Liver And Biliary Tract Disorders Flashcards
(95 cards)
1
Q
Liver enzymes released from damaged hepatocytes
A
ALT and AST
2
Q
Between ALT and ASP, which is better
A
ALT
3
Q
If ALT or ASP is high
A
Something damaging the cells of the liver
4
Q
ALP and GGT found where
A
Bile duct-lining cells
5
Q
Where is ALP found
A
In membrane between the while ducts and the liver
6
Q
If either ALP and GGT are high
A
Something damaging the ducts of the liver
7
Q
GGT and alcoholism
A
glug glug test, can detect excessive alcohol consumption
8
Q
RBC degradation product
A
Bilirubin
Cleared by the liver
9
Q
LFTs found in hepatocytes
A
ALT and AST
10
Q
LFTs found in the intrahepatic canalicular cells
A
ALP and GGT in bile duct lining cells
11
Q
Elevation of AST and ALT
A
Something damaging cells of the liver
12
Q
Elevation of ALP and GGT
A
Something damaging the ducts of the liver
13
Q
The LFT most commonly elevated by excessive alcohol consumption
A
GGT
14
Q
Why is ALT considered more liver specific than AST and ALP
A
Because AST and ALP are found in may other organs (ALP in bone)
15
Q
Which hepatitis viruses are transmitted via blood
A
BCD
-parenteral, IV, tattoos
16
Q
Which hepatitis viruses are transmitted fecal/orally?
A
A and E
17
Q
Hepatitis A
A
- transmitted orally/fecally
- short lived jaundice
- acute nad self limiting, dont need to treat
- never has a carrier status
18
Q
Carrier status of hep A
A
Never has a carrier status
19
Q
Which two hepatitis infections can be synergistic together and cause a very bad infection
A
B and D
20
Q
Most easily transmitted hepatitis virus
A
B
21
Q
Carrier status of hep B
A
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
Q
Chance of becoming a carrier in HBV
A
20%
23
Q
If you are a chronic carrier of HBV, what is the chance you will get cirrhosis of the liver
A
20%
24
Q
If you have liver cirrhosis from being a chronic carrier of HBV, what is the chance of getting liver cancer
A
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
```
