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

name the two blood supplies of the liver

portal vein & hepatic artery

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T/F: cirrhosis is reversible

False

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portal vein goes ( ) liver

into the

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what makes up a portal triad?

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

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

bilirubin

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increased uncongugated bilirubin

hemolysis

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increased conjugated bilirungin suggest

biliary obstruction

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decreased albumin suggest

liver disease

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increased PT and PTT (decreased coagluation factors) suggest

liver disease

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what are the four clinical sydromes of liver disease?

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

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what is jaundice?

hyperbilirubinemia

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pre-hapitic jandice:

unconjugated bili (hemolysis)

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hepatic jaundice:

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

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post-hepatic jaundice

conjugated bili (ex. obstruction by gallstones or cancer)

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

cholestasis

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what is cirrhosis?

IRREVERSIBLE scarring

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

65%

25%

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cirrhosis results in…

portal hypertension

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what is the only therapy for cirrhosis?

transplant

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what is portal hypertension?

obstruction to portal blood flow

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prehaptic portal hypertension

portal vein thrombosis, scarring, tumor

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hepatic portal hypertension

cirrhosis (most common!)

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posthepatic portal hypertension

right CHF, hepatic vein thrombosis

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signs of portal hypertension

varicies and splenomegaly

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

varices

CPC, may also have hypersplenism

splenomegaly

what is hepatic failure?

loss of 80-90% of functional capacity of liver

most common cause of heaptic failure

cirrhosis

hepatic failure leads to... (which does what?)

hepatic encephalopathy (increased ammonia and other toxins)

hepatic failure may develop what?

hapatorenal and hepatopulmonary syndromes (both have unknown etologies)

what percentage of hepatic failure is fatal?

80%

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

- acetominophen | - other drugs, autoimmune hepatitis or viral hepatitis

what are the 3 hepatitis clinicopathologic syndromes?

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

is there a thing as chronic hep A virus?

nope!

viral hepatitis: causes epidemic hepatitis

hepatitis A virus (HAV)

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

hep B (HBV)

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

hep C (HCV)

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

65% | 90%

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

35%; | 90%

Rx for HCV...how much is this?

interferon and/or Solvadi; | $1,000/tab for 12 or 24 weeks)

viral hepatitis: infects only those with HBV

HDV

HDV: how type usually recovers?

coinfection (at the same time as HBV)

HDV: which type has most go on to chronic hepatitis

superinfection (after previous HBV)

viral hepatitis: most common form of epidemic hepatitis in India

HEV

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

HEV

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

HEV

non-viral inflammatory liver disease: types of abscesses

1) bacterial/fungal | 2) amebic: entamoeba histolytica

abscess: more common in immunodeficient pts, high mortality

bacterial/fungal

abscesses: countries with poor sanitation practices

amebic: entamoeba histolytic

chronic progressive hepaitis

autoimmune hepatitis

autoimmune hepatitis: what percent female?

80% (>50% have other autoimmune diseases)

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

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

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

half of the cases!

which toxic liver injury are dose-related?

alcohol, acetaminophen

which toxic liver injuries are NOT dose-related?

other drugs, anesthetic gase | aka idiosyncratic

what is a leading cause of liver disease?

alcohol abuse

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

non-alcoholic fatty liver disease (NASH)

NAH may progress to...

cirrhosis

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

hemochromatosis (10:1)-- 1/200 people

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

Wilson disease

metabolic liver disease:causes liver disease and emphysema

hereditary alpha-1 antitrypsin deficiency

prolonged biliary obstruction causes ( )

secondary biliary cirrhosis

what is the most common cause of biliary cirrhosis?

gallstones (then pancreatic cancer)

circulatory disorders: inhibits intrahepatic flow

cirrhosis

circulatory disorders: secondary to CHF

chronic passive congestion

circulatory disorders: obstruction of the main hepatic vein

Budd-Chiari syndrome

tumors of liver: most common tumor in liver

metastases

tumors of liver: oral contraceptives

hepatic adenoma

tumors of liver: malignant tumor, CHILDREN

hepatoblastoma

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

hepatocellular carcinoma

tumors of liver: increased serum AFP levels

hepatocellular carcinoma

tumors of liver: risk increased with HCV, sclerosing cholangitis

cholangiocarinoma

tumors of liver: cholangiocarcinoma survival rate

15% 2 year survival

cholelithiasis vs. choledocholihiasis

choledocholithiasis= stones in common bile duct

gallstones: cholesterol stones= ( )%

80%

gallstones: risk factors for cholesterol stones

female, obesity, older

gallstones: pigement stones ( )%

20%

gallstones: pigment stone risk factors

chronic hemolysis

gallstones may lead to ( )

cholecystitis (acute and chronic)

what is the most important problem of extrahepatic bile ducts?

Obstruction!