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(DIT) Rapid Fire + 4/5 Stars > Liver > Flashcards

Liver Flashcards

(54 cards)

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1
Q

Zones of liver lobule and susceptibility

A

Zone 1: highest O2 content, includes the portal triad
-Viral hepatitis

Zone 2: middle

Zone 3: closest to Central v.
-furthest from oxygenated blood - highest risk of ischemia
-toxic injury
highest p450 concentration

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2
Q

Hepatocyte protein production

A 
coagulation factors
complement
albumin
apolipoproteins
CRP
antiotensinogen
transferrin
ceruloplasmin

Synthesis of cholesterol and phospholipids (non protein)

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3
Q

Hepatocyte drug/toxin metabolism

A

CYP450 enzymes
UDP-glucuronyltransferase
ALT and AST
Steroids –> inactive metabolites

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4
Q

Hepatocyte storage

A

glucose - glycogen
Chloesterol and TGs - VLDL particles
Minerals
Vit B12, A, D, E, K

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5
Q

Hepatocyte bile function

A

breakdown fats

carrier for excretion of bilirubin

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6
Q

UDP-glucuronyl transferase

A

transfers glucuronyl group to bilirubin
- conjugation –> direct bilirubin aka conjugated bilirubin

Low in newborns:
decreased bilirubin conjugation
causes physiologic jaundice (indirect bili)

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7
Q

Kernicterus

A

bilirubin buildup in the brain –> neurotoxicity

Chorea
cerebral palsy
hearing loss
gaze abnormalities

Tx: phototherapy - blue lights

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8
Q

Gilbert Syndrome

A

AR - UDT1A1 mutation in promoter region of UDP-GT gene

Not much produced –> slow conjugation

Slight elevation of indirect bilirubin
benign, asx unless under stress –> mild jaundice

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9
Q

Crigler Najjar Sn type I

A

complete absence of UDP-GT
unable to conjugate bilirubin and excrete it
Jaundice and elevated indirect bilirubin in first few days

w/o tx –> kernicteris –> death in couple years

Tx: phototherapy, plasmapheresis
Cure via liver transplant

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10
Q

Crigler Najjar Sn type II

A

mutated UDP-GT - not as effective

Less severe, clinically like Gilbert Sn

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11
Q

Phenobarbital test for neonatal jaundice

A

induces production of hepatic enzymes
-distinguishes types

Crigler Najjar Type I - no change - no gene to induce

Crigler Najjar Type II reduced indirect bilirubin

Gilbert Sn reduced indirect bilirubin

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12
Q

Dubin-Johnson Syndrome

A

Cannot excrete conjugated bilirubin in bile
elevated direct bilirubin

liver turns black (dark)

D’s - Dubin, direct up, dark liver

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13
Q

Rotor Syndrome

A

like Dubin Johnson - elevated direct bili

no black liver

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14
Q

Stages of Alcoholic liver disease

A

1: steatosis - fat droplets w/in liver cells
- reversible if stop drinking

2: alcoholic hepatitis - inflammation w/ fatty depostis
3: Cirrhosis - irreversible

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15
Q

Alcoholic hepatitis

A

inflammation with fatty deposits
hepatocytes swollen and necrotic
neutrophils invade parenchyma

Mallory bodies - eosinophilic squiggly blobs

RUQ pain, anorexia, jaundice
low grade fever
>2:1 AST: ALT
-ALT low d/t B6 deficiency

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16
Q

Cirrhosis

A

irreversible

scarring and fibrosis
nodular surface
hard and nodular on palpation if palpable
-shrunken and contracted

liver enzymes may be high, normal, or low - trashed hepatocytes

Hepatocytes pink and blue collagen (scarring /fibrosis)
necrotic

Sclerosis centralized around central v in zone 3 of lobule

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17
Q

Liver failure effects

A

Coagulopathy - increased PT and PTT
-bleeding and bruising

Decreased albumin production = lower osmotic pressure
-edema, ascites

Can’t metabolize ammonia –> hepatic encephalopathy

  • confusion, delirium, hypersomnia
  • -> coma and death
  • asterixis
  • Fetor hepaticus (musty odor to breath)

High estradiol - can’t metabolize steroids

  • -> testicular atrophy, gynecomastia
  • spider telangectasias (spider angiomas)
  • Palmar erythema

Jaundice
low LDL and HDL

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18
Q

Portal hypertension

A

HSM
Ascites –> paracentesis
-risk spontaneous bacterial peritonitis (potentially deadly)

Portosystemic anastomases dilate, become varicosed

  • caput medusae - abdominal wall veins
  • anorectal varices - rectal v.
  • esophageal varices
  • renal varices
  • paravertebral varices
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19
Q

Treatment of esophageal variceal bleeding

A

Octreotide - somatostatin analog

propranolol, nadolol to prevent

endoscopic banding

Transjugular intrahepatic portosystemic shunt (TIPS)
-worsen risk of hepatic encephalopathy, bypass liver

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20
Q

Medications used in cirrhosis

A

diuretics - decrease ascites and edema

beta blocker - prevent esophageal varices bleeding

Vit K - maximize clotting potential

Laculose - trap ammonia in gut, excreted in stool

  • decrease serum ammonium levels
  • tx hepatic encephalopathy
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21
Q

Aminotransferases

A

AST, ALT

ALT >= AST - viral hepatitis
AST > ALT - alcohol

Hepatocytes

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22
Q

Gamma-glutamyl transpeptidase (GGT)

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A

liver pathology
excess etOH
biliary tree disease

23
Q

Alkaline phophatase

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A

biliary obstruction - gallstones, cancer

Active bone formation - kids, Paget dz of bone, bone cancer

24
Q

Nutmeg liver

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A

back up of blood into liver d/t right sided HF
JVD

speckled liver section

can be due to Budd Chiari Syndrome

Long time –> central lobular congestion and necrosis
–> fibrosis (aka cardiac cirrhosis)

25
Budd-Chiari
Obstruction of IVC and hepatic vs Central lobular congestion and necrosis --> congestive liver disease - hepatomegaly - ascites - abdominal pain - Portal HTN --> esophageal varices, caput medusa NO JVD ``` Assoc w/: hyper coagulable stages pregnancy polycythemia hepatocellular carcinoma ```
26
Reye Syndrome
Potentially fatal children w/ aspirin for viral infections hepatoencephalopathy Early: rash, V, HA, confusion --> hypoglycemia, stupor, coma, death Damage to cellular mitochondria --> decreased beta-oxidation -aspirin metabolites reversible inhibitor of enzymes Aspirin only okay in kids w/ Kawasaki disease
27
Wilson disease
``` AR Defect in ATP7B Inadequate copper excretion into bile Impaired conversion of copper to ceruloplasmin -low ceruloplasmin in serum ``` ``` Copper accumulates in liver, brain, cornea, kidneys, joints -Kayser-Fleischer rings -Cirrhosis --> increased risk of HCC hemolytic anemia Basal ganglia degeneration Parkinson like sx Hepaticencephalopathy --> dementia Fanconi syndrome : proximal tubule dysfunction in kidney, decreased reabsorption ``` Tx: penicilliamine "copper penny"
28
Hemochromatosis
excess iron deposition Triad: cirrhosis, bronze DM, skin pigmentation Other: CHF Testicular atrophy increased risk of HCC Labs: high ferritin (cellular storage of Fe), high total serum Fe, decreased total iron binding capacity (TIBC - all used up, can't bind more), high transferrin saturation Primary - AR Secondary - excessive transfusions d/t chronic anemia Tx: phlebotomy Deferexamine - SQ Oral: deferiprone, deferasirox
29
Alpha1-antitrypsin deficiency
Autosomal codominant Panacinar emphysema: too much elastase activity Cirrhosis - mutated form of protein accumulates in liver cell, toxic Early onset
30
Hepatic adenoma
Females 20-44 yo - OCP years Risk: OCP use, anabolic steroids, glycogen storage disease type I and III Sx: RUQ pain, usually asx 10% transform to HCC Tx: dc OCP, serial imaging and AFP, +/- resection (esp over 5 cm)
31
Hepatic angiosarcoma
Malignant endothelial neoplasm in liver Risk: vinyl chloride, arsenic exposure
32
Hepatocellular carcinoma
MC primary liver tumor ``` Risk: HBV, HCV Wilson dz Hemochromatosis a1-antitrypsin deficiency alcoholic cirrhosis Aflatoxin from aspergillus ``` ``` Sx: Jaundice tender hepatomegaly ascites polycythemia hypoglycemia ``` Marker: AFP - check serially
33
General hepatitis
asx - transmit infection w/o knowing Sx: malaise, arthralgias, fatigue, N/V, RUQ pain, scleral icteris, HSM, LAD ``` Labs: high ALT and AST High serum bilirubin high alk phos high urine bilirubin ``` Causes: viral infections, chronic alcohol use, toxins Micro: Councilman bodies Mallory bodies (more common in etoh liver dz)
34
Hepatitis A
ssRNA Fecal/oral route, poor sanitation 30 d incubation risk: international travel (Mexico, S. America) labs: HepA IgM during illness HepA IgG after resolution or vaccination (1 dose 12 mo - 18 yrs, 1 booster 1 yr later) Tx: supportive - self limited
35
Hepatitis E
ssRNA Fecal oral/route, contaminated water more likely to cause fulminant hepatic failure in pregnant Labs: PCR, HepE IgM tx: supportive
36
Fecal-oral transmitted hepatitis
"vowels come from the bowels" | HAV, HEV
37
Hepatitis D
ssRNA Delta virus, defective pathogen Infections in presence of HBV Transmission MC blood, sexual contact 20% mortality (highest) Tx: pegylated IFN-a for 1 yr prevention - HBV vaccine
38
Hepatitis C
ssRNA 50-85% chronic infection; 5-35% --> cirrhosis Increased risk of hepatocellular carcinoma - u/s q6mo for surveillance Extrahepatic manifestations: membranoproliferative glomerulonephritis, essential mixed cryoglobinemia, lymphoma, thyroiditis, porphyria cutanea tarda, lichen planus, DM Transmission: MC blood, sexual contact (rare) Dx: HepC Ab, RNA Tx: Ledipasvir - sofosbuvir Ombitasvir-paritaprevir-ritonavir + dasabuvir
39
Hepatitis B characteristics
dsDNA!!! Transmission: perinatally, sex MC, blood Chronic infection - less than 5% acquire as adult - 90% acquire perinatally Extrahepatic manifestations - d/t circulating immune complexes -polyarteritis nodosa, membranous nephropathy, aplastic anemia Increased risk of HCC - U/S every 6 mo, +/- AFP (high false +) -more than HCV
40
Significance of HBsAg
active disease
41
Significance of HBsAb
recovery from active infection or immunization
42
HBcAb significance
Hx of infection - IgM early; IgG late
43
HBeAg significance
active viral replication = high transmissibility
44
HBeAb significance
low transmissibility
45
HBV DNA
active viral replicaiton tx indicated when high and high LFTs
46
``` HBsAg+ HBsAb - HBcAb + IgM HBeAg + HBeAb - HBV DNA high ```
Active HBV infection
47
``` HBsAg- HBsAb- HBcAb+ IgM HBeAg HBeAb HBV DNA high/low ```
Acute infection - Window period - Abs neutralize Ag - on the way to recovery
48
``` HBsAg- HBsAb+ HBcAb+ IgG HBeAg- HBeAb+ HBV DNA - ```
Past infection - recovered
49
``` HBsAg - HBsAb+ HBcAb- HBeAg- HBeAb- HBV DNA- ```
vaccine
50
``` HBsAg+ HBsAb- HBcAb+IgG HBeAg+ HBeAb HBV DNA high ```
Chronic infection - immune tolerance still active HBV, little liver damage
51
``` HBsAg+ HBsAb HBcAb+ IgG HBeAg + --> - HBeAb HBV DNA high --> low ```
Chronic infection - immune clearance high LFTs, damage happening Likely to clear and respond to treatment
52
``` HBsAg+ HBsAb HBcAb+ IgG HBeAg- HBeAb HBV DNA Low ```
Chronic infection - inactive carrier normal LFT 20-30% can reactivate
53
treatment of HBV
MC: tenofovir entecavir, telbivudine, lamivudine, adefovir Pregnant women: if HBV DNA elevated w/ active liver involvement - lamivudine -Give baby HBV vaccine and HBV immune globulin w/in 12 hours of birth
54
Autoimmune hepatitis
elevated AST and ALT Type 1: ANA, anti-smooth muscle Ab Type 2: anti-liver-kidney microsomal Ab, anti-liver cytosol Ab ``` Other disease w/ autoimmune features: hemolytic anemia T1DM thyroiditis celiac sprue UC ```

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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