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39 Cards in this Set
- Front
- Back
You prove this by demonstrating the thickened gallbladder wall, free fluid in the gallbladder fossa, and a 7mm stone jammed into the neck of the gallbladder---your patient has cholecystitis. What things will be Elevated? |
Elevated -conjugated bilirubin -white blood cells -Alkaline phosphatase |
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Your patient has cirrhosis and is in clinic for a liver biopsy. Because of the depleted function of his liver, he has low levels of clotting factors. Which enzyme, will be tested to make sure your patient is not at risk of bleeding out during the procedure? |
Prothrombin The clotting factor prothrombin is a precursor to thrombin, which is needed for the formation of normal blood clots. |
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What cell did the liver use to convert into bilirubin? |
Red Blood cells
Results from the degradation of heme by reticuloendothelial liver cells, causing a reddish bile pigment. |
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Portal hypertension leads to varices in the abdominal wall and gastrointestinal system.
What elevated clotting factor would lead to a thrombus (blood clot) obstructing the Portal Vein? |
Platelets
Collateral circulation develops when the normal venous channels become obstructed. The most common collateral pathways are through the coronary and esophageal veins, as occurs in 80% to 90% of patients with portal hypertension. |
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What are Varices? |
Varices are tortuous dilations of veins that may develop because of increased pressure in the portal vein, usually secondary to cirrhosis. Bleeding from the varices occurs with increased pressure. |
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Blood Urea Nitrogen is excreted by the liver so it can then be eliminated from from the body by the kidneys. If the liver can't convert the toxin ammonia into into urea, what can condition can a patient develop? |
Loss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy |
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What is Bilirubin? |
A waste product that is formed when hemoglobin breaks down. It is insoluble in water and is carried to the liver bound to albumin. It is made water soluble in the liver by conjugation with glucuronic acid. After it is convert into a soluble form, it is a part of bile and passes through the Common Bile duct into the gallbladder to be stored or passes right away into the gut. |
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What does it mean to higher-than-normal levels of Direct/conjugated bilirubin serum in the blood? |
This may indicate the liver is not clearing the bilirubin properly. Maybe a blocked bile duct
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How do you measure indirect/ unconjugated bilirubin and why would you have an elevated level of it? |
Indirect/ unconjugated bilirubin is usually measured by subtracting direct bilirubin from the total bilirubin. Elevated levels may indicate a deficiency is an enzyme that helps break down (Gilbert's syndrome) |
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What is the Porta Hepatis made up of and where do they flow? |
Flow into the Liver - Hepatic Artery -Portal View Flow away - Hepatic Duct |
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What is a liver cell called and how are they arranged? |
Hepatocytes and are arranged in units called Acini-- cylinder with a collection of 3 vessels at the center of each acinus. Portal track includes the portal vein, hepatic artery and a tiny bile duct. |
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What is the average weight of an adult liver ? |
1500g in Lecture, she said 3-5lbs |
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Describe sinusoids and the structure with the liver? |
Central vein leads into the hepatic vein |
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What are the 9 main liver functions listed on the hand out? |
1) Carbohydrate metabolism 2) Fat metabolism 3) Protein metabolism 4) Production of Urea 5) Synthesis of proteins such as clotting factors and albumin 6) Detoxification of drugs, alcohol and hormones 7) Storage 8) Production of Bile 9) Excretion of Bilirubin |
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What does the liver store? |
Glycogen (storage from of glucose) iron copper vitamins A, D, K and others vitamins |
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What is the process in which Carbohydrates are metabolized in the liver for storage and release? |
After eating, Blood glucose levels are high. Insulin is released by the pancreas which cause glucose to to enter the hepatocytes. In the liver, glucose is converted to glycogen and stored. When blood glucose is low, pancreas releases glucagon to break down glycogen to maintain plasma glucose levels. |
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What does the liver do to fatty acids? |
The liver oxidizes the the fatty acid and produces acetyl CoA which is used in the citric acid cycle (aka tricarboxylic acid cycle) for energy production. |
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What can the liver convert protein into? 4 were listed on the handout |
-Convert to something that will make ATP in the tricarboxylic acid cycle -Convert them into glucose (process called gluconeogenesis(glucose+new+creation)) -Convert them into fat -Inter-convert some amino acids into others |
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What does the liver do with ammonia? |
Convert it into urea which is them eliminated through urine. |
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How does bile leave the liver? |
Bile is secreted by the liver cells(hepatocytes) into the bile canaliculi which drain into the bile ductules which drain into the bile ducts. From the Bile ducts, they drain into the right and left hepatic ducts which unite to form the common hepatic duct. This leads into the Gallbladder where it is stored until needed. |
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What does bile do? |
Bile is like a detergent and will help the body absorb fat in the small intestine and gut (by making them stay in a solution) |
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What is Hemochromatosis? |
An excessive accumulation of iron, which is deposited in the cells of organs --mostly liver and pancreas. |
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What is a normal amount of total body iron stored in an adult and how much in the liver? What is the total body amount of iron stored in an adult with HHC (Hereditary hemochromatosis)? |
Normal total body ranges from 2-6 gms about 0.5 gm stored in liver HHC amount may be as high as 50gm |
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Clinically, what 3 things do HHC patients have? |
1)Cirrhosis (fibrosis of the liver) 2)Diabetes mellitus(due to the destruction of the pancrease to secrete insulin) 3)Skin Pigmentation |
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Is the progression of hemochromatosis preventable and how? |
Yes, regular phlebotomy to remove excess iron |
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What are signs and symptoms of hepatitis? |
- right upper quadrant pain - fever - jaundice |
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A classic sign of liver failure is jaundice. What is jaundice? |
The liver in unable to conjugate bilirubin(breakdown product of RBC). Bilirubin builds up in the blood and is deposited in tissues of the skin and eyes. |
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What things can happen when bilirubin can not be conjugated? |
-stools may become "clay-colored" -urine may become dark due to bilirubin converted into urobilin |
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Name 4 things that are tested for Liver function tests. |
1)Bilirubin 2)Serum enzyme assays -Alanine aminotransferase (ALT) -Aspartate Aminotransfererase (AST) -Alkaline Phosphatase 3)Serum proteins (albumin and blood clotting factors) 3) Blood ammonia |
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What does elevated levels of alkaline phosphatase mean? |
elevated levels usually mean impaired biliary tract function (Bile duct system) Slight to moderate increases occur in hepatitis and cirrhosis. |
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What are the 3 alcohol-induced hepatic illnesses and if they are reversible? |
1) alcoholic fatty liver; Reversible 2)alcoholic hepatitis ; Reversible 3)alcoholic cirrhosis; not Reversible |
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Alcohol is in your intestines and is on a path to your liver via Portal blood. What happens next? |
Alcohol is oxidized by the enzyme ADH(alcohol dehydrogenase) top convert into acetaldehyde. Acetaldehyde (VERY TOXIC) is metabolized into acetate by ALDH(aldehyde dehydrogenase). Acetate can be used to make energy. |
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Name 3 ligaments on the liver |
- Falciform Ligament - Teres Ligament - Coronary Ligament |
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What are the 4 main consequences due to portal hypertension? |
1)ascites 2)formation of porto-systemic venous shunts 3)congestive splenomegaly 4) hepatic encephalopathy |
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What is a treatment for portal hypertension? |
Transjugular intrahepattic porto-systemic shunt (TIPS) It will lower portal vein blood pressure but it does not improve survival rates |
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What is GEJ (gastroesophageal junction)? |
The most common natural porto-systemic shunts that develop so pressure and reversed blood flow from the portal vein is relieved. |
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name 3 techniques used to stop Variceal bleeding |
- vasoconstrictor medicines - balloon tamponade - endoscopic sclerosis of varices (sclerotherapy) |
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What is ascites and 4 know factors that contribute to it |
It is an excess accumulation of fluid within the peritoneal cavity 1) kidneys retain excessive salt and water 2)decreased urine output 3)reduced albumin-less protein to hold fluid in blood 4)increased blood pressure int the portal veins - forces fluid out of the blood vessels |
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What is spontaneous bacterial peritonitis (SBP)? |
occurs within patients with cirrhosis and ascites -bacterial infection of the fluid that can develop without known source -patient develops chills, fever, abdominal pain, and have cloudy ascitic fluid. -Antibiotic treatment is usually effective |