Liver Path III Flashcards Preview

GI II Exam 1 > Liver Path III > Flashcards

Flashcards in Liver Path III Deck (55):
1

consequences of cirrhosis, male

hepatic encephalopathy
esophageal varices
splenomegaly

2

consequences of cirrhosis, females

oligomenorrhea, amenorrhea, sterility, hypogonadism

3

jaundice

yellow staining of membranes by bilirubin

4

cholestasis

inability to excrete bile

5

bile salts

can lead to pruritis - itching

also malabsorption of fats - no Vit K dependent clot factors

6

cholesterol retention

eruptive xanthomas - periorbital or tendinous

7

canal of hering

travel of bile - to portal tract

8

small ductule cholangioncytes

canal of hering

imflammation/proliferation

9

large ductule cholangiocytes

volume/alkalinity

10

cholestasis and parenchyma

enlarged hepatocytes, dilated canalicular spaces, apoptotic cells, kupffer cells present

11

portal tract and cholestasis

edema, bile pigment retention, neutro inflammation

12

UDP

uridine diphosphatase - conjugates bilirubin with glucuronic acid

13

unconjugated bilirubin

binds albumin
-not excreted in kidney

14

conjugated bilirubin

does not bind albumin - lost in urine

15

urobilinogen

brown color of stool and yellow color of urine

16

choluria

dark urine

17

pale stool

in cholestasis
-no bilirubin to darken stool - stercobilinogen

18

unconjugated hyperbilirubinemia

hemolysis
gilbert
crigler najjar

19

mixed hyperbilirubinemia

look at AST, ALT, alk phos, and GGT

high AST, ALT - hepatic
high alk phos and GGT - cholestatic

20

AST < ALT

viral serology

21

AST > ALT

alcoholic liver disease

22

20-30yo with black liver

dubin johnson

23

high conjugated bilirubin

dubin johnson
rotor syndrome

24

gilbert

shortage of enzyme
-jaundice under stress

unconjugate bilirubin high

25

crigler najjar type 1

no enzyme
-kerniceterus - levels >20
bad

unconjugated bilirubin high

26

crigler najjar type 2

some enzyme

bilirubin 6-20

unconjugated bilirubin high

27

bilirubin in urine

always pathological - detected on dipstick

28

delta-bilirubin

in plasma bound to albumin

not measured

longer half life

this is why after hepatitis starts to resolve or obstruction treated - conjugated levels take some time to return to normal

29

neonatal jaundice

cannot conjugate 2 weeks old

physiologic jaundice of newborn that goes away
-unconjugated

worse with breast feeding deconjugating enzymes in milk

30

alpha1 antitrypsin deficiency

can cause neonatal jaundice

31

neonatal jaundice causes

biliary atresia - require surgery

non-biliary disorders - alpha1 antitrypsin deficiency

idiopathic

32

panlobular giant cell transformation of hepatocytes

neonatal hepatitis

33

biliary atresia

jaundice before 8 weeks old in neonate
-elevated conjugated**

two forms - fetal and perinatal

34

fetal biliary atresia

aberrant intrauterine development of biliary tree - situs inversus, congenital heart disease

35

perinatal biliary atresia

most common**

bile ducts destroyed after birth - unknown etiology

type 1 - common duct
type 2 - right or left hepatic bile duct
type 3 - common - above porta hepatis - not correctable**

36

cholestasis histo

zone 3 bilirubin in hepatocytes and bile canaliculi

zone 1 ductule proliferation and fibrosis

37

large bile duct injury

classically obliterative cholangitis

immunohisto stain IgG4 positive plasma cells surrounding bile duct

38

ampulla of vater

bile ducts dump into duodenum

39

acute jaundice

flu-like, RUQ pain, acholic stool, choluria, pruritis, eruptive jaundice, encephalopathy

40

chronic jaundice

cirrhosis

portal HTN, ascites, variceal hemorrhage

41

spider angiomata

chronic jaundice - estrogenic

42

ALT/AST measure of hepatocyte integrity

viral infection - destroy hepatocyte
cirrhosis - can have normal levels

43

most common cause of elevated AST/ALT

NASH

44

AST:ALT greater than 1

more likely alcohol

and never >500

greater than 300 - consider infection, toxic insult

45

more specific indicator

ALT

46

GGT

specific to liver

can isolate liver as source of problem

47

mild increase in GGT

more than 3 drinks/day

48

alk phos and GGT

induced enzymes

49

albumin

measure of hepatocyte function
-half life 20 day - slow changes

50

protime

measure of hepatocyte function

must rule absorption of vit K factors**

51

IgA

alcoholic liver disease

52

IgM

primary biliary cirrhosis

53

IgG

autoimmune hepatitis

54

liver biopsy

gold standard

cholestasis - ultrasound
hepatitis - lab tests

55

child pugh score

used in chronic liver disease - cirrhosis

class determines one and 3 year survival - based on looking at bilirubin, albumin, PT, ascites, and hepatic encephalopathy