Disorders of the liver and biliary system

Question 1

Liver inflammation/injury tests

Answer 1

• hepatocyte inflammation/injury: AST/ALT-aminotransferases

- bile duct system: alkaline phosphatase-ALP, gamma glutamyl transferase-GGT

Question 2

Liver function tests

Answer 2

total bilirubin - jaundice
prothrombin time (INR) -clotting factors
albumin - large serum protein.

Question 3

Hepatitis–liver inflammation

Answer 3

Acute hepatitis: less than 6 month duration
Chronic Hepatitis: greater than 6 months duration
Cirrhosis: compensated (no symptoms)
decompensated: liver failure, portal hypertension, liver cancer.
* almost everyone has liver cancer has underlining cirrhosis

Question 4

Acute Hepatitis symptoms

Answer 4

jaundice (maybe)
fatigue
nausea
*anicteric (no jaundice) acute hepatitis will have influenza-like and digestive tract symptoms but no jaundice.
*Icteric acute hepatitis will be preceded by days to weeks of non-specific symptoms including malaise, nausea, and decreased appetite. the urine then darkens and is followed by jaundice that may last up to a month.
*cholestatic acute viral hepatitis refers to a prolonged (2 months to two years) jaundice and pruritus, even though other symptoms abate. With time the cholestasis will pass without sequelae.

Question 5

Causes of Acute Hepatitis

Answer 5

viral hepatotropic: (ABCDE)
viral non-hepatotropic: CMV, HSV, EBV. 
Medication: acetaminophen.
Ischemia
autoimmune
ALCOHOL

Question 6

Acute hepatitis outcomes

Answer 6

1. death or liver transplantation (rare)
2. self limited (recovery)
3. chronic evolution

Question 7

acute liver failure/fulminant hepatic failure

Answer 7

a sudden, severe acute hepatic injury accompanies by overt liver failure. rare.

• hallmark of acute liver failure is the development of COGNITIVE PROBLEMS, change in consciousness, and eventually overt coma. vomiting, fetter hepaticas and fever are also seen. PROLONGED PROTHROMBIN TIME is a hallmark of liver failure.
• *the severity of transaminase elevation and jaundice are not good indicators.**

Question 8

chronic hepatitis

Answer 8

> 6 months
ongoing inflammation directed toward the hepatocytes. the hepatocyte injury continues until either the stimulus is removed or the inflammatory response is diminished.

Question 9

causes of chronic hepatitis

Answer 9

A: alcohol, autoimmune
B: HBV
C: HCV
D: HDV, drugs
copper overload (Wilson's disease)

other causes:
*alpha 1 antitrypsin deficiency*
Iron overload (hereditary hemochromatosis)
nonalcoholic steatohepatitis
cholestatic liver disease

Question 10

cirrhosis

Answer 10

extensive fibrosis of the liver leads to eventual loss of normal architecture.
-loss synthetic function
-portal hypertension
cell necrosis and inflammation leads to wound healing
-thick bands of fibrous scar
-connect portal triads and central veins.
-lead to regenerative nodules. (cirrhosis)
hepatocytes surround by thick band of fibrosis.
macro & micronodular.

Question 11

complications of cirrhosis

Answer 11

1. liver failure
2. portal hypertension
3. liver cancer (hepatocellular carcinoma)

prolonged prothrombin time.
decrease of serum albumin concentration
congestion and enlargement in spleen (splenomegaly)
other veins that feed into the portal venous system become engorged with blood and enlarge (VARICES), most commonly found in the esophagus.
hypertension include 1