Flashcards in Liver Deck (84):
how big is the liver?
Size of a football
what is one of the primary products of the liver?
Bile (80% or > cholesterol)
2 forms of bile
conjugated and unconjugated
What are the LFTs?
Transamin (SGOT/AST, SGPT/ ALT)
What are 2 serum proteins to measure?
what is a coagulation indicator?
what is a good measure of someones nutritional status. Can show if they need artificial nutrition.
Ways to look at the liver
US (good for hallow vs. solid)
CT of RUQ and abdomen
What is percutaneous transhepatic cholangiograph? (PTC)
Puncture through the liver to one of the major vessels and put dye in there to show biliary drainage system.
What is an MRI choloangiopancreatography
High resolution, close-up of the main junctions where the cystic ducts and common bile duct join into the ampulla
Invasive tests for liver issues.
surgical exploration & excision
a yellow green coloration of the skin, sclera & mucous membranes. May be associated w/ pruritis
Jaundice is detected when bilirubin levels are above what?
2.5 mg/100 mL
Mechanisms that can cause jaundice. 6 causes
Excessive bilirubin production (pre conjugation)
Decreased hepatic uptake (pre conjugation)
What does indirect bilirubin mean?
if bilirubin is unconjugated will be in the urine?
No, urine will be free of bilirubin
What are ways to get excess unconjugated bilirubin (bilirubinemia)?
RBC destruction, decreased uptake, concurrent illness
impaired conjugation, hereditary
what can cause conjugated (direct) bilirubinemia?
Intracellular, canalicular, ductule, septal, intralobular problems
What is the onset with direct bilirubinemia?
Gradual with pruritis
what symptoms will you have with conjugated bilirubinemia?
steatorrhea (odor, float) from lack of fat absorption
What will labs look like with conjugated bilirubinemia?
^ Alk phos
what are symptoms of indirect bilirubinemia
anemia on CBC due to RBC destruction
How do you revere the coagulopathy found with conjugated bilirubinemia.
what causes extrahepatic obstruction?
Stone, stricture, tumor block biliary tree
Signs of extrahepatic obstruction.
GB may be palpable, painless
What is a sudden onset of extrahepatic obstruction often associated w/
What does extrahepatic obstruction look similar to?
What do you see on labs for extrahepatic obstruction
High direct biliruin
High alk phos
moderate high LFTs
What symptoms will someone with extrahepatic obstruction have?
Hepatitis picture with prodromal anorexia, nausea, abd pain, malaise. Hepatomegaly, ecchymoses, tender
what will labs look like with hepatocellular dz?
alk phos 2-4x upper limit of normal
LFTs >5x (ULN) (except with Hep C or alcoholism)
After 7 days of hepatocellcular dz what will happen?
Coagulopathy due to decreased clotting factors
What will happen after 10-14 days of hepatocellular dz?
What can you see with chronic hepatocellular dz.
atrophy of the testes
Why do you get encephalopathy with hepatocellular dz?
unconjugaeted bilirubin is lipophilic so it can cross the BBB
How much of alcoholic cirrhosis is silent?
Up to 40%
what do the majority of people with cirrhosis have?
what is a codition with excessive levels of iron in blood and body than can damage liver, testes, ovaries, heart.
What are heredity and metabolic cuases of cirrhosis
Primary biliary cirrhosis (PBC)
what is an inflammatory biliary dz common in women. Need a liver tranplant.
Primary biliary cirrhosis (PBC)
signs of chronic viral and alcoholic hepatitis
why is there peripheral edema with chronic hepatitis?
such low protein in blood, so fluid part of blood isn't held in by osmotic pressure and seeps into soft tissue
what is the leading cause of death with chronic viral and alcoholic hepatitis
bleed- esophageal varcieal or gastric
What is there a chronic morality risk of with chronic viral and alcoholic hepatitis?
Progressive fibrotic liver disease
Associated with other autoimmune disorders
Cholestatic and fibrotic manifestations
primary biliary cirrhosis
Labs to get with primary biliary cirrhosis
what is the key finding with primary biliary cirrhosis
positive anti-mitro Ab
Patient presents with dypnea, arthritis, skin discoloration, fatigue.
what is a TIPS
Trans hepatic intraperiotoneal shunt
artificial connection b/w portal circulation and systemic circulation to take pressure off portal system
how do you treat wilson's
Txs for primary biliary cirrhosis
treatment for hemochromatosis
what are signs of alcoholic liver dz
parotid gland enlargement
what is a chemical toxin that farm workers may encounter. causes tumors of the liver
drugs that can cause tumors of the liver
what type cancer is almost always in someone with hep c
what lab is diagnostic for a hepatocellcular carcinoma
How do you get HAV (hepatitis A virus)?
men having sex with men
How do you get HAB?
How do you get HCV?
What is HDV like?
What is HEV like?
how many binge drinkers develop fatty liver?
90% of binge drinkers
who are more susceptible to liver injury with less intake.
what type hepatitis has a 4-24 week incubation is has an insidious/acute onset
what type hepatitis has a 2-6 week incubation and onset is acute
What type of hepatitis has a 5-10 weeks incubation on insidious onset
do the hepatitis viruses actually kill cells?
No, the body's rxn to the viruses actually do harm
what is the pathologic picture of hepatitis
hyperplasia & cholestasis
Patient presents with Fever, spider angioma, hepatomegaly, splenomegaly, ascites, caput medusa,
malnutrition, ecchymoses, parotid enlarge-ment, jaundice, nausea
what do you suspect
alcohol harm to the liver
what ratio is elevated in alcoholic hepatitis?
what will be elevated with chronic alcoholic hepatitis.
MCV (mean corpuscular volume)
cell size is large
what drugs can cause cholestatic liver problems?
What can outdated tetracycline lead to?
Problem with liver
what drugs can give you fatty liver
what drugs can lead to hepatitis
what can you get miex hepatitis/ cholesterol from
what drugs can lead to necrosis of liver cells
What drugs can cause granulomas in the liver?
quinidine (off market)
how much time do you have to give antidote for acetamenophen OD?
treatment for hep b and D
treatment for hep c
treatment for hep A and E