liver Flashcards Preview

DIT topics > liver > Flashcards

Flashcards in liver Deck (71):
1

role of fetal liver

major site of hematopoiesis in fetus: mesodermal hematopoietic stem cells migrate from mesonephros → to liver at 3 wk GA (source of fetal blood cell until BM at 28 wks GA)

2

portal triad

portal vein
hepatic artery
bile ductule

3

blood supply to liver

portal vein (from mesenteric veins, gastric vein): toxins + nutrition from GI
hepatic artery: O2 blood

4

hepatocytes role

make proteins
energy, vitamin, mineral storage
metabolize drugs/toxins
make bile → dump bile into bile canaliculi (opposite flow to sinusoid flow → bile ductule → hepatic duct → common hepatic duct...)
excrete bilirubin

5

zone affected first by ischemia + hypotension

zone 3: pericentral vein zone (farthest from O2 blood source - hepatic artery)

6

zone affected first by viral hepatitis

zone 1: periportal zone (next to portal vein)

7

zone most sensitive to metabolic toxins (acetaminophen overdose, site of alcoholic hepatitis)

zone 3: pericentral vein zone

8

zone with highest concentration of P450 enzymes

zone 3: pericentral vein zone

9

examples of proteins made by liver

coag factors
complement
albumin
apolipoproteins: lipid transport
transferrin: iron transport
ceruloplasmin: copper transport
others:
cholesterol
phosopholipids

10

examples of drug + toxin metabolism of liver

P450 enzymes
UDP glucoronyl transferase
ALT and AST: transaminases
steroid hormones → inactive metabolites (need for breakdown of estrogen, progesterone, testosterone, vitamin D, cortisol, thyroid hormone)

11

storage role of liver

glucose as glycogen
store cholesterol with TG in liver (esp VLDL)
iron bound to ferritin
B12, ADEK

12

role of bile

breakdown fats
carrier for excretion of bilirubin

13

complication of excess unconjugated bilirubin for several months in newborn

kernicterus: unconjugated bilirubin in brain

chorea
cerebral palsy
hearing loss
gaze abnormalities
brain damage → death

14

neuro effects of excess unconjugated bilirubin in newborn (occur in hrs-days)

bilirubin is neurotoxic:
lethargy
hypotonia

15

prevent kernicterus

phototherapy: convert bilirubin to isomer that can excrete

16

AR mutation in promotor for UDP-glucoronyltransferase gene →↓ amounts of UDP-glucoronyltransferase enzyme
conjugate bilirubin more slowly → slight elevation of INDIRECT bilirubin
benign and asymptomatic unless infection or alcohol (incidental finding)

Gilbert syndrome

17

complete absence of UDP-glucoronyltransferase enzyme
can't conjugate bilirubin and excrete it into the bile
jaundice + ↑ INDIRECT bilirubin in first few days of life
may have NEURO sx
if no treatment: kernicterous (die in a couple years)

type I crigler-najjar syndrome

18

treatment of type 1 crigler-najjar syndrome

phototherapy
plasmaphoresis - remove unconjugated bilribubin bound to albumin
definitive: liver transplant (makes UDP-GT)

19

mutated UDP-glucoronyltransferase enzyme
jaundice + ↑ INDIRECT bilirubin in first few days of life (but less than type I)

type II crigler-najjar syndrome

20

distinguish type I vs type II crigler-najjar syndrome

give phenobarbital (barbiturate): induces liver enzyme production (even UDP-GT)
type II pr Gilbert: ↓ bilirubin
type I: no change (no UDP-GT in liver!)

21

problem putting conjugated bilirubin back into bile → conjugated bilirubin trapped in hepatocytes → turns liver BLACK
↑ DIRECT serum bilirubin
benign - no treatment necessary

dubin-johnson syndrome

22

milder form of dubin-johnson syndrome
mild elevation in DIRECT bilirubin
liver DOESN'T turn black

rotor syndrome

23

stages of alcoholic liver disease

steatosis (fatty liver)
alcoholic hepatitis
alcoholic cirrhosis

24

fat droplets in cytosol of hepatocytes seen in HEAVY drinks
REVERSIBLE if stop drinking

steatosis: fatty liver

25

inflammation + steatosis
swollen necrotic hepatocytes
neutrophils in liver parenchyma
MALLORY bodies: intracytoplasmic eosinophilic inclusions of keratin

alcoholic hepatitis

26

RUQ pain
anorexia
jaundice
low-grade fever
↑AST>ALT (AST >2x the ALT, A Scotch and Tonic = AST)
enlarged, swollen liver

alcoholic hepatitis

27

IRREVERSIBLE
scarring + fibrosis
palpate hard, nodular liver edge
enlarged OR shrunken liver
AST/ALT: may be high, normal, low (trashed liver)
residual nodules of hepatocytse with collagen + sclerosis (blue on trichrome stain) surrounding them (replaced necrotic hepatocytes)
sclerosis located around central vein (zone 3)

alcoholic cirrhosis

28

complications of cirrhosis

liver failure: no hepatocytes
portal HTN: blood can't flow through sinusoids (causes hepatosplenomegaly) → portal vein

29

coagulopathy: ↑PT, PTT (need vitamin K)
bleeding/bruising
↓osmotic pressure → peripheral edema, ascites
no metabolism of ammonia → hepatic encephalopathy (confusion, delerium, hypersomnia, coma, death, asterixis, fetor hepaticus (musty odor of breath)
↑estradiol levels: testicular atrophy, gynecomastia, spider telangiectasia on chest, palmar erythema
↑ unconjugated bilriubin: jaundice, slceral icterus
↓LDL and HDL (liver not making)

liver failure

30

hepatosplenomegaly (blood backs up in these organs, can cause enlarged liver even though cirrhotic)
fluid leaks from liver due to back up of blood → ascites
caput medusa: umbilica veins dilated
anorectal varices: tortuous, dilated vein
esophageal varices (if active bleed → hematemesis, melena)

portal hypertension

31

complication of ascites

spontaneous bacterial peritonitis (SBP)

32

treatment of active esophogeal variceal bleed

↓ splanchnic circulation: octreotide (somatostatin analog)
B blocker: propranolol, nadolol

33

prevent esophageal varicel bleeding

endoscopic banding
transjugular intrahepatic portosystemic shunt (TIPS) - create shunt from portal vein → systemic circulation to bypass liver →↓ portal HTN, ↓ variceal blood flow, ↑ hepatic encephalopathy

34

treatment of hepatic encephalopathy

lactulose: trap ammonia in gut so excreted in stool →↓ serum ammonia levels

35

cirrhosis (alcohol, hep viral infection, hemachromatosis) is risk factor for

hepatocellular carcinoma

36

cocktail of meds for severe cirrhosis

diuretics
B blocker: nadolol, propranol
vitamin K: make clotting factors
lactulose: encephalopathy

37

aminotransferase (AST, ALT, liver enzymes) can suggest

viral hepatitis: ALT = or > AST
alcoholic hepatitis: AST > ALT (AST >2x)

38

gamma-glutamyl transpeptidase (GGT)

↑ in following:
liver + biliary tract diseases
excessive alcohol

39

akaline phosphatase

↑ in following:
biliary obstruction: gallstones, cancer
active bone formation: children (normal), Paget disease of bone, bone cancer
HCC

40

R sided heart failure or Budd-Chiari syndrome→ back up of blood into liver → nutmeg liver → if persists, centrilobular congestion + necrosis → cardiac cirrhosis

nutmeg liver (speckled)

41

occlusion of IVC or hepatic veins → congested liver
hepatomegaly
ascites
ab pain
portal HTN → esophageal varices, caput medusae
NO JVD

budd-chiari syndrome

42

congested liver
JVD

right sided heart failure

43

liver disease associated with:
hypercoagulable states
pregnancy
polycythemia
HCC

budd-chiari syndrome

44

children receiving aspirin for viral infection → aspirin metabolites inhibit mitochondrial enzymes →↓ B oxidation →
hepatoencephalopathy:
rash, vomit, headache, confusion → hypoglycemia, stupor, coma, death

reye syndrome

45

AR ATP7B enzyme defect:
1) inadequate copper excretion into bile → copper accumulates in:
liver, brain, cornea, kidneys, joints
2) impaired conversion of copper to ceruloplasmin (need for transport in blood) →↓ serum ceruloplasmin

wilson disease

46

features of wilson disease

cirrhosis of liver
Kayser-Fleischer rings: corneal deposits
↓ serum ceruloplasmin
basal ganglia degeneration: parkinsonian sx
asterixis, dyskinesia, dysarthria
hemolytic anemia
hepatic encephalopathy → dementia
fanconi syndrome: PT dysfunction in kidney
↑ risk HCC

47

Kayser-Fleischer rings: golden corneal deposits near edge of eye

wilson's disease

48

complication of wilson disease

↑ risk HCC

49

treatment of wilson disease

penicillamine (copper penny)

50

excess iron deposition
triad:
cirrhosis
diabetes mellitus
skin pigmentation
other complications:
congestive heart failure
testicular atrophy
↑ risk HCC

hemachromatosis

51

called "bronze diabetes"

hematochromatosis

52

causes of hematochromatosis

AR disease
secondary: excessive transfusion (chronic anemia states: B thalasemia, SCD)

53

↑ ferritin (complex of iron in apoferritin- primary cellular storage of iron): screening test
↑ total serum iron
↓ total iron binding capacity
↑ transferrin saturation (binds iron and transports it through plasma)

hemachromatosis

54

treatment of hematochromatosis

phlebotomy (iron is in RBCs - DOC)
subq:
deFEroxamine (for Fe): chelating agent
oral agents:
deferiprone
deferasirox

55

panacinar emphysema and liver cirrhosis in young person or non-smoker

α1 antitrypsin deficiency

56

autosomal codominant disease
↑ elastase activity → break down elastic tissue in lungs →
panacinar emphysema
mutated form of α1 antitrypsin made in liver and polymerizes → accumulates in liver →cirrhosis: jaundice, ↑ LFT

α1 antitrypsin deficiency

57

role of α1 antitrypsin

inhibit elastase (breaks down elastin)

58

female 20-40 yo
asymptomatic (incidental on imaging) or RUQ pain
associated with OCP use, anabolic steroids, glycogen storage disease type I and III

hepatic adenoma

59

complication of hepatic adenoma

malignant transformation to HCC in 10%

60

treatment of hepatic adenoma

stop OCP
serial imaging
check AFP to ensure not getting HCC
resect if > 5cm

61

malignant endothelial neoplasm of liver

hepatic angiosarcoma

62

risk factors of hepatic angiosarcoma

vinyl chloride
arsenic

63

liver disease with elevated α fetoprotein

HCC

64

risk factors for HCC

hep B/C
wilson disease
hemachromatosis
α1 antitrypsin deficiency
hepatic adenoma
alcoholic cirrhosis
carcinogen exposure (aflatoxin from aspergillus)

65

jaundice
tender hepatomegaly
ascites
polycythemia due to ↑ epo
hypoglycemia

HCC

66

serum marker for HCC

AFP

67

risk factors for hepatitis

IVDU (Hep B + C)
alcoholism (alcoholic hepatitis)
travel to developing countries/poor sanitation (fecal oral route: Hep A + E)

68

asymptomatic (but can transfer via sexual contact)
symptoms:
malaise
arthralgias
fatigue
N/V
RUQ pain
jaundice/scleral icterus
tender hepatosplenomegaly
LAD

hepatitis

69

labs:
bilirubinuria
↑AST + ALT (ALT higher or equal to AST in viral, AST higher in alcohol)
↑ serum bilirubin
↑ serum alk phosphatase

hepatitis labs

70

resolves with absitence

fatty liver disease

71

due to binge drinking

alcoholic hepatitis

Decks in DIT topics Class (115):