Liver And Biliary Tract Disorders Flashcards Preview

Pathology Block 12 > Liver And Biliary Tract Disorders > Flashcards

Flashcards in Liver And Biliary Tract Disorders Deck (95):
1

Liver enzymes released from damaged hepatocytes

ALT and AST

2

Between ALT and ASP, which is better

ALT

3

If ALT or ASP is high

Something damaging the cells of the liver

4

ALP and GGT found where

Bile duct-lining cells

5

Where is ALP found

In membrane between the while ducts and the liver

6

If either ALP and GGT are high

Something damaging the ducts of the liver

7

GGT and alcoholism

glug glug test, can detect excessive alcohol consumption

8

RBC degradation product

Bilirubin
Cleared by the liver

9

LFTs found in hepatocytes

ALT and AST

10

LFTs found in the intrahepatic canalicular cells

ALP and GGT in bile duct lining cells

11

Elevation of AST and ALT

Something damaging cells of the liver

12

Elevation of ALP and GGT

Something damaging the ducts of the liver

13

The LFT most commonly elevated by excessive alcohol consumption

GGT

14

Why is ALT considered more liver specific than AST and ALP

Because AST and ALP are found in may other organs (ALP in bone)

15

Which hepatitis viruses are transmitted via blood

BCD
-parenteral, IV, tattoos

16

Which hepatitis viruses are transmitted fecal/orally?

A and E

17

Hepatitis A

-transmitted orally/fecally
-short lived jaundice
-acute nad self limiting, dont need to treat
-never has a carrier status

18

Carrier status of hep A

Never has a carrier status

19

Which two hepatitis infections can be synergistic together and cause a very bad infection

B and D

20

Most easily transmitted hepatitis virus

B

21

Carrier status of hep B

5-10% of adults go to carrier status, the younger you are when you are infected, the more likely you will be a carrier (90%)
-means they never clear the virus from their body

22

Chance of becoming a carrier in HBV

20%

23

If you are a chronic carrier of HBV, what is the chance you will get cirrhosis of the liver

20%

24

If you have liver cirrhosis from being a chronic carrier of HBV, what is the chance of getting liver cancer

20%

25

What causes the most liver cancer and deaths in the world

HBV, a lot of places in the world do not vaccinated against this

26

Only Ab that will clear someone from HBV

The Ab that the vaccine produces
-anti-HBs
-carriers never produce this

27

What can HBV cause

Acute hepatitis, liver pain, and yellow eyes
-can go to fulminant hepatitis which leads to death
-can lead to chronic hepatitis, carrier that does not clear the virus from the blood stream

28

HDV

-defective, needs B
-will not get a D infection without B
-if vax against B, will protect against D
-transmitted by everything
-can lead to fulminant hepatitis in B or carrier status

29

90% of people infected with this hepatitis become carriers

HCV
-follows the 20/20 rule, 20% chance the carriers will develop liver cirrhosis, 20% chance the liver cirrhosis patients will develop liver cancer

30

Is HCV chronic or acute

Chronic

31

HCV

-chronic
-asymptomatic for a cast majority of those years
-treatment is very effective

32

Number one cause of chronic hepatitis, cirrhosis, and liver cancer

HCV

33

HbsAG

HBV virus
-acute or chronic HBV present
-if absent, recovered or immunized

34

Anti-HBsAG

Ab that clears the body of HBV
-not present in acute or chronic HBV
-present when recovered or immunized

35

Anti-HbcAg

Everyone that gets HBV develops this, but you will not clear the virus unless you develop HbsAG
-not present in immunized

36

Largest internal organ

Liver

37

Produces the most clotting factors and proteins

Liver

38

Bilirubin elimination

Liver eliminates bilirubin by converting fit to bile

39

Site of cholesterol and glucose metabolism

Liver

40

Exocrine pancreas

Digestive

41

Endocrine pancreas

Insulin, glucagon

42

Inflamed liver

Hepatitis
-other viruses can cause hepatitis, not just HEp ABC
-acetaminophen and Tylenol most common reason for accidental liver failure

43

Acute viral hepatitis

-illness that usually resolves
-incubation and prodrome with flu like symptoms
-increase bilirubin levels, jaundice, first place you see it is in the eyes
-increased LFTs
-usually resolves

44

Chronic viral hepatitis

Virus not being removed from the body

45

The best, most specific livertest

ALT

46

Why is AST not very specific

It is found in a lot of other tissues, more abundantly in muscle than liver so its not very specific

47

If liver enzymes are elevated, can you recover from it or not?>

Yes

48

Kills hepatocytes, causes high levels of AST and ALT. GGT and ALP are slightly elevated

Viral hepatitis

49

Blocked bile duct and bilirubin

If the bile duct is blocked, cant get rid of bile, so bilirubin will start rising pretty quickly if blocking bile duct

50

Stoping bilirubin metabolism

Have to damage a lot of liver cells to be able to stop bilirubin metabolism

51

Bilirubin, GGT, and ALP levels in gallstones

Very high

52

AST and ALT levels in gallstones

Slightly elevated

53

Primary hepatitis

Hepatocytes rupture and spill AST and ALT 8x

54

Secondary hepatitis

Liver swells/narrows/damages canaliculi
-ALP/GGT/bilirubin 2x

55

Primary bile duct blockage

Very high bilirubin/ALP/GGT 8x

56

Secondary bile duct blockage

If uncorrected hepatocytes incur Minor damage, and mildly increased AST and ALT

57

What hepatitis has a vaccine we can give?

HAV and HBV(and D)

58

Recent infection immunoglobulin

IGM

59

Old infection immunoglobulin

IgG

60

What is the exception to IgG for infections

If there is a 4x change in IgG titer, treat like IgM

61

What is the hepatitis that is most likely to cause chronic infection

HCV

62

Recall which hepatitis viruses can be vaccinated against and interpret a case to determine if the patient has been vaccinated, recovered or is a carrier of HBV

HAV
HBV (and D)

63

Portal hypertension

Ascites

64

How does cirrhosis cause ascites

The blood flow coming into the liver through the portal system is scarred and there will be increased back up of blood

65

Predict the impact of a bile duct blockage on bilirubin and urine and fecal urobilinogen

The liver dumps bile and conjugated bilirubin into gut to be recycled normally, some bacteria convert the bilirubin to urobilinogen which gives urine and feces their color
-if there is a blockage and it does not get dumped into the gut, there will not be urobilinogen, no color to their stool, liver is not dumping bilirubin into the gut like it should (clay colored stool)

66

What’s the difference between hemochromatosis and polycythemia Vera

Hemochromatosis: iron overload
Polycythemia Vera: RBC overproduction

67

Skin color in someone with hematochromotiss

Bronzed skin

68

How do you treat PCV and hemotochromisi

Phlebotomy

69

What levels are high in hematochromotiss

Serum iron and ferritin

70

Offending agent in Wilson’s disease

Mutation in ATP7P gene (copper transport protein)

71

Ceruloplasmin and Wilson’s disease

Copper transport protein, low levels but could be elevated in acute phase

72

Spectrum of presentation of Wilson’s

-asymptomatic state to fulminating hepatitis, choleric liver disease +/- cirrhosis, neuropsychiatric manifestation
-psychiatric abnormalities may be Preston before hepatic or neurological signs
-ocular: kayser-fleisher ring (copper in the descemet’s membrane), sunflower cataracts

73

Kaiser fleischer rings

Present in 50% of patients with hepatic rings but are Preston invariably in neurological WD

74

Ceruloplasmin in Wilson’s

Low, but can be high

75

Copper in Wilson’s disease

High free copper (unbound)

76

Goal treatment for Wilson’s disease

Copper removal with ultimate goal of normalizing free copper levels in plasma

77

What kind of drugs used for treating Wilson’s disease

-chelating agents: penicillamine, trientine, tetrathiomlybdate
-blocking intestinal copping absorption: zinc sulfate

78

Difference between penicillamine and zinc acetate

-pencillimaine is a leading drug, it chelates it
-zinc acetate blocks the absorption of copper in the GI

79

Endocrine pancreas’s

Insulin
Glucagon

80

Exocrine pancreas

Proteases, amylase, lipases

81

Two primary causes of pancreatitis

Alcohol abuse and gallstones

82

What blood enzymes are elevated in pancreatitis

Increased serum amylase and lipase

83

The most likely complication of pancreatitis

Pancreatic cancer

84

If this is made, it will destroy the HBV virus

Surface antigen is the part that is Ab are made to it
-with vaccination (only with the surface antigen, cant get to the core)

85

Which Hepatitist resolve easily

A and E

86

Why order a PT/INR when investigating liver disease

See if liver is functioning

87

End of chronic liver disease where the liver is replaced with fibrous tissue

Cirrhosis

88

Signs of cirrhosis

Weight loss, fluid retention, ascites, edema, jaundice, confusion, variceal bleeding

89

Causes of cirrhosis

Virus hepatitis, alcohol, acetaminophen, drugs, biliary obstruction

90

Complication in cirrhosis

Portal HTN, GI bleeding, liver failure

91

First place you see jaundice

Sclera of eye

92

Gallstones

Choleslithiasis

93

Inflammation to the gallbladder

Cholescystitis

94

Who is cholecystitis most common in

Overweight females of childbearing age

95

Signs of cholescystitis

RUQ pain
ASP and GGT elevated
Pain and belching after fatty meal
Murphys sign
Leukocytosis with left shift