Flashcards in Final Exam -- GI Disease III (Liver) Deck (86):
What are some of the roles of the liver?
Glucose homeostasis, fat/protein/hormone/bilirubin/drug metabolism, bile formation, plasma protein production, clotting factor production, blood detoxification.
The liver releases certain proteins when there is acute damage. Which four proteins can you test for, as discussed in class? Which two of these are most commonly done?
Aspartate amino transferase (AST)*
Alanine Transaminase (ALT)*
Alkaline Phosphatase (ALP)
AST and ALT are the most commonly done.
Testing for serum bilirubin (both conjugated and unconjugated) is one way to test for liver function. Which, conjugated or unconjugated, is found in small amounts in the serum of healthy patients?
Testing for serum bilirubin (both conjugated and unconjugated) is one way to test for liver function. Which, conjugated or unconjugated, is not found in the serum of healthy patients?
True or false: bilirubin in the urine may be an indicator of liver damage or disease.
What is the name of the protein produced in the liver that transports unconjugated bilirubin to the liver? Is a test for this protein a good indicator of acute damage? Why or why not?
Albumin. Testing for serum albumin may give an idea of the level of liver function; however, it has a half life of 15-20 days, so it is not a good indicator for acute damage or disease.
Jaundice is the discoloration of skin, conjunctiva, and mucous membranes resulting from elevated plasma bilirubin. What is a normal bilirubin serum level? How much of an increase is typical in jaundice?
Normal levels are less than 1-1.5 mg/dL.
Jaundice levels are around 3-4 mg/dL.
Fill in the blanks: old hemoglobin is broken down in the ___________, releasing ____________ (unconjugated/conjugated) bilirubin, which is transported by _____________ to the _____________, where it is converted to ________________ (unconjugated/conjugated) bilirubin and exceted into the bile.
Old hemoglobin is broken down in the spleen, releasing unconjugated bilirubin, which is transported by albumin to the liver, where it is converted to conjugated bilirubin and exceted into the bile.
What are the symptoms of jaundice, besides the yellowing of skin, conjunctiva, and mucous membranes?
Pale stools*, dark urine*, itching, ever, chills, abdominal pain, and weight loss.
Why does jaundice cause pale stools and dark urine?
Bilirubin is normally responsible for the dark color of feces. If there is an obstruction that keeps the bilirubin from getting into the bile, it will spill over into the serum and be filtered by the kidneys. Low bilirubin in the bile leads to pale stools, high bilirubin in the serum leads to dark urine.
What is the name of the disease caused by a defect in the ATP7B gene? Is this an autosomal dominant or recessive condition? Transport of what substance is decreased in this condition?
Wilson Disease; autosomal recessive. Copper transport is decreased.
A defect in which gene leads to Wilson Disease? Transport of what substance is decreased in this condition?
ATP7B gene; copper transport is decreased.
Where does copper deposition occur in Wilson disease?
Liver, brain, and cornea
Wilson disease can present with liver, brain, and ocular symptoms. Name the liver symptoms.
Hepatitis, liver failure, cirrhosis
Wilson disease can present with liver, brain, and ocular symptoms. Name the brain symptoms.
Dysarthria, gait abnormalities/ataxia, dystonia, tremor, Parkinsonism, drooling.
Wilson disease can present with liver, brain, and ocular symptoms. Name the eye symptoms.
Kayser-Fleisher Ring, sunflower cataract
In what percent of hepatic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
In what percent of neurologic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
Diagnosis of Wilson Disease is based on clinical manifestations (evidenced by a liver biopsy or the psychiatric symptoms or ocular manifestations) and lab testing. What lab tests could you do?
Serum ceruloplasmin low (less than 200 mg/L; transports copper)
Serum copper low (less than 65 mcg/L; deposits in tissues, doesn't stay in blood)
24 hour urinary copper excretion (more than 100 mcg).
How would you treat a patient with Wilson Disease?
Detoxify with chelation, and prevent accumulation of copper by avoiding shellfish, liver, mushrooms, nuts, and chocolates. You can also have the patient take zinc to decrease copper absorption in the intestines.
Which type of hepatitis is the most common cause of chronic liver disease and indications for liver transplantation?
What is the typical transmission of Hepatitis A?
Is there a vaccine for Hepatitis A?
True or false: in an acute Hepatitis A infection, 70% of adults are symptomatic.
Does Hepatitis A have a chronic form?
True or false: Hepatitis A is typically self-limited
What are the prodromal symptoms of HAV?
Fatigue, nausea, upper quadrant pain, anorexia, fever
What are the symptoms of HAV?
Dark urine, pale stools, jaundice, pruritis
True or false: most HAV-infected individuals exerpience full recovery within 2 months.
False; most experience recovery within 6 months.
HAV is diagnosed from the typical clinical presentation, as well as detection of what?
IgM anti-HAV antibodies
What is the typical transmission of Hepatitis B?
Percutaneous, sexual, or perinatal.
Is there a vaccine for Hepatitis B?
True or false: in an acute Hepatitis B infection, 70% of adults are clinical, 30% are subclinical.
False; 70% are subclinical, and 30% are clinical.
True or false: in an acute Hepatitis B infection, newborns are typically subclinical.
True or false: in Hepatitis B, the incidence of chronic infections increases with age.
False; it decreases with age (from 90% neonatal to less than 1% in adults)
True or false: most cases of acute HBV are self-limiting.
How is HBV diagnosed?
By detecting HBV antigens or IgM and IgG HBV antibodies.
Though most patients with HBV are asymptomatic, what symptoms are possible?
Flu-like symptoms, jaundice, and liver failure (these last two are rare)
What are some potential complications of HBV?
Cirrhosis, hepatocellular carcinoma, hepatic failure, and serum sickness
Treatment for acute HBV is supportive. In chronic, treat with antivirals.
What is the typical transmission of Hepatitis C?
Percutaneous (especially drug use)
Is there a vaccine for Hepatitis C?
True or false: acute Hepatitis C is usually subclinical
What percentage of Hepatitis C cases are chronic?
True or false: in HCV, chronic cases are more common than acute.
What are the symptoms of acute HCV?
Fatigue, myalgias, right upper quadrant pain, N&V, poor appetite. (Remember that most acute HCV is asymptomatic, though.)
What tests can be run to help diagnose HCV?
HCV antibody test, HCV RNA assay, and other liver tests.
What are some antiviral therapies specific to HCV?
Ribavirin, pegylated interferons, sofosbuvir, simeprevir, telaprevir, boceprevir.
What ocular finding is a concern with interferon therapy?
Interferon retinopathy (CWS, superficial hemorrhages around ONH and posterior pole; also possible are subconj hemorrhages, BRAO, RD, ONH edema, and vitreous hemorrhages)
True or false: HDV requires co-infection with HBV for replication.
What is the typical transmission of Hepatitis D?
Is there a vaccine for Hepatitis D?
No, but the Hepatitis B vaccine helps protect against HDV
What percentage of patients with Hepatitis D have a Hepatitis B coinfection?
What percentage of patients with Hepatitis D have a Hepatitis B superinfection?
More than 90%
How is HDV diagnosed?
Detection of IgM HBV antibody; detection of HDV RNA by RT-PCR
What is the only drug approved to treat HDV?
Interferon alfa (IFNa)
What is the typical transmission of Hepatitis E?
Is there a vaccine for Hepatitis C?
Yes, but not available in the US
True or false: acute Hepatitis E has a 20% mortality for middle-aged males
False; it has a 20% mortality in pregnant women.
Does Hepatitis E have a chronic form?
True or false: the symptoms of HEV are similar to those of HAV but are less severe.
False; the symptoms of HEV are much more severe than those of HAV.
How would you treat a patient with HEV?
Supportive care, since HEV is self-limiting.
In which form of hepatitis are pregnant women more likely to get fulminant hepatic failure, which a higher rate of mortality?
90-100% of heavy drinkers have hepative steatosis, which is accumulation of ________ in the liver.
10-35% of heavy drinkers have alcoholic hepatitis, also known as alcoholic steatohepatitis. This is inflammation of a fatty liver.
True or false: 5-15% of heavy drinkers have cirrhosis.
What test detects and quantifies the level of hepatic steatosis?
What test quantifies the amount of liver fibrosis?
What are the symptoms of steatosis?
What are the symptoms of alcoholic hepatitis (alcoholic steatohepatitis)?
Jaundice, fever, anorexia, ascites (causing abdominal distention), muscle wasting, abdominal pain
What are the symptoms of cirrhosis?
Weight loss, weakness, jaundice, upper GI bleed, spider angioma, gynecomastia, ascites, splenomegaly, palmar erythema, digital clubbing, asterixis, hepatic encephalopathy, absent/irregular menstruation, erectile dysfunction, infertility in men, hepatomegaly.
____________ is characterized by the presence of fibrosis and regenerative nodules in the liver.
Cirrhosis results from chronic liver disease, most commonly ___________ and ____________.
Alcoholic liver disease and hepatitis B/C (also from fatty liver)
Which test is the definitive diagnosis for cirrhosis?
True or false: cirrhosis is mostly irreversible, so all you can do is limit the further damage done, manage the symptoms, and decide whether transplantation is a good fit.
Patients with cirrhosis are 40 times more likely to develop what other condition?
True or false: lab tests are very useful for diagnosis of hepatocellular carcinoma.
False; they are non-specific. Ultrasound is used on screenings.
If a liver nodule is found on ultrasound, how big would the nodule be in order to evaluate with imaging and possible biopsy, rather than just following the patient?
More than 1 cm
What are the treatment options for hepatocellular carcinoma?
Liver resection or transplantation, tumor ablation by radiofrequency, transarterial chemoembolization.
What is the 5-year survival rate for hepatocellular carcinoma in the US?
Which of the liver conditions discussed in class are more common in men?
Which of the following does not cause jaundice?
Which of the following is not a cause of cirrhosis?
Alcohol liver disease
Are the expected levels of serum copper higher or lower in patients with Wilson's Disease? What about serum ceruplasmin?
Both would be lower. There is less serum ceruplasmin to transport the copper, and the copper tends to accumulate in the tissues, not in the blood.
In what condition would a patient develop a Kayser Fleischer ring?