Chapter 30 HEPA Flashcards
Relate the mechanism of bile formation and elimination to the development of cholestasis and
jaundice
-The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy,
Jaundice occurs by obstruction of outflow of bile causes from structural disorders, cholelithiasis, tumors
Characterize the function of the liver in terms of bilirubin elimination and describe the difference between unconjugated and conjugated hyperbilirubinemia.
-as the bilirubin passes through the liver, it converts into conjugated bilirubin.
Unconjugated bilirubin is free biliruin in the blood which is not water soluable
Conjugated hyperbilirubinemia is Diseases that reduce the rate of secretion of conjugated bilirubin into the bile or the flow of bile into the intestine produce a mixed or predominantly conjugated hyperbilirubinemia due to the reflux of conjugates back into the plasma. Elevated conjugated bilirubin levels usually indicate hepatobiliary diseas
List diagnostic tests used to assess liver function and relate them to impaired liver function.
-serum levels enzymes are o assess injury to liver cells
ALT: liver specific
AST: not liver specific
Serum protein levels
prothrombin time
Coagulation factors
GGT: measures hepatic excretory functions. Alcohol abuse
Ultrasound - detecting stones
Computerized Tomography -
MIR
BIOPSY
describe hepatitis A, source of infection, incubation period, acute disease manifestations, development of chronic disease, and the carrier state.
- usually benign and self limiting
- survives in sea, waste water
- fecal-oral transmission
- incubation 25-30 days
- virus excreted in stool 2-3 weeks prior to symptoms
MANIFESTATION
-asymptomatic if !
Vaccine available
>6 years old Abrupt Fever, malaise Nausea, anorexia, abdominal discomfort Dark urine Jaundice (not everyone) Does not cause chronic hepatitis or produce carriers, but can progress to "acute fulmunant"! Vaccine available
describe hepatitis B, source of infection, incubation period, acute disease manifestations, development of chronic disease, and the carrier state.
Transmission -Infected blood transfusion, perinatal Oral/sexual contact Can result in acute, chronic or fulminant Can produce carrier state
- long incubation
- can develop into chronic disease and carrier state
MANIFESTATION -Jaundice Unusually light-colored stool Fever Malaise Gastrointestinal symptoms such as loss of appetite, nausea, and vomiting Abdominal pain Frequently there will be no symptoms, and it is only discovered in a blood test
describe hepatitis C, source of infection, incubation period, acute disease manifestations, development of chronic disease, and the carrier state.
TRANSMISSION
- blood transfusion
- IV
- SEXUAL INTERCOURSE
- TATTOO, PIERCING
INCUBATION is 2 to 26 weeks, AV 6 to 12 weeks
MANIFESTATION
-asymptomatic or mild non specific
MOST WILL DEVELOP CHRONIC HEPATITIS
and is a carrier
Chronic Hepatitis > 6 months Usually HCV Fatigue, anorexia, jaundice, elevated serum aminotransferase Complications: cirrhosis, cancer
pathogenesis and manifestations of acute fulminant hepatitis.
PATHO
-Progression from acute hepatitis to encephalopathy in 2-3 weeks with no evidence of chronic liver disease
MANIFESTATION -GI symptoms Systemic inflammation Hemorrhage Jaundice Elevated blood ammonia levels CNS symptoms/Hepatic Encephalopathy Cerebral edema
Describe the significance and manifestations of hepatic encephalopathy.
-Encephalopathy is Accumulation of neurotoxins as liver unable to remove toxins –ammonia!
Usually converted to urea in liver
MANIFESTATION -Signs of liver failure (slow or rapid) Asterisis or "flapping tremor" Personality changes Speech difficulties Decreased mental alertness and ability Coma, convulsions
what is drug-induced liver disease
- unintentional tylenol OD
- age and dose dependant
What is alcohol-induced liver disease and summarize the three patterns of injury
genetic and environmental factors
alcohol induced liver disease
1st: Fatty liver disease
Steatosis (liver is yellow), hepatomegaly
Reversible*
2nd: Alcoholic hepatitis
Inflammation & necrosis of liver cells
Rapid onset jaundice/fever/pain/anorexia/ ascites/nausea…. encephalopathy
3rd: Alcoholic cirrhosis
Hepatocyte injury
Nodules compress blood flow
What is nonalcoholic fatty liver disease
Fatty liver disease NOT from alcohol
Simple steatosis to inflammation/necrosis (steatohepatitis)
Associated with: Obesity DM type 1, hyperlipidemia, insulin resistance Rapid weight loss Total parenteral nutrition (TPN)
Manifestations Usually asymptomatic RUQ abdominal discomfort Elevated AST, ALT, INR Decreased albumin Normally synthesized in the liver
Potential to result in cirrhosis and end-stage liver disease
Characterize the liver changes that occur with cirrhosis and discuss the manifestations and possible complications
-characterized by diffuse fibrosis and nodules with hepatocytes results in scarring and constriction
Causes
Alcohol, viral hepatitis, non-alcoholic liver disease, biliary disease
MANIFESTATION -Manifestations Asymptomatic until well-progressed Weight loss (camouflaged by ascites) Weakness, anorexia Diarrhea (usually) or constipation Hepatomegaly Jaundice Pain (epigastric/upper RQ, dull, ache)
Complication -Portal hypertension Splenomegaly Thrombocytopenia Insulin resistance Hemorrhoids Caput medusa Bleeding Testosterone/estrogen imbalances Gynecomastia, testicular atrophy Spider angiomas/palmar erythema Encephalopathy
Describe the physiologic basis for portal hypertension and relate it to the development of ascites, esophageal varices, and splenomegly
-increased pressure in the portal vein
CAUSES -Pre-hepatic Obstructive thrombosis Portal vein narrowing Splenomegaly
-Intra-hepatic
Cirrhosis
-Post-hepatic
Right-sided heart failure
Hepatic vein outflow obstruction
Venous thrombosis
ASCITES -Late stage Serous fluid 500+ ml Causes Portal hypertension Sodium/water retention by kidneys Impaired albumin synthesis by liver Can progress to peritonitis
Splenomegaly/Hypersplenism
Decreases life-span of blood cells
Results in anemia, thrombocytopenia, leukopenia
Increased venous pressure to abdomen, rectum, esophagus
Esophageal Varices
Caput Medusa
Hemorrhoids
Relate the functions of the liver to the manifestations of liver failure.
80-90% loss of total liver function
Progressive (d/t alcohol) or rapid (fulminant hepatitis)
MANIFESTATION
GI
Fetor hepaticus: musty, sweet breath
Hematological
Anemia, thrombocytopenia, coagulation defects, leukopenia
Integument
Purpura, bruising, vascular spiders, telangiectasis, spider angiomas, spider nevi, palmar erythema, clubbing, jaundice
Endocrine
Increased androgens/estrogens
Decreased aldosterone
Hepatorenal syndrome
Progressive azotemia, oli (high level of urea, creatinine), guria
Hepatic Encephalopathy
Describe the etiologies and manifestations of hepatocellular cancer
CAUSE -involves liver cells -Chronic viral hepatitis Chronic alcoholism Non-alcoholic fatty liver disease Environmental exposure (arsenic, food mold by-products)
MANIFESTATION
-Weakness, anorexia, weight loss, fatigue, bloating
Dull abdominal ache
Ascites, jaundice, hepatomegaly
