Term
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Definition
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Term
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Definition
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Term
| total bilirubin normal level |
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Definition
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Term
| direct bilirubin (conjugated) normal level |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| this is the functional unit of the liver that consists of plates of hepatocytes hexagonally arranged around the central vein. |
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Definition
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Term
| these are wide, "leaky" capillaries without basement membrane empty into the central vein. |
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Definition
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Term
| which vessel delivers most of the blood supply to the liver? describe the blood supply in liver. |
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Definition
| the hepatic portal vein delivers most of the blood supply through nutrient-rich, deoxygenated blood. some blood supply occurs via the hepatic artery. the two blood supplies mix in the sinusoids, then drain into the central vein. blood then leaves the liver via the hepatic vein that drains into inferior vena cava. |
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Term
| what are the 3 functions of bile in the body? |
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Definition
1. emulsification
2. absorption of fat (via micelles)
3. solubilize cholesterol |
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Term
| T/F- direct (conjugated) bilirubin is lipid soluble. |
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Definition
| False. direct bilirubin is WATER soluble. Indirect bili is lipid soluble. |
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Term
| which nerve is involved with bile secretion? |
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Definition
| the vagus nerve, stimulated by by parasympathetic system. |
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Term
| these two hormones are involved in bile secretion. |
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Definition
| CCK and secretin. Fatty acids, amino acids in the duodenum stimulate CCK causing gall bladder to contract and empty and also cause relaxation of Sphincter of Oddi. Acidic chyme stimulates SECRETIN which causes bile secretion. |
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Term
| these cells are important in the synthesis of many important serum proteins, hormonal and growth factors. |
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Definition
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Term
| name some functions of the liver. |
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Definition
| regulation of nutrients, production of bile, conjugation of bilirubin, and the detox of drugs for excretion. |
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Term
| this LFT marker increases with hepatic injury or obstruction. |
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Definition
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Term
| this LFT marker is an indicator of hepatic excretion. |
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Definition
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Term
| this marker reflects the liver's continued ability to synthesize important proteins. |
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Definition
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Term
| which LFT marker is sensitive to cardiovascular and hepatocellular disease? |
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Definition
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Term
| describe cholestatic disease... |
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Definition
| retention of bile in the liver. Alk phos is increased. |
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Term
| what are some S & S of hepatocellular failure? |
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Definition
| jaundice, muscle wasting, ascites, excessible bleeding, vitamin/blood protein deficiencies, glucose imbalance, impaired hormone production |
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Term
| describe the cause of edema in liver failure. |
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Definition
| decreased protein intake leads to decreased production of clotting and HYPOALBUMINEMIA = generalized edema |
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Term
| Why would a male patient present with gynecomastia, impotence, and testicular atrophy if they are in liver failure? |
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Definition
| due to the impaired processing of endogenous steroid hormones. |
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Term
| describe "prehepatic" jaundice. |
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Definition
| due to increased bilirubin production (hemolytic disease) |
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Term
| describe "hepatic" jaundice. |
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Definition
| deficient bile production or bilirubin metabolism due to liver disease (hepatitis) |
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Term
| describe posthepatic jaundice. |
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Definition
| due to bile drainage blockage (gallstones) or pancreatic/bowel cancer |
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Term
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Definition
| obstruction in blood flow through liver, venous drainage is congested--> creates varices (gastric, esophageal, hemorrhoidal), caput medusae, ascites |
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Term
| what are 3 causes of esophageal varices? |
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Definition
| alcoholic cirrhosis, posthepatic cirrhosis, and chronic infection (schistosoma) |
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Term
| what are S&S of hepatic encephalopathy? |
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Definition
| dementia, psychotic sx, spastic myelopathy, asterixis "liver flap" =(CLASSIC FINDING). |
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Term
| What is the main cause of sx and correlates with severity of dysfunction in hepatic encephalopathy? |
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Definition
| the arterial AMMONIA level |
|
|
Term
| what are 3 causes of esophageal varices? |
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Definition
| alcoholic cirrhosis, posthepatic cirrhosis, and chronic infection (schistosoma) |
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Term
| how do you treat hepatic encephalopathy? |
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Definition
| correct cause, restrict dietary protein <60gm/day, osmotic diuretics or antibiotics, and enhancement of excretion of nitrogenous wastes |
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Term
| this condition often develops with Grade 3 or 4 hepatic encephalopathy. |
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Definition
| cerebral edema. this causes increased ICP--> cerebral hypoxia. this condition is a major cause of death in acute hepatic failure. |
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Term
| name some S&S of cerebral edema. |
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Definition
| deepening coma, systolic HTN, decerebrate posture, pupillary dilation, respiratory arrest with brain herniation. |
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Term
| how do you treat cerebral edema? |
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Definition
| 1. IV mannitol infusion. this will decrease edema by pulling water off the brain (osmosis). the patient needs to be in SEMI-FOWLERS POSITION. sodium pentothal is a second line agent. moderate hypothermia may be helpful. |
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Term
| how do you treat ascites? |
|
Definition
1. abd paracentesis. check fluid for protein, albumin, cell count
2. sodium restriction
3. diuretics (spironolactone)
4. albumin infusions to initiate diuresis #1-3 fails.
4. abd shunts |
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Term
| T/F Chronic viral hepatitis occurs more frequently in acute hepatitis C patients. |
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Definition
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Term
| what would be the typical presentation of a patient who has hepatitis? |
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Definition
| -prodrome of viral - like symptoms (anorexia, N/V, malaise, aversion to smoking)fever (low grade), hepatomegaly, +/- jaundice, normal to low WBC, marked transaminase elevations early in the course |
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|
Term
| describe the acute phase of acute viral hepatitis. |
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Definition
| usually lasts for a few weeks with complete clinical and laboratory recovery |
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|
Term
| common lab findings on hepatitis.. |
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Definition
WBCs- normal to low
mild proteinuria
bilirubinemia
jaundice
increased AST and ALT
marked prolongation of PT (correlates with increased mortality)
serologic testing is the ONLY way to dx a specific virus |
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|
Term
| this type of hepatitis is transmitted by fecal-oral route and it is an acute short-lived illness with a VERY LOW mortality and NO long term sequelae. |
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Definition
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Term
| when is a hep A positive patient most contagious? |
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Definition
| during weeks 2-7 incubation period and during early illness |
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Term
| T/F if a patient has Anti-HAV IgG antibodies, then they are in acute infection. |
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Definition
FALSE. Anti-HAV IgM= acute infection
Anti-HAV IgG= previous infection and immunity. |
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Term
| what is the treatment for hep A? |
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Definition
| rest, nutritious diet, avoid alchohol, tylenol, all hepatoxins, clean all personal items and laundry. |
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Term
| this type of hepatitis is generally longer and more insidius onset, longer course of disease, and has slower recovery. |
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Definition
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Term
| What is the transmission route for Hep B? |
|
Definition
| parenteral, sexual contact |
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Term
| What is a major route in transmission of hep B in developing countries? |
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Definition
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Term
| T/F Hep B has an insidious onset and the incubation period is 2-6 months. |
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Definition
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Term
| this indicates acute HBV infection. |
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Definition
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|
Term
| this indicates immunized or recovered pt from Hep B. |
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Definition
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Term
| this appears during acute hepatitis, but PERSISTS indefinitely in pts. |
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Definition
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Term
| this represents viral replication and infectivity, appears during incubation period shortly after detection of HBsAg. |
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Definition
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Term
| what is the treatment for hep B? |
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Definition
| supportive. usually will resolve spontaneously. if in fulminant disease= aggressive Rx for coagulopathy, encephalopathy, cerebral edema. |
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|
Term
| which drugs can be used to decrease tissue injury and suppress HPV replication? |
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Definition
| interferon, lamivudine, adefovir, entacavir, telbivudine |
|
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Term
| T/F the HPV vaccine is given in 2 doses, 2 months apart. |
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Definition
| FALSE! you give the vaccine in 3 DOSES, at 0,1, and 6 months. 95% response rate. (unless you are Tony :) ) |
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|
Term
| T/F- you would vaccinate a patient against Hep A even when they are Hep A positive to prevent FULMINANT hepatitis. |
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Definition
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|
Term
| If Joe stuck himself while getting an ABG on a patient who was Hep B positive, what would you do for poor Joe? |
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Definition
| you would give hime HBIG (hep B surface antibody) for prophylaxis post needle stick. you would give this one week post needlestick and repeat 1 month later. also give Joe a HBV vaccine with this. |
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Term
| T/F up to 10% of cases of hep C are from IV drug use. |
|
Definition
| False- 50% of cases are from IV drug use. |
|
|
Term
| what are the 3 routes of transmission for hep C? |
|
Definition
| PARENTAL, maternal- neonatal (small), sexual (small) |
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|
Term
| What is the incubation period for HCV? how will patients usually present? |
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Definition
| 6-7 weeks. illness will usually be mild, asymptomatic, waxing and waning transaminase elevations. |
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Term
| T/F- Hep C has a low rate of chronic hepatitis. |
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Definition
| False- Hep C has >80% rate of chronic hepatitis |
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|
Term
| how is diagnosis made for Hep C? |
|
Definition
| based on detection of antibodies of HCV. (flucuations in ALT, polyarteritis nodosa, membranoproliferative glomerulonephritis) |
|
|
Term
| why is Hep C difficult to study? |
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Definition
| lack of a suitable cell line for replication (low titer) and high mutation rate. |
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Term
| T/F- Hep A is a common cause of end stage liver disease in the US. |
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Definition
| false= hep C. 20% of the time will progress to significant liver dz. |
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Term
| of the 3 serotypes of Hep C, which one is the most common in the US? |
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Definition
| type 1 (lower Rx response rate) |
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|
Term
| What drugs are involved in the treatment of HCV? |
|
Definition
| pegylated interferon (IM Q wk) and Ribavirin (po BID) |
|
|
Term
| How will you stage HCV disease? |
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Definition
| liver biopsy. viral load and viral genotype need to be checked. |
|
|
Term
| what are some adverse effects of interferon and what are some contraindications? |
|
Definition
| flu-like symptoms. contraindications in immunosuppresion or autoimmune disease, significant psychiatric disease or depression. |
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|
Term
| T/F- hep D is not pathologic by itself, and it must be in conjunction with HBV to be pathologic. |
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Definition
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|
Term
| T/F transmission of Hep D is through eating a bad sub from subway. |
|
Definition
| False- Transmission is through PARENTERAL and INTIMATE PERSONAL CONTACT. |
|
|
Term
| Which two antibodies are involved in diagnosing hep D? |
|
Definition
| anti-HDV IgM and IgG(ELISA) |
|
|
Term
| How is Hep E transmitted? |
|
Definition
| enterically; associated with large WATER-BORNE epidemics in may developing countries. |
|
|
Term
| T/F Hep E usually causes a benign self-limiting illness and has HIGH mortality in pregnant women. |
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Definition
|
|
Term
| T/F chronic hepatitis is liver inflammation that lasts >10 months. |
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Definition
| FALSE. Liver inflammation lasting > 6 months. |
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Term
| AKA triaditis, transaminitis. this is a chronic, low grade liver inflammation of ANY cause. inflammation is confined to PORTAL TRIADS without any destruction. |
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Definition
| chronic persistent hepatitis |
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Term
| T/F chronic persistent hepatitis can progress to serious disease and needs drugs for tx. |
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Definition
| false- does not progress to serious disease, no drug rx needed. pts are usually asymptomatic or mild, nonspecific sx are noted. Serum transaminases are ELEVATED. |
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|
Term
| This condition is a progressive, destructive inflammatory dz and it may spontaneously arrest or progress to macronodular or micronodular cirrhosis. |
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Definition
|
|
Term
| what conditions can lead to chronic active hepatitis? |
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Definition
| majority of HCV,minority of HBV pts. autoimmune hepatitis in young women, metabolic liver disease (Wilson's, hemochromatosis), and agents such as MINOCYCLINE AND NITROFURANTOIN can all lead to this condition. |
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Term
| How do you diagnose a patient that you think may have chronic active hepatitis? |
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Definition
| abnormal LFTs, screen for viral and autoimmune hepatitis, serum iron and ferritin (to rule out hemachromatosis), serum ceruloplasmin, and confirm by LIVER BIOPSY (also for grading and staging) |
|
|
Term
| what two antibodies are involved with autoimmune hepatitis? |
|
Definition
| ANA and ASMA (anti-smooth muscle antibodies) |
|
|
Term
| what is the treatment for autoimmune hepatitis? |
|
Definition
| corticosteroids, immunosuppressives |
|
|
Term
| How would you describe cirrhosis? |
|
Definition
| IRREVERSIBLE END STAGE of hepatic injury, characterized by diffuse hepatic FIBROSIS. |
|
|
Term
| Name and describe the two types of cirrhosis. |
|
Definition
1. biliary cirrhosis- persistent inflammation of the bile ducts--> inflammation and scarring of the liver
2. primary sclerosing cholangitis- an autoimmune condition that is seen with patients with coexisting UC and recurrent episodes of cholangitis--> biliary scarring and obstruction |
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|
Term
| name some S&S of cirrhosis. |
|
Definition
| stigmata of advanced liver disease, spider angiomatas, palmar erythema, prominent muscle wasting, marked fatigue |
|
|
Term
| alcholic liver disease is manifested by 1 or more of these conditions... |
|
Definition
| fatty liver, hepatitis, cirrhosis |
|
|
Term
| AKA alcoholic steatohepatitis. fat deposition in liver cells caused by either defect in fat metabolism within the cell or excess fat delivery to the cell that cannot be metabolized. |
|
Definition
|
|
Term
| what can cause steatohepatitis other than alcohol? |
|
Definition
| DM, obesity, protein malnutrition, TPN, drugs |
|
|
Term
| T/F steatohepatitis is usually found incidentally and is usually mild or asx. |
|
Definition
|
|
Term
| what will labs generally look like and how will patients present with steatohepatitis? |
|
Definition
| liver enzymes are MILDLY ELEVATED, TGs usually VERY HIGH. Hepatomegaly may be present-> abd discomfort. symptoms are usually MILD or ASX. |
|
|
Term
| What is the treatment for steatohepatitis? |
|
Definition
| weight reduction, D/C alcohol, manage DM, treat hyperlipidemia. |
|
|
Term
| Describe alcoholic hepatitis. |
|
Definition
| active inflammation and necrosis of hepatocytes in the centrilobular region. intracellular inclusions called MALLORY BODIES develop. occurs when chronic alcoholics BINGE drink and drink higher quantities than usual. Sx range from MILD to SEVERE. hepatitis can be complicated by acute alcohol withdrawal and delirium tremens |
|
|
Term
| How do you diagnosis alchoholic hepatitis? |
|
Definition
1. pt hx. exclude other diagnoses (U/S CT/MRI to R/O neoplasms, pancreatic disease, ascites)
2. LIVER BIOPSY confirms diagnosis. |
|
|
Term
| what 3 characteristic findings will you find on a liver biopsy in an alcoholic hepatitis patient? |
|
Definition
steatosis (fatty deposits)
ballooning of hepatocytes
fibrosis |
|
|
Term
| T/F ALT >AST in alchoholic hepatitis. |
|
Definition
| FALSE. AST > ALT, and is usually twice as high. This suggests a TOXIC etiology |
|
|
Term
| what is the treatment for alcoholic hepatitis? |
|
Definition
| R/O viral hepatitis, check serum acetaminophen levels, R/O metabolic disorders, correct malnutrition and vitamin deficiencies, and CORTICOSTEROIDS with worsening liver failure and coma. Thiamine can be given. Vit B12 and folate PRN. Subcut. vit K with prolonged PT or INR. |
|
|
Term
| T/F patients with both cirrhosis and alcoholic hepatitis have a 5 year mortality rate of 60%. |
|
Definition
| true. prognosis is grave if pt continues to drink. |
|
|
Term
| T/F modest levels of alcohol consumptions DOES NOT place patients at risk. |
|
Definition
| false! risk is increased with 3 drinks (30g) per day. |
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