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Flashcards in Liver Deck (84):
1

how big is the liver?

Size of a football

2

what is one of the primary products of the liver?

Bile (80% or > cholesterol)

3

2 forms of bile

conjugated and unconjugated

4

What are the LFTs?

Transamin (SGOT/AST, SGPT/ ALT)
Alkaline phosphatase

5

What are 2 serum proteins to measure?

albumin
prealbumin

6

what is a coagulation indicator?

Prothrombin

7

what is a good measure of someones nutritional status. Can show if they need artificial nutrition.

Prealbumin

8

Ways to look at the liver

Plain films
US (good for hallow vs. solid)
CT of RUQ and abdomen

9

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.

10

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

11

Invasive tests for liver issues.

Needle biopsy
open biopsy
ERCP
surgical exploration & excision

12

a yellow green coloration of the skin, sclera & mucous membranes. May be associated w/ pruritis

Jaundice

13

Jaundice is detected when bilirubin levels are above what?

2.5 mg/100 mL

14

Mechanisms that can cause jaundice. 6 causes

Excessive bilirubin production (pre conjugation)
Decreased hepatic uptake (pre conjugation)
Impaired conjugation
Intrahepatic cholestasis
Extra-hepatic obstruction
Hepatocellular injury

15

What does indirect bilirubin mean?

Unconjugated

16

if bilirubin is unconjugated will be in the urine?

No, urine will be free of bilirubin

17

What are ways to get excess unconjugated bilirubin (bilirubinemia)?

RBC destruction, decreased uptake, concurrent illness
impaired conjugation, hereditary

18

what can cause conjugated (direct) bilirubinemia?

Intracellular, canalicular, ductule, septal, intralobular problems

19

What is the onset with direct bilirubinemia?

Gradual with pruritis

20

what symptoms will you have with conjugated bilirubinemia?

pale stools
dark urine
steatorrhea (odor, float) from lack of fat absorption

21

What will labs look like with conjugated bilirubinemia?

^ Alk phos
mild LFT
normal albumin
coagulopathy

22

what are symptoms of indirect bilirubinemia

anemia on CBC due to RBC destruction
jaundice

23

How do you revere the coagulopathy found with conjugated bilirubinemia.

Vitamin K

24

what causes extrahepatic obstruction?

Stone, stricture, tumor block biliary tree

25

Signs of extrahepatic obstruction.

GB may be palpable, painless

26

What is a sudden onset of extrahepatic obstruction often associated w/

Colangitis

27

What does extrahepatic obstruction look similar to?

intrahepatic cholestasis

28

What do you see on labs for extrahepatic obstruction

High direct biliruin
High alk phos
moderate high LFTs

29

What symptoms will someone with extrahepatic obstruction have?

Dark urine
pale stools
possible coagulopathy

30

Hepatitis picture with prodromal anorexia, nausea, abd pain, malaise. Hepatomegaly, ecchymoses, tender

Hepatocellular dz

31

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)

32

After 7 days of hepatocellcular dz what will happen?

Coagulopathy due to decreased clotting factors

33

What will happen after 10-14 days of hepatocellular dz?

hypoalbuminemia

34

What can you see with chronic hepatocellular dz.

chronic fibrosis
portal HTN
ascites
gynecomastia
atrophy of the testes
encephalopathy

35

Why do you get encephalopathy with hepatocellular dz?

unconjugaeted bilirubin is lipophilic so it can cross the BBB

36

How much of alcoholic cirrhosis is silent?

Up to 40%

37

what do the majority of people with cirrhosis have?

portal HTN

38

what is a codition with excessive levels of iron in blood and body than can damage liver, testes, ovaries, heart.

hemochromatosis

39

What are heredity and metabolic cuases of cirrhosis

Wilson's, Gaucher's
Primary biliary cirrhosis (PBC)
Faconi's
Cardiac

40

what is an inflammatory biliary dz common in women. Need a liver tranplant.

Primary biliary cirrhosis (PBC)

41

signs of chronic viral and alcoholic hepatitis

Varices
Ascities
Hypersplenism
peripheral edema
encephalopathy

42

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

43

what is the leading cause of death with chronic viral and alcoholic hepatitis

bleed- esophageal varcieal or gastric
infection
encephalopathy

44

What is there a chronic morality risk of with chronic viral and alcoholic hepatitis?

hepatocellular carcinoma

45

Progressive fibrotic liver disease
Associated with other autoimmune disorders
Cholestatic and fibrotic manifestations

primary biliary cirrhosis

46

Labs to get with primary biliary cirrhosis

Alk Phos
SED/ CRP
Anti-Mitochondrial Ab
IgM (high)

47

what is the key finding with primary biliary cirrhosis

positive anti-mitro Ab

48

Patient presents with dypnea, arthritis, skin discoloration, fatigue.

hemochromatosis

49

what is a TIPS

Trans hepatic intraperiotoneal shunt
artificial connection b/w portal circulation and systemic circulation to take pressure off portal system

50

how do you treat wilson's

d-penicillamine (chelator)

51

Txs for primary biliary cirrhosis

ursodiol
colchicine
MTX
Vit ADK
cholestyramine
zinc
transplant
diet

52

treatment for hemochromatosis

phlebotomy

53

what are signs of alcoholic liver dz

caput medusa
parotid gland enlargement

54

what is a chemical toxin that farm workers may encounter. causes tumors of the liver

aflatoxin

55

drugs that can cause tumors of the liver

Estrogens
anabolic steroids
alcohol

56

what type cancer is almost always in someone with hep c

hepatocellcular carincoma

57

what lab is diagnostic for a hepatocellcular carcinoma

alpha fetoprotein

58

How do you get HAV (hepatitis A virus)?

Fecal-oral
child care
NICU
men having sex with men

59

How do you get HAB?

percutaneous
perinatal
sexual

60

How do you get HCV?

Percutaneous
primarily IVDA

61

What is HDV like?

HBV

62

What is HEV like?

HAV

63

how many binge drinkers develop fatty liver?

90% of binge drinkers

64

who are more susceptible to liver injury with less intake.

women

65

what type hepatitis has a 4-24 week incubation is has an insidious/acute onset

HBV

66

what type hepatitis has a 2-6 week incubation and onset is acute

HAV

67

What type of hepatitis has a 5-10 weeks incubation on insidious onset

HCV

68

do the hepatitis viruses actually kill cells?

No, the body's rxn to the viruses actually do harm

69

what is the pathologic picture of hepatitis

monocyte infiltration
cell necrosis
hyperplasia & cholestasis

70

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

71

what ratio is elevated in alcoholic hepatitis?

ALT/AST >1

72

what will be elevated with chronic alcoholic hepatitis.

MCV (mean corpuscular volume)
cell size is large

73

what drugs can cause cholestatic liver problems?

OCP
Erythromycin
Tegretol
Chloropro

74

What can outdated tetracycline lead to?

Problem with liver

75

what drugs can give you fatty liver

methotrexate
protease inhibitor

76

what drugs can lead to hepatitis

halothane
INH
keocon
verapmail

77

what can you get miex hepatitis/ cholesterol from

azathi
niacin
statins

78

what drugs can lead to necrosis of liver cells

Acetaminophen
Carbon Tetetrachloride
Amanita (mushrooms)
DMF
Yellow phosphorus

79

What drugs can cause granulomas in the liver?

Sulfonamide
allopruinol
quinidine (off market)

80

how much time do you have to give antidote for acetamenophen OD?

17 hours

81

treatment for hep b and D

Interferon, Lamuvidine

82

treatment for hep c

Interferon, Ribavirin

83

treatment for hep A and E

supportive

84

ABCDEF pneumonic for fulminant hepatitis

Acetaminophen Hep A autimmune hept
Het B
Hep C cryptogenic
Hep D, drugs
Esoteric causes- wilson's Budd-Chiar syndrome
Fatty infiltration- acute fatty liver preggo, Reye's