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Pathology > Ch. 12: Disorders of the Liver and Biliary Tract > Flashcards

Ch. 12: Disorders of the Liver and Biliary Tract Flashcards

1
Q

name the two blood supplies of the liver

A

portal vein & hepatic artery

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2
Q

T/F: cirrhosis is reversible

A

False

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3
Q

portal vein goes ( ) liver

A

into the

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4
Q

what makes up a portal triad?

A

1) bile duct
2) hepatic artery
3) portal vein

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5
Q

produced in the spleen (and liver) from hemoglobin breakdown, conjugated to glucuronide in the liver

A

bilirubin

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6
Q

increased uncongugated bilirubin

A

hemolysis

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7
Q

increased conjugated bilirungin suggest

A

biliary obstruction

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8
Q

decreased albumin suggest

A

liver disease

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9
Q

increased PT and PTT (decreased coagluation factors) suggest

A

liver disease

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10
Q

what are the four clinical sydromes of liver disease?

A

1) jaundice and cholestasis
2) cirrhosis
3) portal HTN
4) hepatic failure

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11
Q

what is jaundice?

A

hyperbilirubinemia

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12
Q

pre-hapitic jandice:

A

unconjugated bili (hemolysis)

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13
Q

hepatic jaundice:

A

conjugated or unconjugated bili (ex. viral hepatitis, cirrhosis, drugs)

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14
Q

post-hepatic jaundice

A

conjugated bili (ex. obstruction by gallstones or cancer)

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15
Q

accumulation of bile in the liver by intraheptaic or extraepatic flow obstruction or defective hepatocyte bile secretion

A

cholestasis

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16
Q

what is cirrhosis?

A

IRREVERSIBLE scarring

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17
Q

cirrhosis is ( )% ETOH and viral hepatitis; ( )% cryptogenic

A

65%

25%

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18
Q

cirrhosis results in…

A

portal hypertension

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19
Q

what is the only therapy for cirrhosis?

A

transplant

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20
Q

what is portal hypertension?

A

obstruction to portal blood flow

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21
Q

prehaptic portal hypertension

A

portal vein thrombosis, scarring, tumor

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22
Q

hepatic portal hypertension

A

cirrhosis (most common!)

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23
Q

posthepatic portal hypertension

A

right CHF, hepatic vein thrombosis

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24
Q

signs of portal hypertension

A

varicies and splenomegaly

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25
Q

portosystemic shunts; rectal, esophageal, caput medusae (umbilical vein)

A

varices

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26
Q

CPC, may also have hypersplenism

A

splenomegaly

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27
Q

what is hepatic failure?

A

loss of 80-90% of functional capacity of liver

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28
Q

most common cause of heaptic failure

A

cirrhosis

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29
Q

hepatic failure leads to… (which does what?)

A

hepatic encephalopathy (increased ammonia and other toxins)

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30
Q

hepatic failure may develop what?

A

hapatorenal and hepatopulmonary syndromes (both have unknown etologies)

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31
Q

what percentage of hepatic failure is fatal?

A

80%

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32
Q

in ACUTE cases of hepatic failure, half are due to ( ) in the US; remaining cases are due to ( )

A
  • acetominophen

- other drugs, autoimmune hepatitis or viral hepatitis

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33
Q

what are the 3 hepatitis clinicopathologic syndromes?

A

1) acute viral hepatitin
2) carrier state
3) chronic viral hepatitis

34
Q

is there a thing as chronic hep A virus?

A

nope!

35
Q

viral hepatitis: causes epidemic hepatitis

A

hepatitis A virus (HAV)

36
Q

viral hepatitis: has infected 1/3 of the world population (2 bill), 350 mill have chronic infection

A

hep B (HBV)

37
Q

viral hepatitis: usually (50-70%) progresses to chronic liver disease

A

hep C (HCV)

38
Q

HBV: what percent is subclinical infection? how many can recover completely?

A

65%

90%

39
Q

HBV: what percentage symptomatic acute hepatitis? how many can recover?

A

35%;

90%

40
Q

Rx for HCV…how much is this?

A

interferon and/or Solvadi;

$1,000/tab for 12 or 24 weeks)

41
Q

viral hepatitis: infects only those with HBV

A

HDV

42
Q

HDV: how type usually recovers?

A

coinfection (at the same time as HBV)

43
Q

HDV: which type has most go on to chronic hepatitis

A

superinfection (after previous HBV)

44
Q

viral hepatitis: most common form of epidemic hepatitis in India

A

HEV

45
Q

viral hepatitis: similar to HAVE (transmitted by food/water, mild, no chronic or carrier state)

A

HEV

46
Q

viral infection: exceptionally dangerous to pregnant women (20% fatality)

A

HEV

47
Q

non-viral inflammatory liver disease: types of abscesses

A

1) bacterial/fungal

2) amebic: entamoeba histolytica

48
Q

abscess: more common in immunodeficient pts, high mortality

A

bacterial/fungal

49
Q

abscesses: countries with poor sanitation practices

A

amebic: entamoeba histolytic

50
Q

chronic progressive hepaitis

A

autoimmune hepatitis

51
Q

autoimmune hepatitis: what percent female?

A

80% (>50% have other autoimmune diseases)

52
Q

autoimmune hepatitis: most have ( ) muscle or ( ) antibodies

A
  • anti-smooth

- anti-mitochondrial (these are more common in PBC)

53
Q

how many of cases of fulminant liver failure are due to ACETAMINOPHEN?

A

half of the cases!

54
Q

which toxic liver injury are dose-related?

A

alcohol, acetaminophen

55
Q

which toxic liver injuries are NOT dose-related?

A

other drugs, anesthetic gase

aka idiosyncratic

56
Q

what is a leading cause of liver disease?

A

alcohol abuse

57
Q

metabolic liver disease: very common, metabolic syndrome (obesity, hyperlipidemia, htn and insulin resistance)

A

non-alcoholic fatty liver disease (NASH)

58
Q

NAH may progress to…

A

cirrhosis

59
Q

metabolic liver disease: autosomal recessive; increased iron in liver, pancreas, heart, skin, joint (M:F ratio?)

A

hemochromatosis (10:1)– 1/200 people

60
Q

metabolic liver disease: disorder of copper metabolism (rare, autosomal recessive, increased copper in liver, brain)

A

Wilson disease

61
Q

metabolic liver disease:causes liver disease and emphysema

A

hereditary alpha-1 antitrypsin deficiency

62
Q

prolonged biliary obstruction causes ( )

A

secondary biliary cirrhosis

63
Q

what is the most common cause of biliary cirrhosis?

A

gallstones (then pancreatic cancer)

64
Q

circulatory disorders: inhibits intrahepatic flow

A

cirrhosis

65
Q

circulatory disorders: secondary to CHF

A

chronic passive congestion

66
Q

circulatory disorders: obstruction of the main hepatic vein

A

Budd-Chiari syndrome

67
Q

tumors of liver: most common tumor in liver

A

metastases

68
Q

tumors of liver: oral contraceptives

A

hepatic adenoma

69
Q

tumors of liver: malignant tumor, CHILDREN

A

hepatoblastoma

70
Q

tumors of liver: risk increased with cirrhosis, chronic HBV and HCV

A

hepatocellular carcinoma

71
Q

tumors of liver: increased serum AFP levels

A

hepatocellular carcinoma

72
Q

tumors of liver: risk increased with HCV, sclerosing cholangitis

A

cholangiocarinoma

73
Q

tumors of liver: cholangiocarcinoma survival rate

A

15% 2 year survival

74
Q

cholelithiasis vs. choledocholihiasis

A

choledocholithiasis= stones in common bile duct

75
Q

gallstones: cholesterol stones= ( )%

A

80%

76
Q

gallstones: risk factors for cholesterol stones

A

female, obesity, older

77
Q

gallstones: pigement stones ( )%

A

20%

78
Q

gallstones: pigment stone risk factors

A

chronic hemolysis

79
Q

gallstones may lead to ( )

A

cholecystitis (acute and chronic)

80
Q

what is the most important problem of extrahepatic bile ducts?

A

Obstruction!

Pathology (14 decks)

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