liver Flashcards
(91 cards)
1
Q
liver fxn if BG high
A
glycogenesis: forms glycogen from excess glucose
2
Q
liver fxn if BG low
A
glycogenolysis: breaks down glycogen into glucose
3
Q
beta oxidation
A
breakdown of fatty acids (liver fxn)
4
Q
hep A transmission
A
fecal-oral
5
Q
hep B transmission
A
blood, sexual contact (semen, vaginal secretions, saliva)
6
Q
hep C transmission
A
blood (transfusions, IVDU, multiple sex partners, piercings, tats, immunocompromised individuals, sharing personal items like razors, occupational exposures)
7
Q
hep D transmission
A
percutaneous (increased incidence w IV drug abusers)
8
Q
hep A & B s/s (+1 A only)
A
hepatomegaly
liver tenderness
splenomegaly ~15%
A: lymphadenopathy
9
Q
hep C s/s
A
longterm consequences s/t inflammation- scarring- hep fibrosis- cirrhosis (30%)- hepatocellular carcinoma (3%)- end stage liver disease
10
Q
increases Hep C viral load
A
EtOH lt 50g
11
Q
hep A fecal excretion
A
up to 2 wks before clinically apparent illness
12
Q
hep B onset
A
more insidious than A, can be abrupt
13
Q
hep A illness & recovery
A
acutely ill: 2 - 3 wksfull recovery: ~9 wks
14
Q
*hep B illness, incubation, recovery
A
acutely ill 2 - 3 weeks
*incubation 6 wks - 6 mo (avg 12 - 14 wks)
recovery 16 wks
can become chronic
15
Q
*hep C incubation, illness
A
*incubation 6 - 7 wksfreq asx for years70% infected develop chronic disease
16
Q
labs hep A vs B
A
- WBC WNL
- mild proteinuria
- ↑ bilirubin & alk phos
- ↑ AST & ALT (B gt A)
- bilirubinemia (precedes jaundice)
17
Q
Hep A specific labs x2
A
anti-HAV IgM & IgG
18
Q
- Hep A: IgM
A
- dx marker
- peaks 1st wk illness
- disappears w/in 3-6 mo
19
Q
- Hep A: IgG
A
- indicates prev exposure
- non-infectivity & immunity
- peaks after 1 mo, may persist yrs
20
Q
*Hep B specific labs x6
A
HBsAg, HBcAg, HBeAg
anti-HBs
anti-HBc IgM & IgG
21
Q
*Hep B: first evidence infection / infectivity
A
HBsAg- persists → clinical illness
- indicates infectivity
- if persists 6+ mo ind chronic Hep B
22
Q
*Hep B: successful vaccination
A
anti-HBs
23
Q
*Hep B: recovery & non-infectivity
A
anti-HBs appears then disappears
24
Q
Hep B: anti-HBs
A
appears after virus clearance
- successful vaccination
- appears/disappears = anti-HBs
25
Hep B: IgM
- appears shortly after HBsAg
- helps confirm dx in pts who may have cleared HBsAg
- may persist 3 - 6 mo
26
Hep B: IgG
persists indefinitely whether cured or chronic
27
Hep B: helps confirm dx in pts who may have cleared HBsAg
IgM anti-HBc
28
Hep C dx + sens/spec
```
enzyme immunoassay (EIA) detects ab to JCV- low spec (false +)
- mod sens (false -)
```
29
Hep C confirmatory dx
HCV-PCR RNA (how much HCV in blood?)
30
Hep A & B tx
```
bedrest
fluids - PO
ADMIT:
- cannot maintain hydration
- INR gt 1.6
- encephalopathy
```
31
when to admit Hep A or B
ADMIT:
- cannot maintain hydration
- INR gt 1.6
- encephalopathy
32
Hep A specific tx
- handwashing !!
- immune globulin to all close personal contacts
- avoid EtOH, strenuous exercise, hepatotoxic rx (tylenol)
- prevention: inactivated hep A vax
33
Hep C tx
```
based on genotype (1-6, 1-3 most common)
protocols based on "resp rate"
- peginterferon
- ribavirin
- protease inhibitors
- sovaldi
```
34
peginterferon
helps healthy cells fight HCV, strengthens immune sys
SE
- flu-like: fatigue, HA, fever, chills, n/v, arthralgias, myalgias
-worsening depression
-mood instability
- ↑ susceptibility to inf
35
worsening psych seen as SE to which HCV tx?
peginterferon
36
ribavirin
```
antiviral (HCV), interferes w RNA metabolism
SE
- hemolytic anemia
- MI
- pneumonitis
- dyspnea & infiltrates
```
37
sofosbuvir (Sovaldi)
HCV polymerase inhibitor
- 12 wk course (varies by genotype)
- may include ribavirin & peginterferon
38
no chronic form of which Hep?
Hep A
39
only viral hep that causes fever spikes
Hep A
40
Hep B vaccination
- initial, 1 & 6 mo
- recombinant-derived
- lasts 15 yrs
- booster if titers lt 10 mIU/mL~90% vax'd dev protective ab to Hep B
41
single stranded RNA virus + mutates rapidly (difficult to treat)
Hep C
42
*Hep A: infected markers
anti-HAV
| IgM anti-HAV
43
*Hep A: non-infectivity, immunity
IgG anti-HAV
44
*Hep B: infected
HBSAg
| HBEAg
45
*Hep B: confirmatory dx
IgM anti-HBC
46
*Hep B: non-infectivity, immunity
anti-HBSAg
47
*Hep C specific labs
ab to HCV
| HCV RNA assay
48
chronic hepatitis
B, C, D
- inflammatory response gt 3 to 6 mo
- ↑ ALT & AST
- inflammation of portal sys + lobules (mild, mod, severe)
- fibrosis (mild, mod, severe) or cirrhosis
49
chronic Hep B s/s
- cirrhosis (40-50% die w/in 5 yrs)
- liver failure
- hepatocellular carcinoma
50
chronic Hep B tx
interferon (recombinant human interferon alfa-2b) {Intron A} Lamivudine (Epivir) nucleotide analogs: suppress HB DNA for 1 yr
51
chronic Hep C s/s + risks
- 20% cirrhosis after 20 yrs
- hepatocellular carcinoma
risks:
- gt 50g EtOH qd
- acquire HBC @ 40+
- immunosuppressed
52
chronic Hep C tx
- peginterferon, ribavirin, PI (protocols based on resp rate)
- Sovaldi
53
chronic Hep D s/s + dx
superimposed on B
- dx: ab to Hep D ag (anti-HDV)
- rapid dev cirrhosis
- ↑↑↑ mortality
54
alcoholic hepatitis
* REVERSIBLE *
acute or chronic inflammation → necrosis of parenchyma
most common cause of cirrhosis (Hep C #2)
55
red flag EtOH levels (possible alcoholic hepatitis)
4 oz whiskey15 oz wine4x 12 oz beer (cans)50g/day 10+ years
56
alcoholic hepatitis: risk factors
- 50g/day 10+ years- female (↓ gastric mucosal EtOH dehydrogenase level)
↑ duration (10-15yrs) + ↑ consumption = ↑ probability AH & cirrhosis
57
alcoholic hepatitis: s/s
- h/o N/V
- hepatomegaly, splenomegaly
- jaundice, ascites
- abd pain/tenderness
- fever, encephalopathy
58
alcoholic hepatitis: labs
- CBC: macrocytic anemia, leukocytosis (left shift), thrombocytopenia
- PT ↑ & INR
- AST ↑ gt ALT↑
- ↑ alk phos, bilirubin
- ↓ albumin folic acid deficiency
59
alcoholic hepatitis: tx
- nutritional support: proteins & CHO to offset catabolism, prev hypogly
- vit supplement (Banana Bag): folic acid, thiamine (B1)
* MUST GIVE GLUCOSE + THIAMINE or → Wernicke-Korsakoff Syndrome *
60
alkaline phosphatase
protein found in all body tissues, higher in liver, bile ducts, bone.
61
* Wernicke-Korsakoff Syndrome *
encephalopathy w/ ataxia, confusion, amnesia, confabulation, & impaired learning in alcoholic hepatitis, glucose given without thiamine (B1) can result in this
62
liver cirrhosis leads to what anemia?
macrocytic anemia
63
spider nevi s/s of?
cirrhosis
64
palmar erythema s/s of?
cirrhosis
65
Dupuytren's contractures
flexion 4/5 digits indicating cirrhosis
66
notable late s/s of cirrhosis
pleural effusions, encephalopathy
| + jaundice, ascites, peripheral edema, ecchymotic lesions, asterixis
67
cirrhosis lab findings
macrocytic anemia
↓ WBC s/t hypersplenism thrombocytopenia
prolonged PT, ↑ INR↑ of AST, alk phos, bilirubin↓ albumin
68
ascites r/t cirrhosis: pathophys
portal htn: → ↑ hydrostatic pressure (liver enlarged, pushes fluid out of vessels → 3rd spacing)
hypoalbuminemia → ↓oncotic pressure
69
ascites r/t cirrhosis: tx
restrict Na+ (400-800mg/day)
diuretics: Spironolactone, Furosemide large
-vol paracentesis (4-6L)
TIPS (Transjugular intrahepatic Portosystemic Shunt)
70
TIPS (Transjugular intrahepatic Portosystemic Shunt)
stent btw branch of hepatic vein & portal vein introduced via IJ
takes blood from liver to IVC
71
complications of cirrhosis
```
ascites
spontaneous bacterial peritonitis
hepatorenal syndrome
encephalopathy
portal hypertension
```
72
spontaneous bacterial peritonitis r/t cirrhosis: risk + s/s + tx
risk: h/o variceal bleeding & PPI uses/s: abd pain, ↑ ascites, fever, progressive encephalopathy
tx: cefotaxime (3rd gen cephalosporin) + IV albumin
73
hepatorenal syndrome r/t cirrhosis + dx
renal failure s/t ESLD
dx: azotemia, in abs of shock or sig proteinuria, in ESLD where renal fxn doesn't improve w infusion of 1.5L NS → r/o other causes of renal failure including pre-renal azotemia
74
hepatorenal syndrome labs
- azotemia
- urine vol lt 500mL/day
- urine Na lt 10mEq/L
- urine osm gt plasma osm
- urine RBC gt 50
- serum Na lt 130mEq/L
75
hepatorenal syndrome type 1 pathophys
rapid progression - doubling creatinine to gt 2.5mg/dL in 2 wks
76
hepatorenal syndrome type 2 pathophys
slower progression - more chronic (presents as diuretic-resistant ascites)
77
presents as diuretic-resistant ascites
type 2 hepatorenal syndrome
78
is type 1 or 2 hepatorenal syndrome faster?
type 1 progression more rapid
79
hepatorenal syndrome tx
liver transplantation
80
encephalopathy r/t liver: pathophys
cerebral edema: poss etiologies inc breakdown of BBB -or- Na+ accumulation s/t inhibition of Na-K ATPase
leads to acute ↑ ICP → ↓ CPP, cerebral blood flow, loss of autoregulation
81
encephalopathy stages
I - euphoria, depression, mild confusion, slowed mentation, slurred speech, sleep disturbances
II - drowsiness, inappropriate behavior, tremors
III - sleeps but arousable, confused, incoherent speech, abn EEG, tremors
IV - Unarousable, Abn EEG
82
encephalopathy mgmt
mannitol (hold if serum osm gt 320)↓ ammonia levels:
- lactulose (hold if ileus)
- neomycin (monitor for oto or nephrotoxicity)
83
portal hypertension r/t cirrhosis
progression of liver failure: pressure back up → ascites & varices (esophageal, gastric, duodenal, rectal)
*pre-disposed to a GI bleed ( coagulopathy + likely to bleed + pressure prob d/t vol back up)
84
portal hypertension tx
sclerotherapy
TIPS
balloon tamponade
85
sclerotherapy
tx for portal hypertension: cauterize vessels
86
fulminant hepatitis + s/s
```
viral hepatitis → sudden or severe liver disease
- massive hepatocellular necrosis
s/s (shocky & losing volume)
- jaundice
- hepatomegaly
- ↑ AST & ALT
- ↓ H&H
- prolonged PT
- encephalopathy
```
87
fulminant hepatitis tx
SUPPORTIVE
- maintain perfusion (fluids, inotropes)
- vent support
- monitor f&e, maintain normal glucose
- monitor ammonia: tx w lactulose or neomycin
- consider transplantation
88
Non-Alcoholic Steatohepatitis (NASH)
"silent liver disease"
| resembles alcoholic liver dz in individuals who do not drink
89
NASH clinical findings + dx
↑ ALT & AST
initially pts asx
- liver bx diagnostic
- fatty liver, inflammation, damage to liver cells
90
NASH dz progression
asx → fatigue, weight loss, weakness
| adv disease → liver failure, cirrhosis
91
NASH tx
initially lifestyle → IBW, balanced diet, avoid unnecessary meds, avoid ETOH, ↑ physical activity
liver failure = only tx is transplantation
