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95 Cards in this Set
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- Back
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What are the 7 functions of the liver discussed in class?
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1. Glucose homeostasis
2. Lipid metabolism 3. Bile synthesis 4. Plasma protein synthesis 5. Coagulation factor synthesis 6. Vitamin storage (DAKE and B12) 7. Biotransformation, detoxification, excretion |
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What is the pathologic response to injury in the liver? (5 steps)
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1. Inflammation
2. Degeneration 3. Necrosis 4. Fibrosis 5. Cirrhosis |
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What is another word for inflammation of the liver?
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Hepatitis
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What are the 2 types of liver inflammation?
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Acute and chronic
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What happens in the liver during inflammation?
Is it reversible? |
Influx of inflammatory cells (leukocytes)
Yes |
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What does degeneration of the liver consist of?
Is it reversible? |
-Damage to hepatocytes
-Cells may swell (hepatomegaly) -Accumulation of iron, copper, biliary products, fat droplets -Steatosis (Fatty Liver) accumulation of fat Yes |
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Common causes of Degeneration?
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Alcohol, Obesity, DM
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What is necrosis of the liver?
Is it reversibe? Can it regenerate? |
Cell Death
No Yes |
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What is fibrosis of the liver?
What causes fibrosis? What does it interfere with? Is it reversible? |
Deposition of collagen tissue (fibrous tissue)
Inflammation or death of cells Blood flow to cells No |
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What is another name for Cirrhosis?
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End-Stage Liver Disease
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What characterizes cirrhosis?
Is it reversible? |
Nodule formation
Scar tissue formation No |
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What are the most common causes of Cirrhosis?
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Alcoholism and Hep B and C
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What are three liver function tests we need to know about?
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1. Bilirubin
2. Albumin 3. Aminotransferase |
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What is albumin involved in? (2)
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Colloidal osmotic pressure
Transport of fatty acids, drugs, bilirubin |
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Decreased levels can be due to what 2 things?
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Malnutrition
Active inflammation |
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Where is bilirubin formed? (3 areas)
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Liver (most common) (Hepatic hemoproteins and RBCs)
Spleen (RBC Hemoglobin breakdown) Bone Marrow (premature destruction of RBCs) |
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What are the 2 types of bilirubin?
Which one can be excreted in urine and bile and is combined with glucuronic acid? |
1. Unconjugated
2. Conjugated Conjugated |
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What is jaundice?
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Bilirubin in skin and sclera
Icterus |
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Where is jaundice most evident?
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Sclera
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What are the most common causes of jaundice?
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Hep
Bile flow obstruction Hemolytic anemias |
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What are 3 causes of unconjugated hyperbilirubinemia?
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1. Overproduction
2. Impaired Hepatic Uptake 3. Impaired Conjugation |
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Unconjugated Hyperbilirubinemia due to overproduction can be caused by what 2 things discussed in class?
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1.neonatal jaundice
2. hemolysis |
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Uncojugated Hyperbilirubinemia due to impaired Hepatic uptake can be caused by what?
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Drug effects
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Unconjugated Hyperbilirubinemia due to Impaired conjugation can be what 5 things?
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1.neonatal jaundice
2. genetics (Gilbert's syndrome) 3. cirrhosis 4. drug effects 5. viral effects |
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Which is more common, unconjugated or conjugated hyperbilirubinemia?
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unconjugated
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What are two causes of neonatal jaundice?
How common? Tx? |
1. Increased bilirubin production
2. Impairment of bilirubin metabolism Seen in almost all newborns (liver developing) Light therapy breaks down bilirubin |
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What is kernicerus a result of?
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Neonatal jaundice
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What is kernicterus?
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Accumulation of bilirubin in the brain
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What are the long term consequences of kernicterus?
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Neurologic damage
-mental retardation -VISION PROBLEMS -movement disorders -hearing problems |
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What causes Gilbert's syndrome?
What are the symptoms? |
Mutation in the gene that conjugates bilirubin
Most are asymptomatic |
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Conjugated Hyperbilirubinemia can be caused by what 2 things?
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1. Impaired formation and/or excretion of bile - Cholestasis
2. Impaired drainage of bile - Extrahepatic biliary obstruction |
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What 2 components of bile did we discuss in class?
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Conjugated bilirubin
Cholesterol |
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What 2 things discussed in class can impair hepatic excretion?
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1. Drug - Induced
2. Hepatocellular Disease (hepatitis, cirrhosis) |
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What is Cholestasis?
What drugs can induce cholestasis? |
-Impaired formation of bile
-Impaired excretion of bile Drugs: oral contraceptives methyltestosterone phenothiazines |
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What are the most important signs and symptoms of Cholestasis (3)?
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1. Jaundice
2. Hypercholesterolemia - Xanthomas - Xanthelasma 3. PRURITIS(retention of bile salts) |
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What are the 2 most important causes of Extrahepatic Biliary Obstruction?
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1. Gallstones
2. Pancreatic Head Cancer |
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What is Hepatitis?
What are the 2 general types? Three main causes? |
Inflammation of the liver
Acute and chronic Viral, Drug, Alcohol |
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What are 5 viruses that can cause viral hepatitis?
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1. Hep A
2. Hep B 3. Hep C 4. Cytomegalovirus (CMV) 5. Epstein-Barr (mononucleosis) |
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What are the 3 clinical phases of viral hepatitis (including sub phases)?
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1. Incubation
2. Symptomatic - Preicteric - Icteric 3. Convalescence |
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What are the symptoms of Acute Hepatitis?
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Fever
Muscle or joint aches N&V, D Loss of appetite, fatigue Abdominal pain Jaundice |
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How can you Dx Acute Hepatitis?
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-Clinical Presentation
-Liver Profile - Increased LFTs - Increased bilirubin -CBC -Increased WBC -Increased lymphocytes -Hepatitis profile |
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How to Tx Hepatitis?
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Be supportive
Treat cause |
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What are the 5 viral hepatitis states?
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1. Asymptomatic
2. Acute Hepatitis 3. Chronic Hepatitis 4. Fulminant Hepatitis 5. Carrier |
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What is Hepatitis A also called?
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Infectious Hepatitis
|
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How is Hepatitis A transmitted?
How is it not transmitted? |
-fecal-oral
-contaminated water and foods -saliva, urine, semen |
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What is the incubation time for Hep A virus?
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2-6 weeks
|
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When is the virus shed in the stook for Hep A virus?
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2-3 weeks before jaundice until 1 week after jaundice
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What percent of Hep A patients are anicteric?
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about 50%
|
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Are all cases of Hep A virus apparent?
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Many cases are subclinical
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Is there a chronic carrier state for Hep A virus?
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No
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What are indications for Hep A Virus vaccine?
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Children - Oregon requires
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How is immunoglobulin used in Hep A?
Is it effective against HBV and HCV? |
Antibodies are effective against HAV.
Given to close contacts Partially |
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What is Hepatitis B virus also called?
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Serum Hepatitis
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How is HBV transmitted?
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parenteral (body fluids)
-semen, saliva, sweat, tears, breast milk, blood |
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Is there a chronic carrier state?
What are the percentages for adults and children infected early in life or at birth? |
yes
10% if infected as an adult 90-95% if infected as a child or at birth |
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Which type of Hepatitis virus, HAV, HBV, or HCV is the most common type of acute viral hepatitis?
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HBV
|
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How long can HBV remain in the blood during a prolonged asymptomatic incubation?
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1-7 months
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What percent of patients with HBV are asymptomatic?
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30%
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What is the #1 worldwide source of HBV?
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Maternal-Infant Transmission
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What 2 things can be caused by HBV infection?
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Hepatic cancer and cirrhosis
|
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What are indications for HBV vaccine?
|
Children
High risk people -Dialysis patients -Healthcare personnel -High risk lifestyles -People with other forms of liver disease. |
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What is the one type of Chronic HBV Medication that we need to know?
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Interferon alpha
|
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Why isn't there a vaccine for HCV?
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There are too may subtypes
|
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How is HCV transmitted?
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Parenteral: blood transfusions
Sexual: low incidence Perinatal |
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How long is the incubation period for HCV?
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2 weeks to 6 months
|
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What percent of people with HCV are asymptomatic?
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80%
|
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How many people with HCV have chronic infection?
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85%
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How many people with HCV do not realize they have an infection?
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about 50%
|
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It is the cause of 90-95% of cases of what?
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Transfusion hepatitis
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People who have had blood transfusions before what month and year are at risk for having acquired HCV?
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July 1992
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Which hepatitis virus, A, B, or C is the leading indication for liver transplant?
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C
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What are patients with HCV more at risk for?
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Liver cancer
|
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Hepatitis C virus leads to what in 70% of patients?
|
Chronic Liver Disease
|
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How does interferon work to treat HCV?
What are 2 side effects? |
It interferes with the virus' ability to infect cells.
lethargy and depression |
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What causes fatty liver?
Is it reversible? Can the liver regenerate? |
Alcohol alters lipid metabolism and fat accumulates in the liver.
Yes Yes |
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What are 2 signs of fatty liver?
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hepatomegaly
increased LFTs |
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What are 4 things associated with alcohol induced hepatitis?
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jaundice
increased LFTs ascites encephalopathy |
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What characterizes Alcohol-Induced Cirrhosis?
Is it reversible? |
Fibrosis with nodule formation
No |
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What are 3 complications associated with alcohol induced cirrhosis?
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Hepatic failure
Ascites: low albumin Encephalopathy |
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What can hepatic failure lead to? How?
What are 3 complications associated with hepatic failure? |
Encephalopathy because of hig ammonia
1. jaundice 2. coagulopathy: bleeding problems 3. hypoalbuminemia: ascites |
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What causes encephalopathy in liver failure?
What are 2 symptoms? |
High level of ammonia
1. Impaired consciousness 2. Personality changes |
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What characterizes hemochromatosis?
How is this acquired? |
Increased intestinal absorption of iron with iron deposited in organs (especially the liver, heart, pancreas)
Inherited |
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Where else can iron deposit with hemochromatosis?
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Skin
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What is the hemochromatosis triad?
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1. DM
2. Skin pigmentation 3. Cirrhosis |
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What are 2 important lab findings with hemochromatosis?
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1. Increased serum iron
2. Increased serum ferritin |
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How to Tx Hemochromatosis?
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1. Phlebotomy
2. Iron Chelators 3. Avoid iron in diet and supplements 4. Alcohol: increase iron |
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What causes prognosis for hemochromatosis to be poor?
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cirrhosis*
DM Iron levels remaining high WITH Tx |
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How much is the risk with hemochromatosis for liver cancer?
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more than 200x
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What characterizes Wilson's Disease?
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Copper metabolism disorder
-Failure of excretion of biliary copper Results in accumulation of copper with deposits |
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Where does copper deposit with Wilson's Disease?
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Liver, brain, cornea (Kaiser-Fleisher Ring), Kidneys
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Lab findings with Wilson's Disease?
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Decreased serum ceruloplasmin (a copper transport protein)
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What is the most common presentation of WIlson's Disease?
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Liver Disease
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What is the second most common presentation of Wilson's Disease?
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Neurologic disorders
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What is the eye sign of Wilson's Disease?
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Kaiser-Fleisher Ring
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How to Tx Wilson's Disease?
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Chelation Therapy
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