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pathophysiology 4802 > Disorders of the Liver (Final Exam) > Flashcards

Disorders of the Liver (Final Exam) Flashcards

1
Q

what are some of the functions of the liver

A
  • detoxify certain substances
  • secrete bile
  • important role in metabolism of all three kinds of foods (proteins, fats and carbs)
  • store several substances (glucose, iron, vitamin A, B12 and D)
  • produces plasma proteins
  • serves as a site of hematopoiesis during fetal development
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2
Q

what are the two main disorders of the liver

A
  1. Jaundice
  2. Hepatitis (viral hepatitis)
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3
Q

this is a yellow or greenish pigmentation of the skin caused by hyper-bilirubinemia (plasma bilirubin concentrations above 2.5 to 3.0 mg/dL)

A

jaundice

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4
Q

explain the metabolism of Bilirubin

A
  • see slide 7 in lecture *
    spleen and liver:
    RBC gets destroyed -> hemoglobin -> heme + globin (globin goes to amino acid pool) -> heme gets broken down into iron + biliverdin (iron goes to iron pool) -> biliverdin gets broken down into unconjugated bilirubin which is lipid soluble ->

plasma:
unconjugated bilirubin + albumin (this combinations makes bilirubin soluble in blood) ->

liver:
unconjugated bilirubin + glucuronic acid (conjugated bilirubin is water soluble)

bile channels:
conjugated bilirubin is excreted with bile

intestine:
conjugated bilirubin stools -> urobilinogen (by bacterial activity in the intestine)

liver and kidney:
urobilinogen gets excreted with urine or faces

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5
Q

what are the 3 types of jaundice

A
  1. hemolytic/pre-hepatic
  2. obstructive/post-hepatic
  3. hepatocellular/hepatic
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6
Q

explain the hepatobiliary mechanism of Intrahepatic Obstructive Jaundice

A

hepatocellular damage or obstruction of the bile canaliculi -> liver is unable to conjugate and excrete bilirubin -> conjugated and unconjugated hyperbilirubinemia -> bilirubin deposition in tissues (Jaundice)

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7
Q

explain the hepatobilliary mechanism of extraheptaic obstructive jaundice

A

bile duct obstruction (cholestasis) = this can cause light coloured stools -> conjugated bilirubin accumulates in the liver and enters the bloodstream -> conjugated hyperbilirubinemia -> increased excretion of bilirubin in urine OR bilirubin deposition in tissues (Jaundice)

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8
Q

explain the hematologic mechanisms of jaundice

A

excessive lysis of RBCs -> hepatocytes cannot conjugate and excrete bilirubin as rapidly as its formed so bilirubin enters the bloodstream -> unconjugated hyperbilirubinemia -> bilirubin deposited in tissues (Jaundice)

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9
Q

what are some clinical manifestations of jaundice

A
  • darkened urine
  • light stools
  • yellow discolouration of the sclera of the eye
  • yellow pigmentation of the skin
  • pruritus
  • kernicterus (brain damage caused by too much bilirubin in babies blood)
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10
Q

this is defined as inflammation of the liver

A

hepatitis

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11
Q

this subtype of hepatitis is usually caused by autoimmune disorders, reactions to drugs, toxins and infectious disorders including viruses

A

acute hepatitis

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12
Q

this subtype of hepatitis has symptoms that persist for more than 6 months. (viruses, alcoholism, drug toxicity and autoimmune disorders)

A

chronic hepatitis

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13
Q

____ hepatitis is sometimes associated with cholestatic hepatitis

A

acute

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14
Q

_____ hepatitis is associated with massive necrosis and has a high mortality rate

A

fulminant

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15
Q

this type of chronic hepatitis leads to cirrhosis

A

continuing necrosis

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16
Q

this type of chronic hepatitis does not normally lead to cirrhosis

A

carrier state

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17
Q

this is a relatively common systemic disease that affects primarily the liver. it is caused by five strains of viruses & there are two mechanisms for hepatocyte injury

A

viral hepatitis

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18
Q

this phase of viral hepatitis usually lasts 3-4 days and symptoms are present

A

prodromal phase

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19
Q

this phase of viral hepatitis lasts about 1-4 weeks. threshold bilirubin is 2.6 mg/dL

A

icteric phase

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20
Q

this phase of viral hepatitis includes the disappearance of symptoms. some liver dysfunction may persist

A

convalescent phase

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21
Q

is HAV a DNA or RNA virus

A

RNA

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22
Q

does HAV have antigens or antibodies present

A

antigen (anti-HAV)

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23
Q

what is the incubation period of HAV

A

~30 days therefore onset can be abrupt

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24
Q

what is the route of transmission of HAV

A
  • fecal-oral
  • parenteral
  • sexual
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25
true or false: HAV has a known carrier state
false
26
how can HAV infection be prevented
HAV vaccine and hygiene
27
true or false: HAV leads to chronic hepatitis
false
28
what is the typical severity of HAV
mild
29
how is HAV diagnosed?
presence of anti-HAV - immune globulin M or G (serologic test is highly reliable)
30
the peak of which of the following curves present acute symptoms along with jaundice and an increase in ALT - HAV in stools - IgM anti-HAV - IgG anti-HAV
IgM anti-HAV
31
the peak of which of the following curves occurs in the convalescence and recovery period? - HAV in stools - IgM anti-HAV - IgG anti-HAV
IgG anti-HAV
32
the peak of which of the following curves occurs FIRST (within incubation period of ~ 30 days) - HAV in stools - IgM anti-HAV - IgG anti-HAV
HAV in stools
33
how does HAV infection develop (pathogenesis)?
hepatocyte injury due to direct killing and cellular immune responses (T cells, NK cells and cytokines)
34
is HAV a DNA or RNA virus
DNA
35
does HBV have antigens or antibodies present
antibodies (HBsAg)
36
what is the route of transmission of HBV
parenteral and sexual
37
what is the incubation period of HBV
60 - 180 days thus onset is insidious
38
true or false: HBV has a known carrier state
true
39
what is the typical severity of HBV
can be severe and chronic
40
how does HBV infection develop (pathogenesis)
hepatocyte injury caused by cellular immune responses to viral replication and inflammation resulting in cellular necrosis
41
what does it mean if HBsAb is positive?
have immunity from vaccine
42
what does it mean if HBcAb is positive?
had previous infection
43
what does it mean if HBsAg is present?
have the infection
44
does IgM represent an acute or chronic infection
acute
45
what does it mean if HBeAb is positive
body has high immunity against the virus q
46
what does it mean if HBeAg is positive
infectious
47
in both HAV and HBV infections, which phase (prodromal/preicteric, icteric or convalescence phase) does AST, which is an indicator for hepatocellular damage and necrosis, peak?
icteric phase
48
Is HCV a RNA or DNA virus
RNA
49
does HCV have antibodies or antigens present
Anti-HCV
50
how is HCV transmitted
parenteral and sexually
51
what is the incubation period of HCV
35-60 days
52
is the onset of HCV acute or insidious
insidious
53
true or false: HCV has a known carrier state
true
54
what is the type of severity of HCV
mild
55
how can HCV be prevented
hydride and blood screening
56
what does a serology test show that would be indicative of a HCV diagnoses
- antibodies for HCV - HCV in serum
57
which of the following curves peak first at ~4-5 weeks - Anti-HCV - HCV RNA - ALT
HCV RNA
58
which of the following curves peak after HCV RNA - Anti-HCV - HCV RNA - ALT
ALT
59
which of the following curves peak last at ~24 weeks and then the curves begins to plateau for years - Anti-HCV - HCV RNA - ALT
Anti-HCV
60
how does HCV develop (pathogenesis)
hepatocyte injury caused by immune response, inflammation and fibrosis leading to cirrhosis
61
this type of viral hepatitis is caused by a defective RNA virus and it can cause acute and chronic hepatitis
hepatitis D
62
what does a serology test show that would be indicative of a HDV diagnosis
- anti-HDV IgM and IgG ELISA
63
how can HDV be prevented
- safe sexual practices - screening of blood products - avoidance of IV use - vaccination with HBV vaccine
64
this is an RNA virus that is spread via the fecal-oral route, especially through contaminated water. parenteral transmission may occur
hepatits E
65
this type of hepatitis is one of the most common causes of acute hepatitis in developing countries. cases in developed countries are usually related to recent travel
hepatitis E
66
this incubation period for this type of hepatitis is 2 to 9 weeks. symptom development is similar to that of HAV and usually lasts 2 weeks. fulminant hepatic failure may occur, esp in pregnant women
hepatitis E
67
this represents the irreversible end stage of many different hepatic injuries, including severe acute hepatitis, chronic hepatitis, the metal storage diseases, alcoholism and toxic hepatitis
cirrhosis
68
how may cirrhosis cause ascites (buildup of fluid in the spaces of the abdomen)
cirrhosis -> increased resistance to portal flow -> portal hypertension -> splanchnic vasodilation -> 1. increase in splanchnic capillary pressure -> lymph formation that exceeds lymph return -> ascites 2. arterial underselling -> activation of vasoconstrictor and antinatriuretic factors -> sodium and water retention -> ascites
69
what are some clinical manifestations of cirhhosis
- anorexia - weight loss could be masked by ascites - weakness - diarrhea or constipation - jaundice - pain - bleeding - thrombocytopenia - palmar erythema

pathophysiology 4802 (16 decks)

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