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Test 4 MCM Leesy > B2.069 - Big Case Liver Failure > Flashcards

B2.069 - Big Case Liver Failure Flashcards

(72 cards)

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1
Q

What is jaundice clinically

A

Yellow discoloration of skin and mucosal when bilirubin exceeds 2.5 mg/dL

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2
Q

What causes jaundice

A

When the equilibrium between production of bilirubin and the metabolism and excretion is disturbed.

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3
Q

How is bilirubin made in the body

A

Senescent erythrocytes are broken down to heme which is converted to biliverdin by heme oxygenate and biliverdin reductase by mononuclear phagocytic cells

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4
Q

Why cant bilirubin be excreted through the urine

A

Its water insoluble

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5
Q

How is bilirubin excreted from the body

A

Bilirubin is complexed with albumin (major carrier protein in the body) and carries it to the liver for further processing. It then is taken up by the liver cell to be processed. Once inside the hepatocyte its conjugated by UGT1A1. Then it becomes water soluble so it can be secreted by urine or feces. Its secreted from the hepatocyte to the canulicular membrane to the biliary tree then to the gut.

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6
Q

what population is at increased risk of jaundice

A

Premature babies and babies being breastfed

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7
Q

What is Crigler-Najjar syndrome

A

When you have no UGT1A1 which is needed to conjugate bilirubin albumin complex

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8
Q

What is Gilbert syndrome

A

When you have 30% of the UGT1A1 enzyme needed and it causes jaundice during stress

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9
Q

What is the final step of heme breakdown

A

The hepatic ducts join and deposit conjugated bilirubin into the ampulla Vauter

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10
Q

What’s the difference between conjugated and non conjugated bilirubin

A

Conjugated is water soluble and can be excreted

Unconjugated is not water soluble and cant be excreted regardless of how high the blood levels are

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11
Q

What constitutes unconjugated hyperbilirubinemia

A

ratio of conjugated bilirubin:Total bilirubin

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12
Q

What constitutes conjugated hyperbilirubinemia

A

Ratio of conjugated bilirubin:Total bilirubin is >.4

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13
Q

What are causes of overwhelming the first step of heme breakdown

A

Hemolytic anemia
Resorption from internal hemorrhage
Ineffective erythropoiesis

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14
Q

What are causes of impaired canalicular transport of bilirubin

A

Rotor syndrome
Dubin-Johnson syndrome
Drugs

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15
Q

What is physiologic jaundice of newborn due to

A

decreased UGT1A1 activity

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16
Q

What are the two types of Criglar Najjar syndrome

A

Type I - Absense of UGT1A1 this is incompatible with life

Type II - Decreased presence of UGT1A1

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17
Q

What are other diseases of the liver that can cause jaundice

A

Hepatitis, hepatocyte, necrosis, cirrhosis

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18
Q

What are the normal ranges of AST and ALT

A

AST - 7-40

ALT - 7-56

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19
Q

What do AST and ALT do

A

Live in hepatocyte and they are enzymes that help break things down.

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20
Q

What causes raised AST or ALT levels (generally)

A

Anything that compromises membrane integrity of the hepatocyte

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21
Q

What is confluent necrosis

A

Huge zones of hepatocyte necrosis

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22
Q

What happens to the AST and ALT levels of a patient with massive necrosis

A

It will get really high and then fall off because all the hepatocytes are dead

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23
Q

What is secreted in bile

A

Serum bilirubin total and direct

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24
Q

What are the plasma membrane proteins of bile ducts

A

Serum alkaline phosphatase

Serum gamma glutamyl transpeptidase (GGT)

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25
What is the portal triad
Artery, vein, bile duct
26
What does the bile duct look like on histo
A string of pearls
27
What happens when bile ducts are damaged
They leak alkaline phosphatase, GGT
28
What are the lab studies of acute liver disease
Increase AST and ALT
29
What are the lab studies of acute liver failure
Increased AST, ALT, prolonged PT, increased ammonia
30
What are the labs of obstructive/biliary liver disease pattern
Increased alkaline phosphate, bilirubin and increased GGTP
31
What are the labs for cirrhosis pattern
Decreased albumin, decreased platelets, prolonged PT
32
Why do you seen decreased platelets in patients with cirrhosis?
Portal hypertension and splenomegaly
33
What does the PT measure
extrinsic coagulation pathway | V, VII, IX, X
34
What is hepatic encephalopathy due to
Increased in serum ammonia made as a byproduct of hepatocyte processing of nitrogen containing compounds.
35
What does high levels of serum ammonia cause
Its toxic to neurons so it causes encephalopathy
36
What are clinical manifestations of increased ammonia
Alterations in mental status Disordered sleep Asterixis (flapping tremor) Coma and death
37
What constitutes hepatic failure
80-90% of hepatic functional capacity is gone
38
What is the mortality of hepatic failure
70-95% without transplant
39
What causes hepatic failure
Sudden or massive destruction | End point of progressive damage to liver as part of chronic liver disease
40
What is cirrhosis
Scarring of the liver
41
What are symptoms of cirrhosis
Decrease of protein synthesis Portal hypertension Decreased detoxification
42
What is hyperesterinemia
When the liver cant break down estrogen | It causes gynecomastia in men and testicular atrophy
43
What is cirrhosis most commonly caused by
Viral hepatitis (50% of HCV develops cirrhosis) Alcoholic liver disease NAFLD/NASH
44
What’s the pathogenesis of cirrhosis
Progressive fibrosis and reorganization of vascular micro architecture of the liver Types I and III collagen are deposited in the lobule
45
What does the dying hepatocyte activate
Kupffer cells which secrete cytokines and activate stellate cells to become myofibroblasts (secrete mostly type I collage) which is an irreversible process
46
What causes splenomegaly
Portal systemic shunts Blood backs up from liver bc its hard and fibrous which goes into the spleen and causes it to enlarge which sequesters platelets
47
Why do patients with cirrhosis have low platelets
Because the spleen is enlarged with blood and it sequesters platelets
48
What is periumbilical caput Medusa
When collaterals in the abdominal wall become engorged caused by chronic liver disease
49
What’s a normal reference range for Tylenol
Less than 20
50
What are located in the points of each hexagon in the liver lobule
Portal tracts
51
What zone does the blood come to in the liver
Zone 1
52
Rank the zones of the liver in order of most oxygen to least
1>2>3
53
What zone has the most cytochrome p450?
Zone 3
54
What does cytochrome p450 do with respect to this big case
it breaks down acetometaphen
55
What is the first thing you think of when you thing of centrilobular (zone 3) necrosis
Tylenol poisoning
56
Acetometaphen is converted to what toxic enzyme
NAPQI
57
How is NAPQI taken care of in the body normally
GSH binds with it
58
What is one way to treat acetaminophen overdose?
Giving NAC which is converted to GSH which combines with NAPQI to make a non toxic conjugate
59
After the hepatocyte dies can you give NAC
No it wont work, most effective in first 12 hours
60
What are the types of drugs that cause liver injury
``` Antibiotics Minocycline is big, its for acne Isoniazid - for TB Phsychotropic meds Birth Control pills ```
61
What is are drugs that cause a cholestatic acute injury
Cause canalicular plugs | Caused by anabolic or contraceptive steroid use
62
Alcoholic induced liver disease causes what
Steatosis which is fat deposition in the liver
63
What causes steatosis in the liver with alcoholism
Production of excess reducing equivalents (NADH and H+) due to metabolism of alcohol
64
How does excess reducing equivalents derived from alcohol metabolism cause steatosis
Shunting of normal substrates away from catabolism and toward lipid biosynthesis
65
How many deaths related to cirrhosis are due to alcohol
40%
66
Steps of alcohol induced liver disease
Steatosis Steatohepatitis - inflammation of the liver cell Cirrhosis
67
What is the irreversible point in liver disease
Cirrhosis
68
Where is steatosis initially seen
Centrilobular
69
Histologically what does inflammation and steatosis of the liver look like in alcoholism
Ballooned hepatocytes Fat droplets large and small Intermediate filaments called Mallory hyaline
70
What is non alcoholic fatty liver disease due to
Obesity Dyslipidemia Hyperinsulinemia Insulin resistance
71
What constitutes Metabolic syndrome
``` One of these DM Impaired glucose tolerance Impaired fasting tolerance Insulin resistance Two of High blood pressure Dyslipidemia Central obesity Microalbuminuria ```
72
Steps of NAFLD
Steatosis, steatohepatitis, fibrosis

Test 4 MCM Leesy (6 decks)

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