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liver Flashcards

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0
Q

portal triad and waht contaisn it

A

hepatic artery
portal vein
duct

hepatoduodenal ligaent

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1
Q

cells of liver

A

hepatocytes
cholangiocytes:intercellualr channels–>bile canaliculi
nonparenchy
–kupffer (macrophages)
–sinusoidal endothelial cells- no RBC; leaky barrier
–pit cells
–hepatic stellate cells -collagen synth

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2
Q

splenic vein branches

A

short gastric
pancreatic
L gastroepiploic
IMV

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3
Q

SMV

A

inferior pancreatoduodenal

R gastroepiploic

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4
Q

portal vein

A

superior pancreatic duo

L gastric

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5
Q

biliary system

A

canals of hering–>bile ductules–>terminal ducts–>segmental bile ducts–>R and L lobal ducts–>common hepatic ducts + cystic duct–>common bile duct–>sphincter of oddi

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6
Q

acinus

A

blood supply of a small portion of parenchyma that drains a particular bile duct

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7
Q

lobule

A

blood supply by several separated portal vein branches, each of which also supplies adjacent lobules

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8
Q

bile compromises

A

conjugated bilirubin
cholesterol, phospholipids
bile salts
water, electrolytes

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9
Q

what converts 1% conj bilirubin to urobilinogen

A

intestinal bacteria

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10
Q

places glucose 6 p can go

A

synthesis of glycogen
anaerobic glyclysis
pentose-phosphate shunt

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11
Q

what proteins are not made by liver

A

Igs

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12
Q

what else makes alk P

A

bone

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13
Q

gGT

A

biliary epithelium

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14
Q

liver disease changes bioavailablity of circulating vasoactive substances and endothelial dysfunction

A

eNOS increase in splanchnic and decrease in liver AND increase production of VC–>splanchnic dilation and liver resistance

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15
Q

PHTN syndrome

A

central VS of cns and kidney–>brain dysfunction and hepatorenal syndrome

vasodilation of splanchnic–>arterial hypotension–>decrease in PVR, hypervolemia–> well perfused skin, low BP

vasodilation of intrapulm circ–>dec O2–>hepatopulm

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16
Q

hyperdynamic circulation means that

A

system very suceptible to very minor changes
septicemia–>endotoxin medicated vasoC
Nsaids–>block kidney fx
diurectics–>increase VS

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17
Q

these drugs may improve cirrhosis

A

bblockers to decrease shear stress on hepatic/splanic vessels–>decrease endothelial damage–>decrease enos

a agonist–>VD

anti inflam agents

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18
Q

child pugh predicts

A 
outcome of tx, variceal hemorrhage etc
scored for freq of abnoramilties
A: 5-6
B: 7-9
C: 10-15--decompensated cirrhosis
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19
Q

TIPS not recommendedchilds

A

grade b-c

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20
Q

ALT>AST

A

hepatitis

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21
Q

AST>ALT

A

alcohol or cirrhosis

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22
Q

dx test for ascites

A

SAAG
culture
cytology
CBC and HGB

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23
Q

SAAG >1.1

A

almost alaways decompensated cirrhosis

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24
tx ascites
tx underlying liver dz consider transplant if prognosis is poor decrease dietary Na intake, fluid restriction, and diuretics
25
in diuretic ressistance patients
paracentesis shunts:TIPS extracorporeal ultrafilitartin of ascitic fluid liver transplant
26
sequela of ascites
hepatic hydrothorax- fluid enters chest via diaphragmatic defects umbilicl, inguinal hernias spontaenous bacterial peritonitis: translocation of bacteria from mesenteric LN-->bacteremia-->bacterascites hepatorenal fx (poor px)
27
main cause of jaundice
viral hepatitis
28
hep A
+ stranded RNA picornavirus w/o envelope | feval oral
29
dx hep a
HAV IgM
30
HBV
small DNA virus of hepadnavirus --partially dsDNA + viral envelope + core, DNA polymerase and x particle sexual transfer mom-->child
31
clinical presentation of hepB
acute infection CLD extrahep-rash, gnitis, arthritis, vasculitis, angioneurogenic edema
32
testing hbv
+HbsAg= acute infection if anti-HBc (IgM is )+ +HBsAg w/ sx and - Igm- early acute +HBsAg w/o sx- mild CLD +anti-HVs(afe)--recovery/immunity +HV DNA- best indicator for active viral replicatin
33
tx HBV
entecavir, tenofovir
34
HDV
defective RNa virus--requires HBV first
35
HEV
single stranded + RNA hepevirus | pigs are reservoir
36
HEV transmission
fecal oral | rare instates, but leading cause of jaundice in endemic areas--usually affects both sexes
37
clinical presenation of HEV
incubation 2-9 weeks may cause acute liver failure chronic form possible
38
mortality in HEV
increase sa ton in pregnancy esp third trimester
39
testing HEV
RNA for active rep + IGM= acute, +IGG= past hep
40
hep v
single + sRNa virus, eveloped, flavivirus | 1-6 types
41
how do HCV invaide
interact with surface proteins hepatocyte enter cell by endocytosis uncoat in the low endosomal ph viral envelope fuses with endosome mebrane releasing RNa into cyto rna interacts with ribo single polyprotein produced cleaved by proteases to mature viral protein replicate assembly budding
42
risk of HCV
40-80% | higher than HBV
43
HCV can prodyuce
cryoglobinemia--accum of Igg related products in dependent ares- becoem insoluble in cold temp
44
screening tests
ELISA + RNA detection
45
anti HCV + HCV RNA +
active infection
46
anti HCV + , HCV RNA=
past infection
47
ANTI HCV -, HCV RNA+
acute HCV immunp sup | false positive RNA
48
HHC affects many organs
``` pituitary thyroid parathyroid heart liver panc gonads joints blood skin ```
49
pathiphys A1AT def
lung: A1AT blocks lung elastase in alveoli - -if they lack this-->lung disease and COPD liver: cuumulation of wrongly folded A1AT in cell ER-->cell damage-->apoptosis-->fibrosis and cirrhosis
50
what type of disease is A1AT
AR with codomiannt expression M, S, and Z alleles on SERPINA1 gene on Ch16 (or >100 identified alleles) most normal MM, Z abnormal
51
screening for A1At
recommended in patients with asthma and COPD
52
adults vs children presentaing
adults: lung > liver kids: neonatal jaundice, hepatomegaly, failure to thrive, or acute LF
53
dx A1AT def
decrease serum A1AT (but can increase with iflam because it is an APP) protein phenotyping liver bx (nor req) PAS + diastase resistant gloubles
54
most Fe in body found within
hemoglobin
55
most storage of Fe
macrophages and hepatocytes- small amounts in myoglbin
56
hepcidin
hormone produced in liver-->responds to Fe levels in blood | stimulates Fe transport into cells (macrophages, enterocytes, hepatocytes)
57
ferroportin
main Fe export protein on enterocytes, Mo, and hepatocytes
58
HFE protein
found on hepatocytes; sensory for circulating Fe
59
decrease in hepcidin
increase in circulating Fe
60
increase in hepicdin
increase in Fe transport into cells but decrease in export out because destruction of ferroportin
61
HFE-HC type 1
hereditary impairment of synthesis of fx of hepcidin AR mutation on chr 6 1:7 hetero for C282Y and 1:3 hetero for H63D
62
what happens in HFEHC
impaired hepcidin synthesis-->increase circulating Ge-->incrase transferrin sat-->progressive Fe deposition in parencyma of liver, etc
63
tx HFE HC
phelbotomy
64
NonHFE HC
not assocaited with hepcidin function transferrin saturdation is slightly increased or low iron accumulates in RES and othe rcells not responsive to phebotomy
65
dx hemochrom
increase LFT, inc ferritin, dec transferring, but inc trans sat (>45), decrease TIBC
66
wilson's disease
AR disease involving accumulation of Cu in body secondary to defective secretion by a mutated Cu transporting Ptype ATPase on golgi in hepato
67
job of defective Cup transporting p typeprotein
chaperon Cu into bile by binding apoceruloplasmin to form ceruloplasmin which transports cu
68
wilsons dz presentation
``` liver portal htn nonhemolytic anemia** cns: mental dysability renal dysfx cardiac bone heme ```
69
kayser fleischer ring
cu depposit in descement membrane of cornea-->sunflower cataract seen in 95% of patients with neuropsych sx usually normal vision
70
labs wilson
decrease in ceruoplasmin decrease total Cu (because mostly bound to ceruplasmin) but increase free total Cu fraction
71
tx willsons
d-pencillamine and trientine (chelators), zinc-absorption of excess Cu in the body, liver transplant
72
criggler najjer syndrome
ar disorder with decrease to absent UGT (more severe filbert)--type 1 incompatible with life, type 2 less severe UCBemia in children
73
dubin johnson
D ar disorder of apical canalicular membrane proteins resp for excretion of bili into intrahepatic ducts obstructive with increase CB black liver
74
rotor
similar to dubin with no black liver
75
oxidative metabolism alch
acetate is end product-->uses up O2 and NADH and produces centrilovular hypoxia in a region already low in O2
76
microsomal oxidation
not used much in normals but more in alcoholics, which is bad because acetyladehyde makes percentral zone produce collagen and also is the pathway used to oxidate tyelnol
77
alcohol increases
pmn infiltration
78
cytokines in alcohol
tnf and il6
79
HCT
may be only abnormal liver test
80
two measures of how bad alcholic liver disease is
MDF (pt and bili) >32 predicts 30 mortiality | MELD, >18 predicts 30 day mortality and >5 can get transplant
81
tx alch hepato
supprotive prenisolone for severe or hepatic enceph tnf inhibitor that decreses risk of renal disease abstinance is key1
82
NAFL
steatosis | benign, reversible
83
NASH
fatty liver _ hepatocyte death
84
cirrhosis
regenerative nodules + fibrosis
85
abnormal production of hormones produced by fat
decreased adiponectin-->block FA uptake-->increase FA oxidation and lipid export-->increase insulinsensitivty increase TNFa-->proapoptotic, recruits wbc, increase insulin R
86
liver function tests
AST, ALT ALT can suggest statosis | negative tsts other dz
87
gold standard of estimating severity
bx
88
tx NASH
``` weight loss increase insulin sens with metformin or proglitazone vitamin E/proglitazone change diet coffee ```
89
NAFL to cirrhosis
>10 years, 3%
90
NASH + fibrosis to cirrhosis
5,10 years, 30%
91
autoimmune HLADR3
fibrosis and cirrhosis
92
antibodies for AIH
ana often + but nto specific | usually either SMA or microsaomal but not both
93
polyclonal gammopathy
IgG>IgM>IGa
94
liver bz shows
plasma cells
95
LFT >1000
viral hep AiH shock liver acute drug or toxin liver injury
96
LFT >10000
acetaminophen tox/shock liver
97
other autoimmune dz
primary biliary cirrhosis franulomatous destruction of interlobular bile ducts-->progressive ductopenia-->progressive cholestasis-->cirrhosis and liver failure
98
PE of PBC
``` hyperpih excoriations from prutitis jaundice xanthomas hepatosplen ```
99
labs PBL
lFTs cholestatic (ALP/GCT>>>AST/ALT) AMA*****antimitochondrial antibody ANA+
100
tx of PBC
ursodeoxycholic acid works--improves LFTs and survive
101
PSC vs PBC
PSC0 macroscopic bile duct abnoramlity | PBC- microscopic
102
major comp of PSC
cholangiocarcoma (mc!)
103
ABCDE chronic hep
``` AiD B virus Cvirus Drug induced Etoh ```
104
portal triad and central vein collagen types
I, III
105
percellular reticulin in lobules collagen types
IV
106
causes of hepatic injury
toxin accum inflam ischemia
107
injury leads to
activiaton of hepatic stell cells-->proliferate, multiply, interact with kuppfer cells-->hepatocyte apoptosis & pro fibrosis (TGF B), loss of fenestrating-->cirrhosis
108
pathway of fibrosis
portal fibrosis-->periportal fibrosis-->inflammation that allows fibrosis to swpill over-->bridign fibrosis-->cirrhosis
109
main benign liver tumor
hemangioma
110
hepatocyte beign vs malignant
benign-hepatic adenoma, focal nodular hyperplasia | malignant- hepatocellular carcinoma, hepatoblastoma
111
biliary epithelium benign and malignant
benign- bile duct adenoma, biliary hamartoma malignant- choiangiocarcoma
112
mesenchymal benign vs malignant
benign-hemangioma, angiomylipoma malignant- angiosarcoma
113
biliary hamartoma is
normal tissue an abnormal location
114
hepatocellular adenoma
MC primary malignant HNF1a --associated with MODY3 associated with oral contraceptive, steroids, or pregnancy RUQ mass, pain, hemorrhage
115
focular nodualr hyperplasia
multiple fibrus septae with central scar
116
hepatoblastoma- least common malignant
kids; moms notice diapers arent fitting produces hcg so virilization and precocious puberty surgery and chemo
117
hepatocellular carcinoma
``` 90% malig cancer 80% with HBV or HCV (90% in west) travecular and acinar bile in neoplastic cells compesnated -->decompensated wth rising afetoprotein level ```
118
what doesnt work with HCC
chemo and radioRx--need liver transplant
119
special subset HCC
fibrolammelar hepato--age 20-40, no association with CLD or cirrhosis
120
cholangiocarcinoma
adenocarcinoma arising from intra and extra hepatic bile duct epithelium main site ampulla; no relation to cirrhosis a/w pSC, choledocal cysts, liver flukes, etc
121
CEA
increased in bile duct carcinoma
122
mucin production
in bile duct carcinoma | none in HCC
123
bile duct carcinoma vs hepatocellualr carcinoma spreads through
HCC-veins | BD-lymphatics
124
gross appearance HCC vs BD
HCC-soft and hem | BD-hard whitish

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