Unit 3 Part 1 Flashcards Preview

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Flashcards in Unit 3 Part 1 Deck (138):
1

hepatitis

inflm of liver

2

et of hepatitis

microbes (including virus, bact, fungi, parasite)
drugs
autoimmunity

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5 most common viruses in viral hep

Hep A B C D E virus

4

what are 2 other viruses in viral hep that are more uncommon and have dec threat/concern

hep F G virus

5

what other viruses may cause viral hep

epstein barr, cytomegalovirus

6

what is important to remember about viral hep

viruses all have same patho and similar mnfts but have different mode of transmissions, incubation periods, severity

7

Transmission of Hep a

fecal oral route, person-person, waterbourne, food bourne

8

incubation of hep a

15-50 days

9

carrier state/sev of hep a

mild, no carrier state

10

transmission of hep b

parenterally, sexually, oral-oral, perinatal

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incubation period of hep b

28-160 days

12

what percent of hep b cases are severe

10-15%

13

carrier state in hep b

possible

14

what percent of hep c is chronic

80%

15

transmission of hep c

blood products, infected drug paraphenalia, sex

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carrier state of hep c

freq carrier state (chronic) and chronic liver disease

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what may follow hep c

Chronic liver disease and cirrhosis, liver CA

18

incubation period for hep c

15-160 days

19

2 main mechanisms of viral hep patho

virus causes hepatocyte injury via regular mOa
immune mediated response leading to tissue damage + inflm

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what follows both mechanisms of viral hep

damage of livers fx cells -> necrosis

21

how long may it take for a self limiting case to heal

16 wks

22

3 phases of mnfts in viral hep

prodormal
clinical
recovery

23

mnfts of prodormal phase in viral hep

Lethargy, myalgia, anorexia, nausea, vomitting
abdm pain
fever

24

why does lethary, myalgia, anorexia, N+V occur in the prodormal phase of viral hep

dec liver fx, liver is not metb E or releasing glc

25

why does abdm pain occur in the prodormal phase of viral hep

rt to inflm, inc liver size -> liver pushes out on its capsule

26

when does the clinical phase of viral hep b occur

5-10 days post prodormal

27

what mnfts occur during the clinical phase of viral hep

mnfts get worse
jaundice
pruitis
hepatomegaly

28

why does jaundice occur during the clinical phase of viral hep

dec number of hepatocytes are available to break down heme -> inc bilirubin levels -> circulation

29

why does pruitis occur during the clinical phase of viral hep

dt accum of bile salts in the integument

30

how does hepatomegaly feel in clinical phase of viral hep

inflm, tenderness, pain

31

when do acute mnfts reside in viral hep

in the recovery phase, may take ~3wks

32

how do we track recovery from viral hep

using diagnostics

33

what do we measure when tracking recovery from viral hep

enzyme levels

34

why are enzyme levels important in recovery from viral hep? what trend should we see if prognosis is good

decreasing levels, because decreasing ez levels = normalizing liver fx. inc ez means there is still cell lysis and necrotic cells are releasing their content (thus inc ez level).

35

tx of viral hep (5)

rest liver
diet mod
no alcohol/hepatotoxic drugs
symptomatic relief of pain/prutis
post exposure prophylaxis

36

how do you rest the liver

decrease e req of pt (bed rest, inc sleep_

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what diet mods are used to treat viral hep

dec meal size, eat meals with more calories, dec fat

38

why do we want to decrease fat intake when txing viral hep

bile is used to emulsify fat, inc fat -> inc bile -> inc liver fx

39

what is post exposure prophylaxis

address factors that may have caused the virus

40

what post exposure prophylaxis can you use for hep A/B/C

teaching good hygiene, gamma globulin Tx to inc IR

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what post exposure prophylaxis can you use for hep A/B

vaccinations

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what post exposure prophylaxis can u use for hep c

anti viral drugs

43

autoimmune hep

severe and chronic form

44

et of autoimmune hep

idiopathic
complex trait with enviro trigger and HLA gene on chr 6

45

2 types of autoimmune hep

Type 1
Type 2

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what population has increased incidence of type 1 autoimmune hep

women >40yo, normally these pts have other autoimmune issues

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what causes damage in type 1 autoimmune hep

abn ab's

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what 2 abn ab's cause damage in type 1 autoimmmune hep

ANA's
Anti sm m. Ab's

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ANA

anti nuclear ab, self targets nucleocytes

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anti sm. m. ab;s

targetting sm m. in liver, eg vessels and ducts

51

what population has inc incidence of type 2 autoimmune hep

age 2-14 peds pts, much like RHD

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what abs are targetted in type 2 autoimmune hep

microsomes and cytosol

53

mnfts of autoimmune hep

may be asymptomatic -> liver failure
autoimmune presentations
similar to viral

54

how to dx autoimmune hep

must exclude other types of hep
test for elevated gamma globulin in blood

55

what is important to remember in autoimmune hep

self targeting Abs ONLY, no T cells

56

tx for autoimmune hep

supress pts own IR abs and give new gamma globulins
if drugs dont work - liver transplant?

57

cirrhosis

end stage liver disease -> liver failure
degeneration of liver tissue -> dec fx capacity
fibrosis - nodular liver

58

major problems assoc w cirrhosis

dec liver fx
Portal HTN

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et of cirrhosis (6)

alcohol abuse (60-70%)
hep (mostly c) 10%
drugs
biliary disease
metb disorders
idiopathic cryptogene

60

what metb disorder may be an et of cirrhosis

hemocromatosis - Fe overlaod -> deposition of Fe into tissue surrounding liver -> hepatotoxicity

61

how much alcohol must be ingested to have alcoholic liver cirrhosis

>80g/day in men
>40g/day in women

62

what is the main patho behind cirrhosis

repetitive assault on hepatocytes -> dec regen of hepatocytes until regen doesnt occur

63

what happens in cirrhosis when hepatocytes are noo longer able to regen

scar tissue forms instead

64

what does inc scar tissue formation in cirrhosis ->

compression of ducts and vessels

65

what happens when ducts are compressed by scar tissue (eg cirrhosis)

dec perfusion resulting in venous stasis

66

what does venous stasis in the liver result in

portal htn rt inc hsp

67

complication of portal htn

fluid shift out of v -> ascites

68

what happens if there is bile stasis

gallstones? rt dec bile flow

69

what happens to metb waste in cirrhosis

dec waste clearance

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most common mnfts of cirrhosis

anorexia, wt loss, weakness, hepatomegaly, jaundice

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what do we focus on when txing cirrhosis? why?

complications because common mnfts are unspecific

72

complications of cirrhosis

portal htn
ascites
varices
gi bleed
splenomegaly

73

varices/varix

dilation of a v. assoc with hps, not in portal system! blood moves to these veins causing inc P in these assoc veins and dilate them

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why might a GI bleed occur in cirrhosis

ruptured varix

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why is splenomegaly a complication in cirrhosis

rt to engorgement of splenic v. -> fluid shift out of v. -> inc spleen size

76

tx for cirrhosis

maximize cell regen
tx complications

77

how do you maximize cell regen in cirrhosis

no alcohol, dec fat intake, rest

78

portal htn

inc in P in Hps

79

what is normal hps P

5-10 mmhg

80

what P indicates portal htn

>12 mmhg

81

what is important to remember about HPS

its venous system only

82

how much of the livers venous blood is the hepatic portal v. responsible for (brings in)

70%

83

how much blood does the hepatic a. supply the liver with

30%

84

what percent of hps veins drain the liver

100%

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et of portal htn

pre
intra
post hepatic
mostly dt cirrhosis (intra hepatic)

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major complication of portal htn

hemorrhaging varix

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other complications of portal htn

ascites
portosystemic shunts
spleenomegaly

88

what is a portosystemic shunt

collateral channels form between hps and assoc veins

89

why do portosystemic shunts occur

in attempt to displace some of the P out of the hps

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why is portosystemic shunts not beneficial

it passes the inc P onto other veins, making the problem bigger and it allows blood to bypass liver -> inc of unfiltered blood in circulation

91

why does spleenomegaly occur in portal htn

inc P in hps veins -> engorgement of splenic v. -> inc vol in v. -> inc hsp -> fluid shift into spleen

92

what is important to remember about spleenomegaly and portal htn

enlargment is not dt hypertrophy and the spleen does not have an inc workload

93

portosystemic shunting of blood -> dev of collateral channels. what 3 things arise from this?

caput medusae
hemorrhoids
esophageal varices

94

caput medusae

superficial vessels near umbillicus that becomes engorged dt portosystemic shunt formation. looks like a spiderweb on skin

95

what 2 things can portosystemic shunting of blood lead to

dev of collateral channels
shunting of ammonia and toxins from GI -> general ciruclation

96

what can shunting of ammonia and toxins from GI -> general ciruclation result in

hepatic encephalopathy

97

3 complications of spleenomegaly

anemia, luekopenia, thrombocytopneia

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what does ascites follow

cirrhosis, portal htn

99

how does RS HF lead to ascites

abdm organ distension rt engorgement of vessels in these organs dt inc blood vol -> inc HSP -> fluid shift from organs to body cavity

100

et of ascites

RS HF
water / na retention and or protein loss dt renal failure
severe changes in HSP and or OP

101

mnfts of ascites

dyspnea
abdmn distention

102

dyspnea in ascites

rt inc abdm p dt fluid build up applying its self upwards on to the diaphragm, restricting movement causing difficulty breathing

103

tx for ascites

small vol: diuretics
large vol: paracentesis + albumin tx

104

how do diuretics work

remove fluid from vasculature -> dec blood vol -> dec HSP -> this means hsp in body cavity> then hsp in vessels, causing fluid to shift into vessles

105

what does small vol ascites mean

fluid accum

106

what does large vol ascites mean

fluid accum >5L

107

why does paracentesis alone not work

removing fluid from cavity results making hsp body cavity

108

why do you have to do paracentesis with a vol expander eg albumin

vol expander -> inc OP -> keep fluid in vessels while paracentesis occurs (inc OP in vessels pulls fluid in)

109

Liver failure

cute or chronic

110

how much fx capacity of liver is lost in failure

>80%

111

mortality rate of liver failure

50%

112

et of liver failure

fulminant hepatitis
toxic liver damage
cirrhosis dt viral hepatitis

113

which types of et of liver failure are acute

fulminant hep
toxic liver damage

114

what is important to remember about patho and mnfts of liver failure

hepatiac insuff -> multiorgan failure

115

what systems does liver failure affect

hematology
metabolism
hepatorenal syndrome
hepatic encephalopathy

116

how does liver failure impair hemostasis and cause anemia

def in protein synth -> def in clotting factors and fibrinogen + platlet def

117

what does dec marrow fx rt liver failure ->

thromobcytopneia, luekopneia, erythrocytopneia det dec GF and nutrients to marrow

118

DIC

dissemiated intravascular coagulation

119

why does DIC occur in liver failure

dec liver fx -> inadeq clearance of clotting factors -> clotting factors remain thruout vasculature resulting in inc risk for MI and CVA

120

how does dec liver metb dt LF cause jaundice

inadeq bili processing -> jaundice

121

why does hypoalbuminemia occur and how does it mnft

rt to dec OP
widespread edema + ascites

122

hyperammonemia

inc ammonia in circulation

123

why does hyperammonemia occur

def urea cycle -> inc ammonia dt liver not being able to push eqn to the left to make urea out of excess ammonia

124

hyperestrogenism

dec estrogen catobolism-> accum of estrogen

125

how does hyperestrogenism present in women

absence of menses
dec libido

126

how does hyperestrogenism present in men

atrophy of testes
dec libido
enlargement of breasts

127

hepatorenal syndrom

idiopathic renal failure

128

how does LF lead to renal failure

LF -> severe dec in renal perfusion -> inschemia dt dec blood to kidney + dec blood to filter

129

why is there a dec in blood in LF leading to RF

portal htn results in inc blood vol in HPS and dilated vessels

130

what 2 conditions occur in RF

oliguria
azotemia

131

olgiuria

dec renal output

132

azotemia

build up of nitrogenous waste in blood rt dec sec by kidneys

133

hepatic ecephalopathy

neuro mnfts rt liver failure

134

what is happening in hepatic encephalopathy

toxins are not being removed by liver -> inc toxins in circulation dt liver failure + portosystemic shunts -> toxins affect brain

135

what is the mechanism for hepatic encephalopathy

inc ammonia -> inc glutamate -> alteration of nt's + change in bloods osmolarity dt inc [glutamate]

136

early mnfts of hepatic encephalopathy

asterixis
hyperrflexia

137

asterixis

trembling of hands dt inc nt

138

late mnfts of hepatic encephalopathy

confusion, death, coma