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GI - 2 > 18-1 > Flashcards

18-1 Flashcards

1
Q

What may be the first/only sign of liver disease?

A

Laboratory abnormalities

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2
Q

Hepatocellular lab changes?

A

Increased ALT/AST and LDH

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3
Q

Cholestasis lab changes?

A

Increased Bilirubin, Alkaline Phosphatase and GGT

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4
Q

Hepatocyte Synthetic Function lab changes?

A

Decreased Coagulation factors and Albumin

Increased Ammonia

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5
Q

Albumin changes are likely associated with _____ liver disease

A

Chronic liver disease

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6
Q

Coagulation factors, specifically factor ____ due to its short half life are likely associated with ______ liver disease

A 
Factor VII (PT)
Acute liver disease
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7
Q

What is the blood supply to the liver?

A

Portal vein

Hepatic artery

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8
Q

What 3 things make up the porta hepatis?

A

Bile ducts
Portal vein
Hepatic artery

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9
Q

The lobules of the liver can be divided into zones. Which zone is the most likely to suffer from hypoxia?

A

Zone 3

– Zone 1 is closest to the hepatic artery and portal vein

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10
Q

What test type is the best at showing liver changes due to injury?

A

Biopsy

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11
Q

List Reversible liver injury changes

A
  • Fat and bilirubin accumulation
  • Ballooning of cells with cytoplasmic clearing
  • Clumping of intermediate filaments into mallory hyaline
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12
Q

List Reversible liver injury changes

A
  • Fat and bilirubin accumulation
  • Ballooning of cells with cytoplasmic clearing
  • Clumping of intermediate filaments into mallory hyaline
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13
Q

List Irreversible liver injury changes

A

Necrosis - cells rupture and release contents

Apoptosis - shrinkage

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14
Q

With Apoptosis fo liver cells, what can be seen on biopsy?

A

Acidophil bodies = eosinophilic staining

- Also shrinkage of cells

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15
Q

What liver cells have the primary role of repair via scar deposition?

A

Stellate cells

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16
Q

Under normal conditions, what is the job of the stellate cells?

A

Lipid storage

17
Q

During scar deposition/repair, what things will activate stellate cells?

A

TNF-alpha
ECM changes
Toxins and ROS

18
Q

Once Stellate cells are activated, they convert to?

A

Myofibroblasts

19
Q

What things will activate Myofibroblasts (stellate cells converted)?

A

TGF-beta

IL-17

20
Q

What is a major sign that Myofibroblasts (stellate cells converted) are attempting to repair/deposit scarring?

A

Sinusoidal capillarization

loss of fenestrations

21
Q

2 main ways that the liver can regenerate?

A
  1. Proliferation of remaining hepatocytes

2. Repopulation from progenitor cells

22
Q

Sudden, massive destruction of the liver cells

A

Acute liver failure

23
Q

What are the common causes of Acute Liver Failure?

A

ABCDEF

  • Acetaminophen, Hep A, Autoimmune Hepatitis
  • Hepatitis B
  • Hepatitis C, Cryptogenic
  • Hepatitis D, drugs/toxins
  • Hepatitis E
  • Fatty changes
24
Q

What produces Factor VIII and vWF?

A

Sinusoidal endothelial cells

25
Q

Liver illness associated with encephalopathy and coagulopathy within 26 weeks of initial injury

A

Acute liver failure

26
Q

Fulminant liver failure

A

Very rapid onset of massive necrosis usually due to drugs/toxins

27
Q

What are the signs/progression of Acute Liver Failure?

A
  • Jaundice, N/V, encephalopathy and coagulopathy
  • AST/ALT elevated with enlarged liver
  • Liver shrinks and AST/ALT fall
    = worsening jaundice, multi-organ failure and death
28
Q

What are the leading causes of Chronic Liver Failure?

A

Hepatitis B and C
NAFLD
Alcohol-induced liver disease

29
Q

Chronic Liver Failure is often associated with Cirrhosis. What is that?

A

Response to injury

= Fibrosis with regenerative nodules and shunting of blood

30
Q

Chronic Liver Failure is usually ____ until end stage

A

Asymptomatic

31
Q

Initial symptoms of Chronic Liver Failure?

A

Weight loss, weakness and jaundice

Encephalopathy and coagulopathy

32
Q

What are the unique findings with Chronic Liver Failure?

A

Itching due to cholestasis

Hypestrogenemia = palmar erythema, spider angiomas, hypogonadism and gynecomastic (males)

33
Q

What causes palmar erythema, spider angiomas and hypogonadism with Chronic Liver Failure?

A

Hyperestrogenemia

34
Q

What are the unique findings with Chronic Liver Failure?

A

Itching due to cholestasis

Palmar erythema, spider angiomas, hypogonadism

35
Q

What options do those with Chronic Liver Failure die from?

A

Hepatic encephalopathy
Variceal bleeding
Infections
HCC

36
Q

What are common etiologies with Portal HTN?

A

Prehepatic - portal vein thrombosis
Intrahepatic - cirrhosis
Posthepatic - right side heart failure, budd-chiari

37
Q

What are 4 signs seen with Portal HTN?

A

Hepatic Encephalopathy
Ascites
Venous shunts
Congestive Splenomegaly

38
Q

What are 4 signs seen with Portal HTN?

A

Hepatic Encephalopathy
Ascites
Venous shunts
Congestive Splenomegaly

39
Q

What are 4 signs seen with Portal HTN?

A

Hepatic Encephalopathy
Ascites
Venous shunts
Congestive Splenomegaly

GI - 2 (61 decks)

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