Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med- GI > Hepatology Lecture > Flashcards

Hepatology Lecture Flashcards

(71 cards)

Start Studying
1
Q

Valveless*
Pressure is 3-5 mmHg
75% of total liver blood supply by volume
Posterior to bile duct and hepatic artery
Formed by SMA

A

Portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Venous drainage of the liver thru 3 valveless veins into infereior vena cava
*takes blood back to heart

made up of…R, middle, L

A

Hepatic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Parasympathetic innervation of the liver comes from the…

A

Vagus N

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Parasympathetic and Sympathetic fibers into the liver come from the…

A

Celiac plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Make up the parenchyma of liver

Survive 200-300 days

If healthy..divide and replicate

A

Hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

“Stem cells” of liver

Allow for regeneration

A

Ovalcytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fxns of liver?

A

Metabolic

Catabolic

Storage

Excretory functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gluconeogenesis

Synthesis of phospholipids and cholesterol

Detox of meds and alcohol

A

Metabolic and catabolic fxns of liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Glycogen
Protein
Triglycerides
Iron
Copper
Fat soluble vitamins

A

Storage in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Synthesis and secretion of of bile

A

Excretory fxn of liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Coag factors: PT/INR, PTT
Plasma proteins: albumin
Acute phase proteins: cytokines
Carb metabolism: glycogen, lactate
Lipid metabolism: cholesterol, TGs, lipoproteins
Bilirubin metabolism: bile excretion

A

Synthetic functions of liver

(in hepatocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

is AST elevated in acute or chronic conditions?

A

Acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is ALT elevated in acute or chronic conditions?

A

Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ALT > AST in….

A

Viral, fatty liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AST > ALT in…

A

Alcohol (2:1)

or drug toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What labs do you want if you are checking for hepatocellular damage or inflammation?

A

AST

ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What labs do you want if you are checking for obstructive dz?

A

Bilirubin

Alk-Phos

GGTP (not part of LFTs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which is water soluble, which is not water soluble:

Direct (conjugated) bilirubin

Indirect (unconjugated) bilirubin

A

Direct (conjugated) bili is water soluble

Indirect (unconjugated) bili it NOT water soluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hemolysis of RBCs

Impaired hepatocyte function

..will result in elevation of?

A

Indirect bilirubin (pre-hepatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Obstruction of excretion of bilirubin, cholestasis

…will result in elevation of?

A

Direct bilirubin (post-hepatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Found in bone, liver, intestine, kidney, placenta and leukocytes

*can be fractionated to determine origin

A

Alk-Phos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

**Liver specific!!

Will help differentiate if Alk Phos is elevated because of the liver

A

GGTP

(Gamma-glutamyltransferase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Elevated alk phos (ALP) and elevated GGTP means…

A

obstruction!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Best first step diagnostic for looking at liver?

A

Ultrasound with doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
MC hereditary cause of increased bilirubin Results in impaired enzymatic conjugation of indirect bilirubin
Gilbert's disease
26
S/S: icteric sclera and jaundice..esp **at birth and acute illness** Labs: **elevated indirect bili** normal direct bili Tx: only tx in infancy with **bili lights** to prevent liver failure
Gilbert's disease (normal ultrasound!)
27
No signs and symptoms unless cirrhosis has developed Increased echotecture on U/S Labs: **ALT \> AST** (opposite of alcohol disease)
Non alcoholic fatty liver disease (NASH)
28
What is the relationship of ALT and AST in non alcoholic fatty liver disease (NASH)?
ALT\>AST (opposite of ETOH disease)
29
Autosomal recessive genetic D/O resulting in iron deposition in organs males \> females, often onset 50 yo
Hemochromatosis
30
Labs: **high ferritin** and high % saturation **HFE Gene analysis\*\*\*** Liver biopsy with iron stain Sxs: can be asymptomatic arthralgias, hepatomegaly, **gray skin,** cardiomegaly, conduction D/O Tx: phlebotomy
Hemochromatosis
31
Rare genetic autosomal recessive DO **liver unable to excrete copper..OVERLOAD**
Wilson's disease
32
Labs: * *low ceruloplasmin** (first thing to test) * *elevated 24H urine copper** (second thing to test) ``` Sx: Visual disturbances (**Kayser-Fleischer ring around iris**) Neuro, psych changes ``` Tx: Copper chelators, like zinc
Wilson's disease
33
MC cause of cirrhosis
Alcoholic hepatitis
34
AST\>ALT 2:1
Alcoholic hepatitis (think alcohol when you see this 2:1 ratio!)
35
Occurs with binging, heavy use Can be fatal, pts often have encephalopathy Hepatosplenomegaly with ascites Jaundice
Acute phase of alcoholic hepatitis
36
What do you give for tylenol OD
N-acetylcysteine
37
Associated with autoimmune dzs Females 14-50 **Need biopsy to make diagnosis!** Tx= prednisone, Imuran
Autoimmune hepatitis
38
75% of cases are pts with ulcerative colitis mostly males "beading" of bile ducts on MRCP ``` tx= Ursodiol cure= transplant ```
Primary biliary cirrhosis
39
65% of hepatitis cases in US single stranded RNA enterovirus **fecal oral route!**..think travel, contaminated food/water, close contact with infected individuals
Hep A
40
Incubation pd= 2-6 weeks Severity depends on age **Prodrome phase**= flu like **Icteric phase**= dark urine appears first (bilirubinuria)\*\*\* pale stools soon follow RUQ pain pruritus arthalgias hepatomegaly
Hep A
41
Greatest shedding of virus is during days 14-21
Hep A
42
Which Ig is present during acute infection? (pos for 3-6 mos) Which Ig means youre immune?
IgM= acute infection IgG= immunity
43
Increase in ALT and AST (\>8x norm) Increase in bilirubin (5-15x norm) labs in....
HAV
44
HAV tx?
Usually self limiting. supportive care
45
Transmission= perinatal, sexual, blood **80% of hepatocellular carcinoma (HCC) cases** 3 categories: - immune (thru vaccine or natural infxn) - acute infxn - chronic infxn (active or inactive)
Hep B
46
1-6 mo incubation pd 70% are subclinical 30% develop icteric hepatitis -severe transaminitits and elevated bilirubin
Acute Hep B
47
HBcIgM (core IgM) ...means?
Acute Hep B infection
48
Hepatitis B surface antigen (HBsAg) indicates...
ongoing infection of any duration
49
Hepatitis B core antibody (anti-HBc) indicates...
Acute hepatitis
50
MC bloodborne infection in US **test everyone born between 1945-1965** \*RNA virus...1a, 1b, 2, 3, 4 are MC in US
Hep C
51
Transmission: IV drug use tattoos needlsticks **pre 1990-**transfusions
Hep C
52
Most pts asymptomatic 80% go on to chronic state **\*\*high risk of developing cirrhosis and HCC\*\*\*\*\***
Hep C
53
**Acute** Hep C tx
Supportive care Avoid hepatotoxic drugs
54
Viral load Genotype Tx hx LFTs Coags ETOH/drug screen HIV screen Staging of liver for fibrosis/cirrhosis with fibroscan or bx
Factors that determine best tx option for HCV
55
Direct antiviral agents (DAAs) Sovaldi, Harvoni, Vikiera Pak, Olysio, Daklina \*100% cure rate \*tx 12-24 weeks
treatment for Hep C
56
Is there a vaccination or immunoglobulin (for post exposure) for Hep C?
NO! must screen!!
57
Suddent onset deterioration of hepatocyte function resulting in coagulopathy Causes: Tylenol (45%) Alcohol/drugs Viral
Acute hepatic failure
58
+/- jaundice Increased transaminases (AST/ALT) Coagulopathy INR \>1.5 Encephalopathy due to increased ammonia \*may reuqire emergent transplant
Acute hepatic failure
59
Chronic end stage dz of liver marked by degeneration of cells from inflammation resulting in fibrous thickening of tissue
Cirrhosis
60
There are 4 stages of fibrosis, last being.....
cirrhosis
61
Dx: **abdominal U/S with doppler:** nodular appearing liver +/- hepatosplenomegaly assess portal vein ascites **liver biopsy:** able to stage the fibrosis
Cirrhosis
62
Early: weakness, fatigue, insomnia, muscle cramps, wt loss Late: N/V, abdominal pain, spider angiomas, palmar erythema, portal HTN, HSM, dilated veins in abdomen, ascited, encephalopathy
Cirrhosis
63
Varices occur when portal pressure exceeds..?
10 mmHg
64
1. Upper GI bleeds from esophageal varices 2. Ascites 3. Encephalopathy (due to increase ammonia) 4. Splenomegaly 5. Hepatorenal syndrome (poor prognosis)
Consequences of portal HTN
65
Nonselective beta blockers banding for varices diuretics and paracentesis for ascites lactulose and Xifaxan for enceph.
Management for portal HTN
66
What is the cure for cirrhosis?
Liver transplant
67
associated with cirrhosis weight loss painless jaundice +/- palpable mass hepatomegaly **6x more common in males**
Hepatocellular carcinoma (HCC)
68
Dx: Triple phase CT or MRI percutaneous bx of lesion increased LFTs
Hepatocellular carcinoma (HCC)
69
Alpha fetoprotein tumor marker is elevated with....
**HCC!** ..may also be elevated with chronic Hep C and cirrhosis
70
MC neoplasm of liver
Metastatic liver cancer from: lung, colon, breast, prostate, pancreas, stomach
71
how much of the liver can you remove?
80% **albumin, synthetic ability regained by 3rd week**

Clin Med- GI (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions