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Liver cont. Flashcards

1
Q

This is a progressive, patterned fibrosis of the entire liver

A

Cirrhosis

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2
Q

What is the most common cirrhosis

A

Portal cirrhosis

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3
Q

What causes cirrhosis

A

Repeated episodes of liver necrosis with regeneration and repair and SCARRING

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4
Q

What are the most common causes of cirrhosis

A
  • Alcoholism

- Chronic hepatitis

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5
Q

This results from chronic inflammation of the bile ducts

A

Biliary cirrhosis

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6
Q

Describe biliary cirrhosis

A
  • Autoimmune

- Usually due to secondary things like gallstones

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7
Q

What is Sclerosing cholangitis

A

A cause of bile duct inflammation associated with ulcerative colitis

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8
Q

Describe a cirrhotic liver

A

-Small, scarred, and retracted

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9
Q

In early stages of cirrhosis the liver can be ______

A

fatty

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10
Q

T/F- Iron deposits (hemochromatosis) and accelerated emphysema are common in cirrhosis

A

True

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11
Q

What is equilalent to portal hypertension

A

over 30 cm H2O

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12
Q

What causes portal hypertension

A

Obstruction of portal flow

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13
Q

What are S&S of cirrhosis

A
  • Ascites
  • Congestive splenomegaly
  • Varicosities
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14
Q

What are hemodynamic consequences of portal hypertension

A
  • Ascites
  • Congestive splenomegaly
  • Esophageal varicies
  • Hemorrhoids
  • Prominent periumbilical veins (caput medusa)
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15
Q

What does portal hypertension cause?

A
  • hemorrhoids
  • esophageal varices
  • splenomegaly
  • caput medusa veins radiating from the umbilicus, and contributes to the formation of ascites.
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16
Q

The failing of hepatic metabolism of estrogen results in…

A

High blood estrogen

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17
Q

S&S of high blood estrogen

A
  • Gynecomastia
  • Thickening of scalp and genital hair
  • Palmar erythemia
  • Atrophic testes
  • Spider angiomas
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18
Q

These result from failing hepatic metabolism of ammonia

A
  • Hepatic coma

- Fetor hepaticus (liver breath)

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19
Q

Failure of excretion of bilirubin causes…

A

Jaundice

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20
Q

What does failing hepatic protein sysnthesis cause?

A

-Decrease in plasma albumin–> ascites and edema–> decreased levels of coagulation factors–> bleeding due to increased PT and PTT –> bruising

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21
Q

Common findings in acute alcohol abuse

A

-Steatosis (fatty liver)

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22
Q

Common findings in chronic alcohol abuse

A
  • Cirrhosis
  • Gastric ulcers
  • Accidents
  • Thiamine deficiency
  • Cardiomyopathy
  • Pancreatitis
  • Hypertension
  • Spontaneous abortion
  • Fetal alcohol syndrome
  • Cancers of the mouth, throat, larynx, esophagus, pancreas, and bladder
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23
Q

What does alcohol do to hepatocytes

A

ALCOHOL DAMAGES HEPATOCYTES

24
Q

What are the 3 stages of liver damage?

A
  • Steatosis
  • Hepatitis
  • Cirrhosis
25
How does steatosis manifest?
Large clear areas within the hepatocytes | -they are filled with fat
26
What are councilman bodies?
Necrotic liver cells that are caused by HEPATITIS
27
What are the 3 things that indicate hepatitis
- Necrotic liver cells (councilmen bodies) - Intracellular degenerative inclusions (Mallory bodies) - Fibrosis
28
What are ways that hepatitis A-E differ?
- Mode of transmission - Length of incubation period - if a carrier state can occur - if chronic hepatitis can occur - if fulminant hepatitis can occur - is there increased risk for liver cancer
29
Describe Hep A
- Spread by fecal oral route - Mild, self limiting - DOES NOT lead to severe consequences like cirrhosis or liver cancer
30
What do Hep B and C have in common?
- Spread by bodily fluids - Long viremia - Carrier state - Chronic hep - Increased risk for liver cancer
31
Describe asymptomatic hepatitis
- No symptoms | - Usually discovered on routine labwork with elevated liver enzymes
32
___________ is an asymptomatic chronic infection that you still have the virus and CAN infect others
Carrier state
33
What kind of hepatitis has a carrier state?
Mainly Hep C
34
What are the phases of acute viral hepatitis?
- Incubation - Symptomatic prejaundice - Symptomatic jaundice - Convalescence
35
In what heps do you see jaundice?
- MOST HEP A - half Hep B - Very few Hep C
36
How do you diagnose chronic viral hepatitis
- Liver biopsy | - 6 months or more of lab evidence
37
What types of hep lead to chronic
- NO Hep A - 10% Hep B - 50% Hep C
38
_________ acute disease progressing rapidly to hepatic failure and encephalopathy in a matter of weeks
Fulminant Hepatic failure
39
What types of Hep do you see fulminant hepatic failure?
Hep A | Hep B
40
What Heps do you have an increased risk of cancer
Hep B | Hep C
41
_______ is a benign, self-limited disease with no carrier state or chronic hepatitis
Hep A
42
________ is transmitted by personal contact and oral-fecal contamination of food and water
Hep A
43
clinical phases and blood markers of infection=
Hep A
44
When do IgG and IgM appear in Hep A and what does it mean?
- IgM appears when there are acute phase antibodies in the blood - IgG appears when there is immunity against the infection/reinfection
45
_________ is much more serious and may cause symptomatic acute hepatitis, fulminant hepatitis with massive liver necrosis, or chronic hepatitis that may advance to cirrhosis; a small percent of patients becomes carriers.
Hep B
46
How is Hep B transmitted?
- Transfusions - Blood products - Renal dialysis - Needle stick accidents - IV drug use - Sex
47
Describe Hep B acute infection
- Rapid appearance of virus in blood before symptoms - Disappearance of virus in the blood - Appearance of antibodies for hep B surface antigen (this marks the recovery phase)
48
What are the S&S for chronic hepatitis?
- Continued jaundice - Clinical S&S - Continued presence of Virus in blood (HBsAG)
49
What signals Hep B carrier state?
- Disappearance of S&S | - Persistance of virus in the blood
50
Is there a vaccine for Hep B?
YESSSS- reduced the number of infections by a lot!!
51
Do most people recover completely from Hep B?
Yes because they develop antibodies to HBsAg
52
If you have chronic hep B what are you at risk for?
- Cirrhosis | - Liver cancer
53
What indicates an acute infection for Hep C
-Permanent disappearance of clinical S&S and virus in blood
54
What indicated chronic hep C?
- Reappearance of jaundice or S&S | - Persistent levels of virus in the blood
55
What indicates the hep C carrier state?
Persistent evidence of virus in the blood
56
What percentage of people with Hep C recover?
50% recover completely - majority develop chronic hepatitis - 1/3 of chronic patients develop cirrhosis and have a high chance of getting cancer

Pathophysiology (18 decks)

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