated: hepatocellular / cholestatic
  4. AST > ALT 2:1 = alcoholic
  5. Painless jaundice + weight loss = pancreatic Ca
  6. Charcot triad = cholangitis
  7. Reynolds pentad = + shock + altered
  8. Acute liver failure: INR > 1.5 + encephalopathy + < 26 wk
  9. Gilbert benign, fasting/stress 加重
  10. Mirizzi: gallstone in cystic duct compress CBD
52.2.0.1.2 🔢 必背
項目 æ•žå­—
Jaundice visible bili > 2.5-3 mg/dL
AST:ALT alcoholic > 2:1
Acute hepatitis ALT 1000s
Mirizzi syndrome bili obstruction by stone in cystic duct
Maddrey discriminant function > 32 = severe alcoholic hep
52.2.0.1.3 易錯
  • Painless jaundice 䞍查 cancer
  • Charcot triad delay ERCP
  • AST > ALT 䞍認 alcohol
  • Acetaminophen overdose 䞍查 (DILI)

52.2.0.2 ⭐ 高 yield

52.2.0.2.1 Bili Metabolism
  • Heme → biliverdin → unconjugated → albumin → liver UGT → conjugated → bile → è…ž → urobilinogen
  • Conjugated 過 urinedark urine
  • Unconjugated 侍過 urine
52.2.0.2.2 Hepatitis Serology (HBV)
  • HBsAg + = active infection
  • Anti-HBs + = immunity (vaccine or recovered)
  • Anti-HBc IgM = acute
  • Anti-HBc total + HBsAg − = past infection
  • HBeAg = high replication
52.2.0.2.3 Alcoholic Hepatitis Severity
  • Maddrey DF: 4.6 × (PT - control) + bili

    • 32 = severe → consider steroid (prednisolone 40 mg × 28d)

  • MELD score
  • Lille score (assess steroid response at day 7)
52.2.0.2.4 NAFLD / MASLD (22E rename)
  • Steatosis without alcohol
  • 25% global
  • 可進展 NASH → cirrhosis → HCC
  • FIB-4, NAFLD fibrosis score
  • 治療weight loss, GLP-1 agonist (semaglutide), resmetirom (THR-β agonist) — 22E new
52.2.0.2.5 Cholestasis
  • ALP ↑ + GGT ↑ confirms hepatic origin
  • US first → MRCP > ERCP
  • Treat obstruction
52.2.0.2.6 PBC vs PSC
PBC PSC
性別 女 90% 男 70%
共病 自體免疫 UC
Antibody AMA + p-ANCA +
圱像 small intrahepatic ducts beads on string
治療 UDCA UDCA limited; transplant

52.2.0.3 🎯 自我檢枬

  1. AST/ALT > 2:1? → Alcoholic
  2. Painless jaundice + 老人 + 體重 ↓? → Pancreatic Ca
  3. Charcot triad? → Fever + jaundice + RUQ → cholangitis
  4. Mirizzi syndrome? → Gallstone in cystic duct compress CBD
  5. PBC AMA? → +
  6. Acute liver failure criteria? → INR > 1.5 + encephalopathy + < 26 wk
  7. Resmetirom 22E? → MASH treatment (THR-β)

⚠ AI 草皿。