carnevalle last Flashcards
1
Q
Alcohol effects on liver
A
- Steatosis (exposure)
- fatty change
- perivenular fibrosis
- Hepatitis (severe exposure)
- liver cell necrosis
- inflammation (chicken wire fibrosis)
- mallory bodies (can’t be broken down)
- fatty change
- Cirrhosis (continued exposure or repeated attacks of hepatitis)
- fibrosis
- hyperplastic nodules
2
Q
alcoholic steatohepatitis clinical presentation
A
- Fever
- leukocytosis
- jaundice
- INCREASE AST-ALT < 500UI/L
- AST/ALT > 2
- Increase AP
- ultrasonography
3
Q
alcoholic steatohepatitis prognosis and death
A
- 50-60% if they continue to drink or 90% if they abstain
- End-Stage alcoholic and proximate causes of death:
- hepatic coma
- massice GI hemorrhage
- infection
- hepatorenal syndome following bout of alcoholic hepatitis
4
Q
Causes of Nonalcoholic steatohepatitis (NASH)
A
- Insulin resistane/metabolic syndrome
- obesity, DM, Hyperlipidemia
- Drug hepatotoxicity (tamoxifen, nifedipine)
- Pregnancy
5
Q
Hereditary hemochromatosis
A
- increases the amount of IRON That the body absorbs from gut
- mutation in HFE gene
- symptoms caused by excess iron deposited in body organs
- LABS
- increase serum Fe, transferrin saturation, serum ferritin and hepatic Fe index (2x increase)
- IF TRANSFERRIN SAT and FERRITIN conc are HIGH, genetic testing is warranted
- Complications: skin pigmentation, cirrhosis of liver, diabetes, arthopathy, cardiac failure etc
6
Q
Wilson Disease
A
- Body retain’s copper
- pts have DECREASED ceruloplasmin and excessive deposition of copper
- Copper buildup leads to damage of kidneys, brain and eyes
- untreated –> brain damage, liver failure, and death
- Symptoms appear between 6 and 20
- CHILDREN –> hepatitis, acute/chronic/fulminant
- ADULTS –> neurologic/psychiatric disease, untreated = fatal
- DX
- Decreased SERUM CERULOPLASMIN
- INCREASED hepatic and urinary copper
- Presence of KAISER-FLEISCHER RINGS (eyes)
7
Q
Alpha1-antitrypsin deficiency
A
- Clinical presentation
- neonatal = hepatitis/cholestasis
- Adults = chronic hepatitis/cirrhosis
- Hepatocellular carcinoma
- DX
- Low serum alpha1AT
- abnormal electrophoretic alpha1AT
- liver biopsy
8
Q
Liver cell adenoma
A
- young women
- oral contraceptives
- may harbor hepatocellular carcinoma
- risk of rupture during pregnancy
- normally benign
9
Q
Risk factors of hepatocellular carcinoma
A
- Cirrhosis (occurs in the background of cirrhosis)
- alcoholism
- HBV, HCV
- Heriditary hemochromatosis
- Alpha 1 AT deficiency
10
Q
DX of hepatocellular carcinoma
A
- Increase AFP > 1000
- MRI, CT, aniography, Ultrasound
- SYMPTOMS:
- painful hepatomegaly
- abdominal mass
- weight loss
- portal/hepatic vein thrombosis
- hemorrhagic ascites
- etc
11
Q
Cholangiocarcinoma
A
- malignant primary tumor of bile duct epithelium
- RISK FACTORS = sclerosing cholangitis, thorotrast, Liver flukes
- *
12
Q
Cholelithiasis (gallstones) Types and contributing facotrs
A
- THREE TYPES
- Cholesterol stones (biliary hypersecretion of cholesterol/supersaturation of bile with cholesterol)
- Pigmented stones (predominantly bilirubin calcium salts)
- Mixed
- CONTRIBUTING FACTORS:
- SUPERSATURATION, FALLBLADDER HYPOMOTILITY, CRYSTAL NUCLEATION, and ACCRETION within the gallbladder mucous layer
13
Q
Cholelithiasis clinical features
A
- most remain asymptomatic throughout life
- SYmptoms
- spasmodic, colicky pain owing to obstruction of bile ducts by passing stones
- Right upper abdominal pain
- pain after FATTY MEAL
14
Q
Acute and chronic cholecystitis
A
- Acute:
- hemorrhage inflammation, edema of the gallbladder wall
- neutrophils infiltrating wall and epithelium
- Chronic
- GBthickened and fibrotic
- scarring, lymphocytes, plasma cells, macrophages
15
Q
Acute pancreatitis
A
- Acute epigastric pain with radiation to the back
- SHock
- mortality rate high, about 10-15%
- full blown acute pancreatitis is a medical emergency
- LABS
- increase serum amylase
- rising serum lipase levels
- hypocalcemia due to precipitation of calcium soaps in fat necrosis
- Imagings = enlarged inflammed pancreas
