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Gastrointestinal > Liver path II > Flashcards

Liver path II Flashcards

1
Q

What is decompensated cirrhosis? (4)

A

Liver is failing:

  • portal HTN
  • Hepatorenal syndrome
  • liver failure
  • hepatic encephalopathy
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2
Q

What is the definition of portal HTN?

A

> 12 mmHg

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3
Q

Why is there gynecomastia and testicular atrophy with liver cirrhosis?

A

Decreased ability to breakdown estrogen

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4
Q

What are ascites? What can cause them?

A

Excess fluid in the peritoneal cavity

Heart failure or cirrhosis

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5
Q

What is the Serum-ascites albumin gradient (SAAG)?

A

[albumin] in the serum - [albumin] of ascitic fluid

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6
Q

What is the range of SAAG for portal HTN?

A

> 1.1 g/dL

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7
Q

What is the range of SAAG for non-portal HTN?

A

less than 1.1 g/dL

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8
Q

What is the MOA of ascites formation with cirrhosis?

A

Increased portal pressure, and increased hydrostatic pressure d/t loss of albumin

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9
Q

What happens with the angiotensin system with cirrhosis?

A

Activated d/t decreased intravascular volume

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10
Q

What is the cause of hepatic failure? Loss of what % of the liver is needed for this to happen?

A

Cirrhosis

> 80% loss of hepatocytes

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11
Q

What is fulminant hepatitis? Subfulminant?

A

Hepatocytes are wiped out in the liver

Subfulminant = most, but not all hepatocyte are destroyed, causing a loss of lobules

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12
Q

What are the three clinical features of liver failure?

A

Encephalopathy
Coagulopathy
Jaundice

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13
Q

What can cause multi organ failure with liver failure?

A

DIC and hypotension

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14
Q

What is acute liver failure? Subacute? Chronic?

A 
HyperAcute = 7 days or less of ssx
Acute = within 4 weeks
Subacute= 5-12 weeks
Chronic = >12 weeks
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15
Q

Chronic liver failure occurs in the context of what?

A

Decompensated Cirrhosis

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16
Q

What is hepatorenal syndrome? What causes it?

A

Kidneys crash d/t peripheral vasodilation, but kidney’s constrict, causing ischemia/infarction

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17
Q

What happens to BUN and creatinine with hepatorenal failure? Urinary sedimentation rate?

A

Significant rise in BUN

Normal urinary sed rate

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18
Q

What are the histological changes in the kidney with hepatorenal syndrome?

A

There are none

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19
Q

What is hepatorenal syndrome?

A

Kidneys crash d/t peripheral vasodilation, but kidney’s constrict, causing ischemia/infarction

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20
Q

What is type I hepatorenal failure? Type II?

A

I = doubling of initial serum Cr to >2.5 mg/dL

II = slow increase of serum Cr of 1.5 mg/dL

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21
Q

What is hepatopulmonary syndrome? Cause?

A

Triad of chronic liver disease, hypoxemia, and intrapulmonary vascular dilation

Pulmonary circulation is dilated by NO, causing a v/q mismatch

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22
Q

What is the key mediator for hepatopulmonary syndrome?

A

NO

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23
Q

What causes hepatic encephalopathy? What can this lead to?

A

Increased NH3 brain diffusion with subsequent edema and mercaptans from bacterial in the intestines.

This can lead to herniation of the brain through the foramen magnum

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24
Q

What is decerebrate posturing? Cause?

A

Decerebrate posturing indicates brain stem damage, specifically damage below the level of the red nucleus (e.g. mid-collicular lesion). It is exhibited by people with lesions or compression in the midbrain and lesions in the cerebellum.

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25
Q

What is the only hep virus that is not a ssRNA virus? What type of genetic make up is it?

A

B–dsDNA

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26
Q

What is the transmission of Hep A-E?

A

BCD = parenteral

A E = waterborne

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27
Q

Which Hep cause carrier states? Which cause chronic hepatitis?

A

B C D

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28
Q

Which Hep viruses cause hepatocellular CA?

A

B C D

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29
Q

Acute asymptomatic hepatitis happen in which hep viruses?

A

A B C D and E

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30
Q

Acute symptomatic hepatitis with recovery happen in which hep viruses?

A

ABCDE

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31
Q

Chronic hepatitis wwo progression to cirrhosis happen in which hep viruses?

A

C especially

but B and D can as well

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32
Q

What is a superinfection of hepatitis?

A

B and D together

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33
Q

Fulminant hepatitis occurs with which Hep viruses?

A

E if prego
D if superinfected

Others only rarely

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34
Q

What is the most common form of Hep? How does this usually present?

A

A, usually asymptomatic

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35
Q

What is the viral family of Hep A? Genetic make up? Transmission?

A

Picrona– +ssRNA

Fecal-oral route

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36
Q

How often does Hep A cause fulminant hepatitis?

A

Rarely

37
Q

What is the viral family of Hep B? Genetic makeup? Ssx? How is it transmitted?

A

hepadnavirus
dsDNA
Usual liver stuff
Parenteral/sexual

38
Q

What is the most common worldwide cause of cirrhosis?

A

Hep B

39
Q

What are the outcomes of Hep B infection? (4)

A
  • Complete recovery wwo symptoms
  • Hepatocellular CA
  • Death
  • Chronic hepatitis
40
Q

True or false: most pts with HBV infection will recover without problems

A

True

41
Q

What are the two main extrahepatic manifestations of HBV?

A

Glomerulonephritis

Polyarteritis nodosa

42
Q

What is polyarteritis nodosa that can occur with HBV?

A

Fibrosing of large vessels

43
Q

What Hep virus needs another? Which is needed?

A

D need B surface antigens

44
Q

What is the virus family and genetic makeup of HDV? Route of transmission?

A

Delta virus
-ssRNA
Parenteral

45
Q

What specifically does HDV need to cause disease?

A

HBsAg

46
Q

What is HDV coinfection?

A

B and D infect together in an otherwise healthy individual

47
Q

What is HDV superinfection?

A

D after B infection (in a HBV carrier), causing fulminant hepatitis more often

48
Q

Why is HCV particularly bad compared to the other forms of hepatitis?

A

Most commonly goes to chronic hepatitis

49
Q

How is HCV transmitted?

A

Parenteral
Sexual
drug use

50
Q

What percent of Hep C infections develop chronic Hep? What percent of the % go on to develop cirrhosis?

A

85%

20%

51
Q

What are the extrahepatic manifestations of HCV infection? (4)

A
  • Cryoglobulinemia (cold agglutination)
  • Thyroiditis
  • Glomerulonephritis
  • Thrombocytopenia
52
Q

Which genotype of HCV leads to more severe inflammation: 1 or 2?

A

2

53
Q

What are the factors that drive Hep C to cirrhosis? (4)

A

Immune response
Immunosuppression
EtOH use
HBV infx

54
Q

Which gender is more likely to progress from chronic Hep C infection to liver CA?

A

Male

55
Q

Hep E is only really serious in whom?

A

Prego

56
Q

What are the two types of liver biopsies that you can order?

A

Percutaneous

Transvenous

57
Q

What are the histological changes that occur in hepatocytes with viral hepatitis (2)?

A

Ballooning and cholestasis

58
Q

What are councilman bodies?

A

Councilman or acidophilic bodies are individually dead hepatocytes. They appear as small cells with eosinophilic cytoplasm and, at times, a dark, degenerative, pyknotic nucleus

59
Q

What happens to the lobular arrangement with acute viral hepatitis?

A

Lobular disarray

60
Q

What are the characteristics of the necrosis with a chronic hepatitis infex?

A

Piecemeal necrosis

destruction of the limiting plate of collagen about the portal vein

61
Q

What are the “ground glass” cells in chronic hepatitis infection? Which hepatitis virus does this appear in?

A

hepatocytes are laden with hepatitis B surface antigen.

62
Q

What are the typical histological characteristics of chronic HCV?

A

Lymphoplasmacellular inflammation and interface hepatitis. Portal-portal fibrous septa.

63
Q

What are the three immune diseases of the liver?

A
  1. Primary biliary cirrhosis
  2. Primary sclerosing cholangitis
  3. Autoimmune hepatitis
64
Q

What is fibrosis of the biliary tree?

A

Sclerosing cholangitis

65
Q

Granulomatous cholangitis is seen in what disease?

A

Primary biliary cirrhosis

66
Q

What is the cause of primary biliary cirrhosis?

A

Granuloma formation via T cell cytotoxicity

67
Q

What are the ssx of primary biliary cirrhosis?

A

Signs of slow liver destruction:
Fatigue and itching
Jaundice
Steatorrhea

68
Q

What are the Abs that are in primary biliary cirrhosis?

A

AMA
IgM
Anti Me
PDH-E2

69
Q

What are the four phases of primary biliary cirrhosis?

A
  1. Florid duct lesions (granulomas)
  2. Ductular proliferation
  3. Severe cholestasis
  4. Cirrhosis
70
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid

Liver transplant

71
Q

How long do pts survive with primary biliary cirrhosis?

A

10-20 years

72
Q

What is primary sclerosing cholangitis? Who does this occur in?

A

Fibrous obliterative cholangitis

Older males with UC

73
Q

What are the ssx of primary sclerosing cholangitis?

A

Ssx of slow liver failure:
Jaundice
Pruritis
Liver failure

74
Q

What is the gross appearance of primary sclerosing cholangitis?

A

Beads on a string

75
Q

p-ANCA is positive in what?

A

primary sclerosing cholangitis

76
Q

What labs are elevated with primary sclerosing cholangitis? (4)

A

Isolated alk phos
GGT
5-NT
ERCP

77
Q

What are the histological characteristics of acute and chronic sclerosing cholangitis?

A

PMN infiltration, then cirrhosis

78
Q

What cancer are pts with primary sclerosing cholangitis susceptible to

A

cholangioCA

79
Q

What is autoimmune hepatitis?

A

Chronic inflammation destroying liver tissue causing acute liver failure.

Usually occurs concurrently with some other autoimmune disease

80
Q

What gender is usually affected with autoimmune hepatitis?

A

females

81
Q

What are the three abs that are elevated with autoimmune hepatitis?

A

ANA
SMA
anti-LKM1

82
Q

What is the gene that predisposes to autoimmune hep?

A

HLA DR4

83
Q

What are the histological characteristics of autoimmune hepatitis?

A

Plasma cell infiltrate

84
Q

What are types I - III of autoimmune hepatitis?

A 
I = SMA + ANA
II = Anti-LKm1
III = Anti-SLA/LP
85
Q

What is the treatment for autoimmune hepatitis?

A

Immune suppressors

Liver transplant

86
Q

What happens if there is no treatment with autoimmune hep?

A

Cirrhosis, hepatocellular CA

87
Q

Which of the hepatitis viruses is most likely to lead to chronic hepatitis?

A

C

88
Q

What diseases are associated with primary biliary cirrhosis?

A

CREST
SLE
other autoimmune diseases

89
Q

Increased AMA is seen in what particular liver disease?

A

Primary biliary cirrhosis

Gastrointestinal (42 decks)

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