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ALU 201 > Chapter 2 > Flashcards

Chapter 2 Flashcards

1
Q

How many Americans have chronic liver disease?

A

5.5 million

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2
Q

where is the liver located

A

RUQ of abdomen

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3
Q

the liver is the ___ solid organ in the body

A

largest

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4
Q

as little as ____ % of healthy liver tissue can regenerate into an entire liver

A

25%

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5
Q

what are the three categories of the structure of the liver

A

hepatic vascular system
biliary tree
hepatic lobules

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6
Q

how much blood is in the liver at any one time

A

500 ml or 13%

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7
Q

what type of blood does the hepatic artery bring to the liver

A

arterial (oxygenated) blood

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8
Q

what type of blood is brought to the liver by the portal vein

A

blood that has previously been through the small intestine and spleen.
venous blood0 abt 75% of blood entering liver, and contains the nutrients absorbed from the small intestine

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9
Q

what are sinusoids of liver

A

vascular channels in the liver where blood flows to be filtered

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10
Q

how does blood exit the liver

A

central vein -> hepatic veins -> empty into inferior vena cava

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11
Q

what is the biliary system

A

series of channels and ducts that transport bile from the liver into the small intestine

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12
Q

what produces bile and how is it secreted from the liver

A

hepatocytes create bile, then it is secreted from each lobe of the liver through the left and right hepatic ducts, which join to form the common hepatic duct

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13
Q

what two ducts meet to form the common bile duct

A

the common hepatic duct and the cystic duct from the gallbladder

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14
Q

what happens to bile in the gallbladder

A

it is stored until it is needed for the digestive process

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15
Q

how does bile re-enter the common bile duct

A

through the cystic duct, when enters the duodenum after combining with the pancreatic duct to form the ampulla a of Vater

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16
Q

the ampullary opening into the duodenum is controlled through the muscular sphincter of ____

A

Oddi

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17
Q

what is a hepatic lobule and how many are there in a normal liver

A

the structural unit of the liver, approx 100,000 in a normal liver

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18
Q

what is the primary purpose of the liver

A

maintain homeostasis

estimated 200 functions, although many not yet understood

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19
Q

what are some other functions of liver

A

detoxification
metabolism (convert glucose into energy and carbs to glucose and carbs and protein into fat)
synthesis of lipoproteins and cholesterol
synthesis of plasma proteins (manufacture of many essential blood components (albumin, fibrinogen, certain globulins)
synthesis of immune factors
digestive functions
excretion of bilirubin
storage (glucose in form of glycogen, fats, iron, copper, vitamins)

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20
Q

What are the issues that affect the usefulness of LFTs

A
  1. many tests nonspecific to liver, and abnml results can be associated with other disorders
  2. LFTs have low sensitivity and specificity
  3. results can be affected by outside factors (food intake, fasting, physical activity, meds, sample collection technique, splfcim transport, hemolysis)
  4. due to the liver’s large functional reserve capacity, as well as its regenerative capability, structural or functional damage can evade detection using blood testing
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21
Q

what are the aminotransferases

A

ALT/SGPT

AST/ SGOT

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22
Q

where is AST found

A

liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes, erythrocytes

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23
Q

why is ALT a more specific marker for liver injury

A

highest level of ALT found in liver, with only small amounts in cardiac and skeletal muscle

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24
Q

what is LDH and its use in insurance setting

A

lactate dehydrogenase, present in most tissues of body, serves to determine the presence of a hemolyzed specimen

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25
Q

what are causes of GGT elevation

A
  • can occur with even subclinical hepatocellular damage
  • can be elevated in other conditions like renal failure, CAD, MI, pancreatic disease, DM.
  • alcohol, meds (dilantin), nsaids, warfarin, statins
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26
Q

when are GGT elevations with alcohol present

A

with steady, heavy drinking over time, but not with binge drinking.

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27
Q

what is bilirubin

A

main bile pigment that is formed from the breakdown of hub in RBCs.

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28
Q

what is unconjugated hyperbilirubinemia caused by

A
  • increased production of bilirubin (eg hemolytic anemia)

- decreased conjugation (eg Gilbert’s)

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29
Q

what is conjugated hyperbilirubinemia caused by

A
  • decreased secretion of bile by liver (cirrhosis, hepatitis, primary biliary cirrhosis, drug-induced)
  • cholestasis (biliary obstruction, choledocholithiasis, stricture, neoplasm, biliary atresia, sclerosis cholangitis)
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30
Q

what is alkaline phosphatase and where is it found

A

AP comprises a group of enzymes present in many tissues. primarily found in liver and bone, also present in kidney, intestine, lung and placenta

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31
Q

if AP is elev due to hepatic pathology, what other LFTs will also generally be elevated

A

GGT and/or bilirubin

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32
Q

what are the most common causes of AP elevations

A
  1. liver
  2. bone disease (Paget, osteosarcoma, bone mets from prostate cancer, other bone mets, fractures)
  3. malignant tumors
  4. renal disease (secondary hyperparathyroidism)
  5. primary hyperthyroidism
  6. polycythemia vera
  7. pregnancy
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33
Q

what is albumin

A

most important plasma protein
synthesized in liver
concern is low albumin, can be caused by heavy ETOH abusehypoalbuminemia not specific for liver disease

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34
Q

what is AFP

A

major protein in fetal seem. normal liver in non-pregnant adult does not product AFP. used as a tumor marker for hepatocellular carcinoma
can also be found with cirrhosis, viral hepatitis, other tumors.

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35
Q

what does prothrombin time measure

A

rate of conversion from prothrombin to thrombin after activation of the extrinsic coagulation pathway

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36
Q

what is CDT

A

carbohydrate-deficient transferrin

helps detect heavy alcohol consumption

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37
Q

what is hemoglobin-associated acetaldehyde (HAA) assay

A

specific confirmation test that distinguishes alcohol-related from non-alcohol-related liver enzyme elevations
it is a major metabolite of ethanol

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38
Q

what use do X-rays have in evaluating liver disease

A

add little value
on occasion, calcification d/t gallstones, cysts or scarring
can identify calcified tumors or vascular lesions

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39
Q

what 3 purposes can tumor markers be used for

A

making a diagnosis of cancer
determining prognosis
monitoring effectiveness of cancer treatment

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40
Q

most coagulation factors are synthesized by the ______

A

liver

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41
Q

what does the prothrombin time measure

A

the rate of conversion of prothrombin to thrombin after activation of the extrinsic coagulation pathway

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42
Q

deficiency of what results in prolonged PT? and what is the measurement of PT useful in?

A

deficiency of one or more of the liver-produced coagulation factors
PT measurement is useful in assessing the severity and prognosis of acute liver disease

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43
Q

what are some non-hepatic causes of prolonged PT times

A

vit K deficiency, coagulopathies, inherited deficiency of a coagulation factor, or meds that antagonize the PT complex (warfarin)

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44
Q

changes to CDT occurs when individuals consume how much alcohol

A

usually more than 4-5 drinks per day for 2 weeks or more

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45
Q

What is HAA

A

hemoglobin-associated acetaldehyde assay
a specific confirmation test that distinguishes alcohol-related from non-alcohol-related liver enzyme elevations
it is a major metabolite of ethanol

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46
Q

excessive alcohol intake causes ________ to be chronically present at elevated levels in the blood

A

acetaldehyde. at these high levels, it attaches to blood proteins, creating elev HAA

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47
Q

what is the initial radiological study of choice for many hepatobiliary disorders

A

ultrasound because it is inexpensive, non-invasive, and portable.

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48
Q

what test is becoming the preferred technique for imaging of the hepatobiliary system

A

CT, except for GB, which is better imaged with US

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49
Q

which test can identify between hepatic masses, cystic vs solid and identify abscesses

A

CT

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50
Q

which test is important for characterization and staging of liver lesions seen on other tests and is test of choice for confirming vascular lesions (hemangiomas)

A

MRI

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51
Q

what is FibroScan and what are its advantages and disadvantages

A

noninvasive procedure using US, determine severity of fibrosis, less expensive than liver bx, immediate results. limitations: limitations in people with ascites, morbid obesity, large amounts of chest wall fat, less reliable in people with low grade fibrosis and those with acute liver inflammation

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52
Q

what is the most accurate test to confirm dx of specific liver diseases

A

liver bx

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53
Q

what are the indications for liver bx

A
  1. eval abnm diagnostic findings and hepatosplenomegaly
  2. confirm dx and determination of prognosis
  3. confirm suspected hepatic neoplasm
  4. dx of cholestatic liver dz
  5. eval of infiltrative or granulomatous dz
  6. eval and staging of chronic hepatitis
  7. identification and staging of alcoholic liver dz
  8. eval of effectiveness of treatment of liver disorders
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54
Q

what is the major limitation of liver bx

A

sampling error due to adequacy and/or location of the specimens obtained

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55
Q

define fatty liver and its range of severity

A

when 5% of the liver mass is made of fat

range from mild steatosis (fatty liver) to inflammation (Steatohepatitis), to fibrosis and cirrhosis

56
Q

hepatic steatosis can be caused by

A
  1. increased peripheral mobilization of fatty acids into the liver
  2. increased hepatic synthesis of fatty acids
  3. impaired hepatic catabolism of fatty acids
  4. impaired synthesis and excretion of VLDL from liver
  5. necroinflamamtory changes
57
Q

what is the most common etiology of chronically elevated LFTs in the US

A

NAFLD is replacing alcohol and viral hepatitis as the most common etiology

58
Q

what are the causes of NAFLD

A 
poorly controlled diabetes
insulin resistance
metabolic syndrome
HLD
obesity
acute starvation
post-bariatric surgery
medications (amiodaraone, valproate, corticosteroids, calcium channel blockers, salicylates, high-dose estrogen'tamoxifen)
59
Q

ferritin levels are increased in ____ to ____% of individuals with NAFLD and transferrin saturation is elev in ____ to ____%

A

20 to 50%

5 to 10%

60
Q

as the disease progresses from simple steatosis to NASH, what will be present on liver bx?

A 
steatosis
inflammation
Mallory bodies (eosinophilic cytoplasmic aggregates of protein)
glycogen nuclei
fibrosis
cirrhosis
61
Q

what is treatment for NAFLD

A

modification of risk factors to prevent progression
weight loss, dietary modifications
tighter HLD and diabetes control

62
Q

NASH develops into fibrosis or cirrhosis within ______ years in 10-49% of cases. approx ____% of people die within ten years a a result of cirrhosis

A

within 5-10. yrs

10-40%

63
Q

mortality and morbidity risk of people with NAFLD extends beyond cirrhosis/liver failure because they are at increased risk for…

A

MI
stroke
diabetes
and their complications, because they also more likely suffer from obesity, HLD, insulin resistance, HTN, and/or atherosclerosis

64
Q

what % of the American population consumes ETOH at least occasionally

A

75%

65
Q

what % of alcohol users abuse alcohol or are alcohol dependent

A

10%

66
Q

the pathology of alcoholic liver injury comprises 3 major components. what are they?

A

fatty liver
alcoholic hepatitis (steatohepatitis)
cirrhosis

67
Q

fatty liver is present in over ____% of binge and chronic drinkers?

A

90%

68
Q

a smaller % of heavy drinkers will progress from fatty liver to _________ followed by _________

A

alcoholic hepatitis followed by cirrhosis

69
Q

what % of alcoholics will develop alcoholic hepatitis

A

10 - 20%

70
Q

what are the 7 risk factors for alcoholic liver disease

A
  1. quantity of alcohol consumed
  2. female gender
  3. hepatitis C
  4. genetic variability in alcohol-metabolizing enzymes
  5. malnutrition
  6. co-exposure to drugs or toxins
  7. immunologic dysfunction
71
Q

is fatty liver reversible if alcohol is stopped?

what about cirrhosis?

A

fatty liver can be reversed

cirrhosis cannot

72
Q

what 5 criteria are used to determine a dx of cirrhosis

A
  1. pronounced, insufficiently repaired necrosis of the parenchyma
  2. diffuse connective tissue proliferation
  3. varying degrees of nodular parenchymal regeneration
  4. loss and transformation of the lobular structure within the liver as a whole
  5. impaired intrahepatic and intra-acinar vascular supply
73
Q

what are the major causes of cirrhosis

A 
alcohol
chronic infection (hepatitis B, C, D)
cholestasis (biliary cirrhosis)
autoimmune hepatitis
chemical agents
venous congestion (Budd-chiari syndrome)
homeochromatosis
NASH
74
Q

with cirrhosis, the structural changes in the liver cause … (Symptoms)

A 
jaundice
portal hypertension
esophageal varices
ascites
spontaneous bacterial peritonitis
hepatorenal syndrome
hepatic encephalopathy
coagulopathy
75
Q

describe jaundice

A

hyperbilirubinemia

yellowish discoloration of skin, conjunctiva, mucous membranes

76
Q

what % of people with cirrhosis will develop esophageal varices

A

50% will develop within 2 years of dx, and 70-80% within 10 years

77
Q

why is the mortality rate high with vatical bleed

A

the hemorrhage is typically massive. each episode is life threatening

78
Q

what % of ascites occurs in the setting of cirrhosis

A

85% of cases

79
Q

50% of those with ascites will die within ____ years

A

2

80
Q

what are causes of ascites other than alcohol

A 
other liver diseases 
malignancy
heart failure
infection
pancreatitis
81
Q

what is portal HTN

A

abnormally high pressure in the portal circulation

82
Q

clinically significant portal HTN is present tin ___% of those with cirrhosis

A

60%

83
Q

what are the major clinical manifestations of portal HTN

A

hemorrhage from gastroesophageal varices
splenomegaly with hypersplenism
ascites
acute and chronic hepatic encephalopathy

84
Q

what is hepatorenal syndrom

A

development of acute renal failure in individuals with advanced chronic liver disease and fulminant hepatitis, who have portal HTN and ascites

85
Q

at least 40% of individuals with cirrhosis and ascites will develop HRS within 5 years. what is HRS characterized by?

A
  1. marked decrease in GFR and renal plasma flow in the absence of other identifiable causes of renal failure
  2. marked abnormalities in systemic hemodynamics
  3. activation of endogenous vasoactive systems
86
Q

what is hepatic encephalopathy characterized by

A

disturbances in consciousness and behavior
personality changes
fluctuating neurologic signs
asterisks (“flapping tremor”)
distinctive EEG changes
in severe cases, irreversible coma and death can occur

87
Q

what is the leading cause of chronic hepatitis cirrhosis, and hepatocellular carcinoma worldwide

A

hepatitis B

88
Q

what ranks 2nd (after cirrhosis) as cause of fatal liver disease

A

metastatic tumor (such as from breast, lung, gastrointestinal, and genitourinary cancers)

89
Q

what is Wilson’s disease

A

rare, autosomal recessive inherited disorder of copper metabolism

90
Q

what does Wilson’s disease affect

A

liver, brain, kidneys, eyes, joints

91
Q

what is cholangitis

A

localized or diffuse inflammatory changes affecting the intrahepatic and extra hepatic bile ducts

92
Q

what is primary sclerosis cholangitis

A

chronic cholestatic liver disease of unknown etiology that primary affects young to middle-aged males.

93
Q

primary sclerosis cholangitis is frequently found in association with _______

A

inflammatory bowel disease, particularly UC and chron’s colitis.

94
Q

what is the only effective therapeutic option for end-stage liver disease from PSC

A

liver transplant

95
Q

what are the 2 types of biliary cirrhosis

A

primary - chronic, progressive. unknown etiology possibly autoimmune
secondary - result of prolonged bile duct obstruction, narrowing or closure, most commonly caused by PSC, also by bile duct strictures, tumors, biliary atresia, cystic fibrosis

96
Q

what is Gaucher’s dsiease

A

most common lipid storage disease, caused by gene mutation

97
Q

what are the 3 clinical forms of gaucher’s disease

A
  1. type 1- non-neuronopathic, common in Ashkenazi jews
  2. type 2 - infantile, death within first year of life
  3. type 3- juvenile or subacute neuronopathic less severe
98
Q

what is reye’s syndrome

A

almost exclusively children, usually after viral illness, associated with use of aspirin during the illness

99
Q

functions of the liver include all of the following EXCEPT:

  1. storing iron
  2. destroying damaged WBC
  3. removing toxin
  4. synthesizing cholesterol
A

destroying damaged WBC

100
Q

All of the following statements the Hepatitis B surface antigen (HBsAg) are correct EXCEPT:

  1. it is the easiest marker of acute infection
  2. it measure the viral load
  3. it appears before onset of symptoms
  4. it clears by the convalescence stage of infection
A

it measure the viral load

101
Q

what are the medical treatments for hep C

A

interferon alpha and ribavirin

102
Q

NAFLD can be caused by all of the following EXCEPT

  1. obesity
  2. HTN
  3. metabolic syndrome
  4. insulin resistance
A

HTN

103
Q

what are the primary factors that affect prognosis in hereditary hemochromatosis?

A

early diagnosis

compliance to treatment

104
Q

what are the primary causes of death from hereditary hemochromatosis

A 
hepatocelluar carcinoma
complications or cirrhosis (liver failure portal HTN, bleeding from esophageal varices)
cardiomyopathy CHF, arrhythmias
complications of DM
bacterial and viral infections
105
Q

what are the infectious etiologies of hepatitis

A

viral
bacterial
fungal
parasitic organisms

106
Q

what are the causes of noninfectious hepatitis

A

medications
toxins
autoimmune disorders

107
Q

all hepatitis viruses are RNA viruses except _____ which is a _____ virus

A

hepatitis B is a DNA virus

108
Q

what are the two methods of transmission of viral hepatitis

A

enteric (oral-fecal)

blood-borne

109
Q

which types of hepatitis are enterically transmitted

A

HAV and HEV

110
Q

which types of hepatitis are blood-borne

A

HBV, HCV, HDV

111
Q

are blood-borne or enteric ally transmitted hepatitis viruses associated with persistent infection, viremia and chronic liver disease

A

blood-borne

112
Q

how is chronic hepatitis defined

A

persistent infection for at least 6 months

113
Q

how many people become infected with hep B in the US each year

A

200,000-300,000

114
Q

which type of hepatitis is the world leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwode

A

hep b

115
Q

approx ____% of the world’s population has chronic HBV infection

A

5%

116
Q

how is hep b transmitted

A

exposure to infectious blood or body fluids

117
Q

what are the stages of hep b

A
  1. incubation period - between 15-180 days, avg 60-90 days
  2. prodromal stage - lasts from few days up to 2-4 wks, with non-specific symptoms (malaise, myalgia, GI and flu-like symptoms)
  3. clinical stage - defined by the presence of jaundice (icterus) and hepatomegaly, lab values vary significantly, depending on the degree of severity and course taken, can last 3-6 wks
  4. convalescence phase- all labs normalize within 4-6 months
118
Q

describe stages of progression to liver failure (from chronic hep b)

A

fibrosis -> cirrhosis -> liver failure

119
Q

what is the earliest marker of acute infection with hep b

A

HBV surface antigen (HBsAg), appears before onset of symptoms or elevation of LFTs

120
Q

Should HbsAg clear before the convalescence stage of acute infection?

A

yes

121
Q

HBsAg (surface antigen) persistence for more than 6 months indicates progression to ______ or ______

A

carrier state or chronic HBV

122
Q

what is HBeAg a marker for

A

HBV e antigen (HBeAg) is a marker for highly infectious state and active viral replication

123
Q

should HBeAg clear by the convalescence stage of acute infection?

A

yes

124
Q

persistence of HBeAg for more than 10 weeks suggests progression to _____

A

chronic state

125
Q

HBV core antibody (HBcAb or anti-HBcAb) indicates exposure to ______ and _____

A

exposure to HBV and viral replication

126
Q

which hep b serology test persists for life

A

HBcAb (HBV core antibody)

127
Q

HBV surface antibody (HBsAb or anti-HBsAb) represents _____

A

cure from acute infection and immunity from future infection

128
Q

which hep b serology test, if present with persistent pos HBsAg, but neg HBeAg, represents chronic carrier state

A

HBsAb

129
Q

which two hep b serology tests, if present together, represent immunity as a result of vaccine

A

HBcAb abd HBsAb

130
Q

why is HBV DNA, or viral load, useful for

A

assessment of those with chronic HBV as candidates for antiviral treatment and to track response to treatment

131
Q

what antiviral agents are currently being used for hepatitis

A

lamivudine, adenovirus, entecavir, interferon alfa, pegylated interferon alfa

132
Q

do most infected individuals clear the hepatitis c virus?

A

no

133
Q

how do most new HCV infections occur in US

A

60% in individuals who use IV drugs

<20% through sexual exposure

134
Q

about how many people are infected with hcv

A

4 million, with 2.7 million having chronic infection

135
Q

what are the stages of hep c

A
  1. incubation (6-12 wks)
  2. acute (mild symptoms if any)
  3. chronic HCV develops in 70-80% of people. symptoms usually absent until substantial scarring of liver occurs

ALU 201 (20 decks)

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