38 Liver Disease

Question 1

Hepatocellular Failure

Answer 1

-jaundice
-decr clotting factor>excess bleed
-hypoalbuminemia
-decr vit D, K
-feminization
-osteomalacia
-lack of bile production>impaired absorption of fat soluble vitamins (ADEK)
-abnormal storage/release of glucose
hyper/hypoglycemia

Question 2

Osteomalacia

Answer 2

softening of the bones

-typically through a deficiency of vitamin D or calcium.

Question 3

low vitamin K causes

Answer 3

poor blood-clotting factor production

Question 4

Portal Hypertension

Answer 4

• GI congestion
• dvlpt of esophageal or gastric varices
• hemorrhoids
• splenomegaly
• ascites
• inadequate protein metabolism
• impaired processing of endogenous steroid hormone
• impaired clearance of exogenous drugs + toxins

Question 5

altered lipoprotein processing

[s/s of hepatocellular failure]

Answer 5

s/s of hepatocellular failure

dyslipidemia: hypertriglyceridemia

Question 6

inadequate protein metabolism

[s/s of hepatocellular failure]

Answer 6

• decr prodctn of CLOTTING FACTORS
• —-excessive bleeding
• hypoalbuminemia
• —-gen. edema r/t low serum oncotic pressure

Question 7

MEN’S impaired processing of endogenous steroid hormone

[s/s of hepatocellular failure]

Answer 7

• gynecomastia
• impotence
• testicular atrophy
• fem hair distribution

Question 8

WOMEN’S impaired processing of endogenous steroid hormone

[s/s of hepatocellular failure]

Answer 8

• irregular menses
• palmar erythema
• spider telangiectasia

Question 9

impaired clearance of exogenous drugs and toxins

[s/s of hepatocellular failure]

Answer 9

ammonia is converted to urea

Question 10

JAUNDICE-

PREHEPATIC CAUSE

Answer 10

RBC or spleen issues

-hemolysis, ineffective erythropoiesis

Question 11

JAUNDICE-

HEPATIC CAUSE

Answer 11

liver

• dysfunction of liver cells
• incr of unconjugated or unconjugated bilirubin
• UDPGT mutations/immature

Question 12

JAUNDICE-

POSTHEPATIC CAUSE

Answer 12

bile + bile bladder

obstruction of bile ducts, canalicular bilirubin transport, conjugated hyperbilirubinemia

Question 13

UDPGT

Answer 13

enzyme in liver that converts UNCONJUGATED bilirubin to CONJUGATED

Question 14

high conjugated bilirubin

Answer 14

sign that liver + blood is working fine.

must be POSTPEHATIC jaundice issue

Question 15

Portal Hypertension

Answer 15

sluggish perfusion resulting in INCREASED PRESSURE IN PORTAL CIRCULATION
-congested venous drainage of GI tract

Question 16

Portal Hypertension

s/s

Answer 16

anorexia bc liver cells are not metabolizing
varices (esophageal/gastric/hemorrhoidal can cause rupture>uncontrolled bleeding)
ascites

Question 17

Gastroesophageal Varices

s/s

Answer 17

• hematemesis (blood in vomit)
• melena (blood in feces)
• brt red rectal bleeding
• anemia
• shock

Question 18

Gastroesophageal Varices

Answer 18

venous network in proximal stomach + esophagus can rupture at high pressure

—collateral venous pathway (surrounds the main venous network) will dilate in response to elevated portal pressure

-half of cirrhotic patients

Question 19

variceal bleeding

Answer 19

life threatening

• 50% mortality
• great risk of rebleed bc the ruptures cause fibrosis, which means low clotting factors

Question 20

hepatic encephalopathy

treatment

Answer 20

diet: less protein, more carbs, high fiber
- pripheral or central IV infusions
- amoxicillin + rifamixin

Question 21

ascites occurs with…

Answer 21

portal hypertension + hypoalbuminemia

Question 22

hepatitis

Answer 22

inflammation of liver parenchyma

-caused by cytomegalovirus or epstein barr

Question 23

Hep A vs B

Answer 23

A: ssRNA, hepatovirus, fecal-oral, NO chronic liver disease, IgM

B: dsDNA, hepadnavirus, prenatal/sex, 10% chronic liver disease, HBsAg or antibody to it

Question 24

Hep A [HAV]

Answer 24

aka enteric hepatitis

• fecal-oral
• jaundice,RUQ, malaise, anorexia,

**self limited - lifetime immunity

Question 25

Anti-HAV IgG vs IgM

Answer 25

presence of anti-HAV IgG = previous infection IgM = acute infection

Question 26

HAV treatment

Answer 26

self limiting so supportive | --AVOID ETOH, acetaminophin, hepatotoxin

Question 27

Hep B

Answer 27

aka serum hepatitis | -parenteral or sexual contact by BLOOOOD

Question 28

Hep C [HCV]

Answer 28

by flavivirus | -spread thru IV drug use or blood transfusions

Question 29

most common cause of ESLD

Answer 29

chronic hep C

Question 30

Cirrhosis

Answer 30

irreversible end-stage of many different hepatic injuries - liver is fibrotic, scarred, nodular - results in permanent alteration in hepatic blood flow + liver function

Question 31

diabetes insipidus

Answer 31

lack of ADH hormone polyuria polydipsia polyphagia

Question 32

diabetes insipidus | urine quality

Answer 32

3-5 gal/day | low osmolarity

Question 33

type I vs type II diabetes

Answer 33

i: "INSULIN DEPENDANT" beta cells on pancreas are defected> DECR in insulin production > less uptake of blood glucose - --autoimmune disease ii: "INSULIN RESISTANT" normal level of insulin BUT issues w receptor binding/signaling. cannot take insulin> less uptake of blood glucose

Question 34

gestational diabetes

Answer 34

similar to type II "insulin resistant" | -caused by placenta hormone

Question 35

insulin is synth by....

Answer 35

Beta cell of islet of langerhans in pancreas

Question 36

alpha cells produce...

Answer 36

glucagon

Question 37

insulin actions

Answer 37

- enhance protein synth, prevent muscle breakdown - inhibit gluconeogenesis - enhance fat deposition - stim growth

Question 38

diabetes mellitus

Answer 38

endocrine disorder | chronic hyperglycemia

Question 39

diabetes mellitus diagnosis

Answer 39

2 of the following: - blood glucose above 200 mg/dl - fasting bld gluc lvl>126mg/dl - 75g oral glucose load>2 hrs>bld gluc lvl>126 - HgbA1C lvl above 6.5

Question 40

diabetes mellitus | clinical sympt

Answer 40

polys (uria, dipsia, phagia) + losing weight