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Emma GI > LFTs, Liver Diseases I/II > Flashcards

LFTs, Liver Diseases I/II Flashcards

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1
Q

non-specific LFTs

A
  • low albumin

- high bilirubin

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2
Q

LFTs may be normal in

A

cirrhosis or metastatic cancer

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3
Q

-alkaline phosphatase
-5’-nucleotidase
bilirubin-severe

A

cholestatic

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4
Q
  • AST/ALT
  • protein synthesis
  • Ig
  • removal of ammonia- severe
  • clotting fx - severe
  • glucose homeostasis - severe
A

hepatocellular

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5
Q

measures of excretion and detoxification

A

bilirubin

NH3

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6
Q

dec serum ceruloplasmin

A

Wilson’s disease

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7
Q

inc UC bilirubin

A
  • hemolysis

- Gilbert’s syndrome

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8
Q

inc C bilirubin

A
  • Dublin-johnson

- hepatocyte injury

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9
Q

inc UC bilirubin via inc production

A
  • hemolysis
  • pernicious anemia
  • thalessmia
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10
Q

inc UC bilirubin via dec conjugation

A
  • Gilbert’s syndrome

- Crigler-Najjar syndrome

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11
Q

inc C and UC bilirubin via dec excretion

A

all types of liver disease

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12
Q

T/F serum NH3 is reliable for dc of hepatic encephalopathy or urea cycle disorders

A

F

2/3 Cl by striated m.
inc w/ tourniquets, poor circumstance
less sensitive for encephalopathy than exam

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13
Q

albumin is a better indicator of (acute/chronic) disease

A

chronic

half life of ~18 d

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14
Q

cytokines (TNF, IL-4) inhibit ____ synthesis

A

ALBUMIN

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15
Q

single best measure of hepatic synthetic fxn

A

factor VII (6 hr half life)

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16
Q

ALT

A

primarily in liver
inc w/ high BMI, lipids, glucose
M>F
CYTOPLASMIC

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17
Q

AST

A

less specific for liver injury

found in cardiac m//skeletal m./ kidneys/brain/pancreas/lungs/wbc

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18
Q

AST>ALT

A

alcoholic liver disease, hepatoma

AST=MITOCHONDRIAL, EtOH= mito toxin

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19
Q

Primary AST:ALT pattern with liver disease

A

ALT>AST

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20
Q

alcohol-induced deficiency of _____ leads to alcoholic liver disease

A

pyridoxal phosphate

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21
Q

differentiate alkaline phosphatase elevation by testing for

A

gamma-glutamyl transferase (GGT)

5’-nucleotidase

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22
Q

GGT

A

endoplasmic reticulum and bile duct cells

less specific

also elevated in pancreatic disease, MI, renal failure, COPD, DM, phenytoin

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23
Q

elevated GGT

A

cholestasis

alc liver disease

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24
Q

diffuse polyclonal IgG inc seen in

A

AI Hepatitis

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25
AMA (antimitochondrial Ab)
primary biliary cholangitis
26
ASMA (Anti-smooth muscle Ab)
AI hepatitis
27
ANA (anti-nuclear Ab)
AI hepatits
28
alpha-fetoprotein
if inc w/ underlying cirrhosis, worry about hepatocellular CA
29
causes of low albumin
chronic liver disease malnutrition cytokines
30
alkaline phosphatase has isoenzymes in
liver bone placenta
31
liver zone __ is most susceptible to hypoxia
zone 3
32
The definition of acute liver failure is the onset of hepatic encephalopathy from severe liver injury which develops w/i ______ of the onset of sx (usually jaundice) in a person without pre-existing liver disease
8 weeks
33
acute liver failure due to toxic/ischemic injury results in _______ necrosis
centrizonal necrosis
34
acetaminophen OD, zone _ necrosis
3 | where p450 enzymes are located
35
AI hepatitis histo
plasma cells | interface hepatitis
36
mixed LFTs (elevated alk phos and AST/ALT)
drug-induced hepatitis (augmentin)
37
alcoholic hepatitis (steatohepatitis) histo
- steatosis - ballooning degeneration (&Mallory's hyaline) - inflammation - cholestasis
38
progression from chronic alcohol abuse to hepatocellular carcinoma
EtOH--> steatosis --> fibrosis --> cirrhosis --> HCC
39
metabolic causes of NAFLD/NASH
obesity Diabetes/insulin resistance HLD
40
nutmeg liver
severe CHF
41
hepatic circulatory disorders via outflow obstruction
- Budd-Chiari syndrome - Sinusoidal obstructive syndrome (after bone marrow transplant) - passive congestion (constrictive pericarditis, CHF)
42
hereditary hemochromatosis MOA
usu homozygous C282Y/C282Y (tyrosine for aspartate) - reduced HEPCIDIN --> uncontrolled SI Fe absorption - inc serum transferrin saturation - inc serum ferritin
43
hereditary hemochromatosis presentation
5-6th decade classic triad: cirrhosis, diabetes, skin pigmentation other organ dysfunction - cardiac - arthritis - hypOgonadism - others
44
hereditary hemochromatosis
- phlebotomy | - NO alc/vitC/multivitamins w/ minerals Fe
45
Kayser Fleischer Ring
Wilson's disease
46
Wilson's Disease MOA, clinical features
AR chrom 13 ATP7B gene (encodes Cu transporter) ^mut --> Cu accumulation "hepatolenticular degeneration" liver disease from late childhood onward neuro disease by mid adulthood
47
hepatolenticular degeneration
Wilson's disease
48
Wilson's disease labs
dec serum ceruloplasmin inc urinary Cu excretion inc hepatic Cu
49
Wilson's tx
- Cu chelation w/ penicillamine or Tridentine | - maintenance therapy w/ zinc
50
primary biliary tract diseases
AI cholangiopathies - primary biliary cholangitis/cirrhosis - primary sclerosis cholangitis
51
IBD (ulcerative colitis) associated biliary disorder
primary sclerosis cholangitis
52
primary biliary cholangitis MOA
florid duct lesion - granulomatous - non-suppurative" - chronic inflamm of INTRAhepatic bile ducts - middle aged women - insidious onset - progressive liver disease
53
primary biliary cholangitis labs
inc alk phos inc bilirubin inc HDL anti-mitochondrial Abs
54
granumolatous hepatitis
PBC - mycobacteria, other bacteria, systemic mycosis, parasites - noninfectious (sarcoid, drugs, foreign material)
55
primary biliary cholangitis sx
ITCHING osteoporosis (vitamin D malanbsorp) sick syndrome -dry eyes, mouth
56
UC plus cholestatic labs
primary sclerosis cholangitis
57
primary sclerosis cholangitis histo
concentric periductal fibrosis (onion-skin)
58
primary sclerosis cholangitis MOA
inflammatory fibrosis, involving both intra and extra hepatic bile ducts strictures in biliary tree, beading middle aged males assoc w/ UC
59
primary sclerosing cholangitis is a risk fx for which malignancies
bile duct (cholangiocarcinoma), GB and colon cancers
60
PSC tx
no proven therapy support/surveillance
61
Sjogren syndrome is associated with 70% of cases of which biliary disorder?
primary biliary cholangitis
62
strictures and beading of large bile ducts
primary sclerosis cholangitis
63
hepatocellular masses benign, non-neoplastic
nodular hyperplasias - FNH (focal nodular hyperplasia) - NRH (nodular regenerative hyperplasia)
64
hepatocellular masses benign, neoplastic
hepatocellular adenoma
65
hepatocellular masses malignant
hepatocellular carcinoma hepatoblastoma
66
biliary masses benign
bile duct hamartoma | bile duct adenoma
67
biliary masses malignant
choliangiocarcinoma
68
metastatic tumors of the liver
vascular (hemangioma, angiosarcoma) hematopoietic tumors (lymphoma, leukemia) misc mesenchymal tumors (angiomyolipoma, embryonal sarcoma, others)
69
hepatocellular adenoma
- benign neoplasm of hepatocytes - non-cirrhotic liver - young women, OCPs (men, anabolic steroids) - may rupture, bleed - rare malignant transformation (beta-catenin mutation)
70
focal nodular hyperplasia
-hyperplastic tumor-like growth of hepatocytes (not a true neoplasm) nodular regenerative response to localized vascular perfusion abnormalities central stellate scar non-cirrhotic liver young/middle aged adults (F>M)
71
cirrhosis common hepatic mass lesion
hepatocellular carcinoma
72
non-cirrhotic, <50 y/o common hepatic mass lesion
``` hepatocellular adenoma FNH HCC other primary liver tumors metastases ```
73
non-cirrhotic, >50 y/o common hepatic mass lesion
METS

Emma GI (18 decks)

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