119b biliary tract disorders Flashcards Preview

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Flashcards in 119b biliary tract disorders Deck (18):
1

cholestasis -
1) what is it?
2) what does it cause?
2) characteristic pathology findings on biopsy

1) failure to form bile --> hyperbilirubinemia
2) jaundice
2) canalicular cholestasis
bile plugs

2

enterohepatic circulation - what happens to excreted bile salts?

bile salts are almost all reabsorbed - only 5% made de novo

3

What do ALT/AST indicate?

liver cell death - these are released from hepatocytes when they die (AST is inside mitochondria which is damaged by ethanol)

4

what does high alkaline phosphatase mean?

bile duct obstruction

5

does a stone stuck outside of liver affect ALT/AST?

no

6

what should you look for first in a jaundice patient with high conjugated hyperbilirubinermia?

rule out extrahepatic biliary obstruction via US, CT, MRI, ERCP -- if negative then move to intrahepatic cholestasis causes (primary liver diseases)

7

primary biliary cirrhosis - what does it affect? lab findings?

AMA against microscopic bile canaliculis - inflammation and injury

lab - AMA, high Alkaline Phosphatase and GGT

8

what does high conjugated hyperbilirubinemia mean?

cholestasis - can extra or intrahepatic;

9

bile salt function

fat digestion/absorption
regulate transcription of liver genes
cholesterol metabolism

10

ursodeoxycholic (bile salt) acid therapy - what does it treat? how?

treats cholestatic liver disease and pruritis

makes bile acid pool more soluble and less toxic->
dissolves gallstones

11

what disease does someone have who has occasionally gets scleral icterus when sick?what does it cause?

Gilbert's disease - no clinical consequences but only 50% of normal UDP-GT due to TATA box increase; extra metabolic capacity of the liver accommodates normally

12

how do you get rid of cholesterol in body?

bile salts (50%)

13

Jaundice in the newborn - what is the danger?

BBB sucks and these kids can't conjugate bilirubin (UDP-GT low at birth) if premature - bilirubin can go to brain and screw things up

14

how does alcohol lead to cholestasis?

inflammation downregulates transporters - leads to intrahepatic cholestasis (caused by alcohol and other things)

15

intrahepatic cholestasis of pregnancy

defect in transporters due to genetics that is only clinically significant except when high estrogen levels --> estrogen downregulates transporters

16

what is the only abnormal lab test in Gilbert's disease?

mild unconjugated hyperbilirubinermia (<3)

17

what is the only abnormal lab test in Gilbert's disease?

mild unconjugated hyperbilirubinermia (<3)

18

where does bile formation metabolism occur in the liver cells?

ER