Carnevalle 1

Question 1

Liver tests for hepatocyte integrity

Answer 1

• aminotransferases
  
  • AST = aspartate transaminase
  • ALT = alanine transaminase
• LDH = lactate dehydrogenase

Question 2

Liver tests for hepatocyte function

Answer 2

• serum albumin
• prothrombin time
• serum ammonia

Question 3

Liver tests for bile canaliculus enzymes

Answer 3

• AP = alkaline phosphatase
• 5-NT = 5’-nucleotidase
• GGT = gamma-glutamyl-transpeptidase

Question 4

Cholestasis Clinical

Answer 4

• Symptoms:
  
  • itchy skin (pruritus)
  • jaundice
  • clay colored stools
  • dark urine
  • xanthomas
  • osteoporosis (lack of vit D)
• LABS
  
  • INCREASE AP, GGT, 5’-Nucleotidase (Bile canaliculus enzymes)
  • HyperBILIRUBINEMIA and hyperlipidemia

Question 5

Common causes of Cirrhosis

Answer 5

• alcoholic liver disease (60-70)
• viral hepatitis
• obesity
• cryptogenic

Question 6

pathogenesis of cirrhosis

Answer 6

• hepatocyte necrosis
• progressive fibrosis
• regenerative hepatocyte nodules
  
  • abnormal vascular connections
  • disruption of hepatocyte function

Question 7

Clinical cirrhosis

Answer 7

• Symptoms (decompensated)
  
  • portal hypertension
  • hepatorenal syndrome
  • liver failure
  • hepatic encephalopathy
• LABS
  
  • Increase
    
    • serum bilirubin
    • transaminase
    • GGT
    • prothrombin
  • Decrease ALBUMIN

Question 8

complications of cirrhosis

Answer 8

• hepatic encephalopathy
• malnutrition
• skin spider angiomata
• breast formation due to inability to break down estrogen
• ESOPHAGEAL VARICES
• SPLENOMEGALY
• ASCITES

Question 9

clinical hepatic failure

Answer 9

• Encephalopathy
• coagulopathy –. inability to make clotting factors
• Jaundice
• hypoglycemia
• metabolic acidosis

MULTIPE ORGAN FAILURE

• hypotension
• pulmonary edema
• DIC

Question 10

Hepatorenal Syndrome

Answer 10

• Refers to ACUTE RENAL FAILURE that occurs in setting of CIRRHOSIS or FULMINANT LIVER FAILURE
• Hepatorenal syndrome due to an alteration in blood flow and blood flow and blood vessel tone in the intestinal system which results in ALTERED blood flow to the kidney

Question 11

Hepatorenal syndrome clinical

Answer 11

• liver failure + renal failure (normal kidney)
• Oliguria/anuria
• INCREASE BUN, CREATININE
• LOW urinary Na conc
• normal urinary sediment

Question 12

Hepatic encephalopathy

Answer 12

• potentially reversible neuropsychiatic abnormality in setting of either ACUTE or CHRONIC liver failure
• DX by exclusion
• INCREASED NH3 Brain DIFFUSION with EDEMA IS THE CAUSE

Question 13

Hepatic encephalopathy Clinical

Answer 13

• Spatial perception distorted
• sleep disturbance
• personality changes
• lethargy
• COMA
• Decerebrate posture
• Asterixis (tremor against resistance)
• abnormal EEG