E2 Liver Patho Flashcards
What is the functional unit of the liver?
Lobules
What are the liver cells called?
Hepatocytes
What is unique about hepatocytes?
Only cells in the body that can re-grow/ regenerate
What do kuffer cells do?
remove bacteria & toxins from blood
What are the major functions of the liver?
- Metabolism &/or storage of: fat, CHO, PRO, Vits, & minerals
- Blood volume reservoid: distends/compresses to alter circulating blood volume
- Blood filter: removes bili
- Blood clotting: prothrombin & fibrinogen
- Drug metabolism & detoxification
The liver is the _____ organ
largest (3 Ibs)
The portal circulatory system brings blood to the liver from the
stomach, intestines, spleen, and pancreas for metabolism
The blood enters the liver through the ______ and recieves what type of blood?
Portal vein
Deoxygenated
The liver is responsible for the _______ effect
first pass
Liver function test abnormal trends?
- Liver enzymes: Increase
- Bilirubin: Increased
- Ammonia: Increased
- PT: Increased
- Serum Protein: Decreased
- Serum Albumin: Decreased
Jaundice is also called
icterus
Jaundice is usually noticeable when bilirubin is
> 2-2.5 mg/dl
What are the 3 causes of jaundice?
- Hemolytic–> increased breakdown of RBCs (pathophysiologic, too many RBCs, Bleeding)
- Hepatocellular–> Liver unable to take up bili from blood or unable to conjugate it
- Obstructive–> Decreased or obstructed flow of bile
Bilirubin is a byproduct of what?
Hemoglobin
Direct bili=
Indirect bili=
Conjugated
unconjugated
Elevations of indirect bili=
bili overproduction OR impaired liver functioning
(Hemolysis or erythropoiesis)
Elevations of direct bili=
liver working, but can’t get bili out
(Bile obstruction, gallstone)
jaundice clinical manifestations
-Urine darker
-Liver enzymes increased
-Stools normal or clay colored
-Pruritis
What is viral hepatitis?
Inflammation of the liver
What are the viruses that cause hepatitis?
A,B,C (D&E)
Epstein-Barr
Cytomegalovirus
What also causes hepatitis that is not a virus?
Alcohol abuse
Bacteria
Chemicals
Drugs
Who is Hepatitis E dangerous to?
Pregnant women
Pathogenesis of viral hepatitis?
- Viral infection
- Immune response: inflammatory mediators in liver
- Lysis of infected cells
- Edema & swelling of tissue
- Tissue hypoxia
- Hepatocyte death
Leads to liver failure
Clinical manifestations of viral hepatitis?
-Similar btwn types
-Many asymptomatic
-Abnormal LFTS but need to trend
Prodromal phase of viral hepatitis?
-2 weeks after exposure
-Fatigue
-Anorexia
-Malaise
-N/V
-H/A
-Hyperalgesia (increased sensitivity to pain)
-Cough
-Low grade fever
Last 1-2 wks
HIGHLY transmissible
Icteric phase of viral hepatitis?
“Active phase”
-Begins w/ jaundice
-Dark urine
-Clay colored stools
-Enlarged liver, painful on palpitation
-Abdominal pain increase in severity
-Last 2-6 weeks
Recovery phase of viral hepatitis
-Resolution of jaundice
-6-8wks after exposure, sympts diminish
-Liver remains enlarged/tender
Complications of viral hepatitis?
-Majority recover completely
-Mortality rate <1% (except elderly & comorbidities)
Complications
-Chronic hepatitis
-Liver cirrhosis
-Liver cancer
-Fulminant viral hepatitis (ALF)
How is Hepatitis A transmitted?
-FECAL to oral
-Parental
-Sexual
r/t sanitation practices/ foood handling OR not washing hands
Other Hep A things to know
-Usually mild severity
-Does NOT lead to chronic hepatitis
-Usually effects children & adults
-Prevent: hand hygiene & hep A vaccine (High risk/ traveling)
S/S of Hep A
-Acute onset w/ fever
-Fatigue
-N/V/D
-Stomach pain
-No appetite
-Dark pee & pale poop
-Jaundice
How is Hep B transmitted?
Parental or sexual
Other Hep B things to know
-Insidious onset
-Severe disease, may be prolonged or develop into chronic
-Any age group (not kids)
-Prevention: Safe sex, hygeine, & HBV vaccine (Healthcare workers & kids)
Hep C transmission
-Parental
-Sexual
-Mother to fetus
-Medical mishaps
Other things to know about Hep C
-Insidious onset
-Mild to severe s/s
-can develop into chronic (80%)
-Any age affected
-Can lead to hepatocellular carcinoma, liver transplant
-Prevention: screening blood, hygiene, NO vaccine, new treatment
S/S of Hep C
-None
-Stomach pain
-Vomiting
-Yellow eyes or skin
Hep A series
2 doses 6 months apart
Recommended but NOT required
> 1yr old & special populations (traveling, healthcare workers, food handlers)
Hep B series
3 doses at least 4 months apart
All newborns
Titer if healthcare
What are the two classes of drugs used for chronic HBV?
Interferons & Nucleoside analogs
Chronic HBV is only for high risk patients like:
- Increased AST levels
- Hepatic inflammation
- Advanced fibrosis
Disadvantages of HBV treatment
- Prolonged therapy
- Costs & adverse effects
- High relapse
Who gets the new treatment for HCV? and what is used
Direct-acting antiviral therapy (and interferon-based regiments)
Anyone w/ detectable viral loads
What is a special consideration for acetaminophen if taking pt has hepetitis?
take <2g day
If severe avoid acetaminophen & NSAIDs
Hepatitis can lead to _____
Cirrhosis
Hepatitis is _____ while Cirrhosis is _______
Reversible
Irreversible
What is cirrhosis?
Irreversible, inflammatory fibrotic liver disease (scarring)
Chaotic fibrosis leads to obstructive biliary channels & blood flow —>
Jaundice & portal hypotension
Regeneration in cirrhosis is disrupted by
hypoxia, necrosis, atrophy, & liver failure
Common causes of cirrhosis?
- Hep B &C
- Excessive alcohol intake
- Idiopathic
4.Non-alcoholic fatty liver disease (NASH, NAFLD) - Autoimmune conditions
- Hereditary metabolic conditions
The liver converts alcohol to what
acetylhyde
Acetylhyde in excessive amounts does what?
Alters hepatocyte function & activates hepatic stellate cells which is the primary cell involved in liver fibrosis
Acetylhyde inhibits exports of protein from the liver which alters metabolism of vitamins & minerals & induces malnutrition
What are the stages of alcoholic liver disease?
- Alcoholic fatty liver
- Alcoholic steatohepatitis
- Alcoholic cirrhosis
Explain the Alcoholic fatty liver phase
-Mildest, asymptomatic
-Reversible
Explain the alcoholic steatohepatitis phase
-Precursor to cirrhosis
-Inflammation, degeneration of hepatocytes
-Anorexia, Nausea, Jaundice, Edema
-Irreversible
Pathogenesis of cirrhosis
- Hepatocytes destroyed
- Cells try to regenerate
- Disorganized process
- Abnormal Growth
- Poor blood flow & scar tissue
- Hypoxia
- Liver failure
Explain the alcoholic cirrhosis phase
-Fibrosis & scarring alter liver structure
-Inflammation, oxidative stress, cellular damage, cellular necrosis
-Irreversible
Stages of liver damage
- Fatty liver- deposits of fat lead to liver enlargement
- Liver Fibrosis-scar tissue forms
- Cirrhosis- growth of connective tissue destroys liver cells
Cirrhosis early manifestations
GI distrubances
-N/V
-Anorexia
-Flatulence
-Change in bowel habits
Fever
Wt loss
Palpable liver
Cirrhosis late manifestations
-Jaundice
-Peripheral edema
-Decreased albumin & PT
-Ascites
-Skin lesions (spider angioma)
-Hematologic problems (anemia & bleeding)
-Endocrine problems
-Esophageal & anorectal varices
-Encephalopathy
Describe the endocrine problems that go along with late cirrhosis
Women: stop ovulating & periods stop (amenorrhea)
Men: hypogonadism, impotence, infertility
Portal hypotension lead to the development of what?
fragile distended veins (if they burst lots of bleeding and high mortality)
What is portal hypertension?
Resistant portal blood flow that leads to varices & ascites
What are causes of portal hypertension?
-Systemic hypotension
-Vascular underfilling
-Stimulation of vasoactive (RAAS) systems
-Plasma volume expansion
-Increased CO
S/S of portal hypertension?
Asymptomatic until complications
-Variceal hemprrhage
-Ascites
-Peritonitis
-Hepatorenal syndrome
-Cardiomyopathy
Treatment of portal hypertension?
Nothing except liver transplant
What % of cirrhosis pts get hepatic encephalopathy?
30-40%
What is the primary driver of the hepatic encephalopathy diagnosis?
LOC
Range from Change in behavior to Coma
(liver not filtering so toxins building up in brain causing confusion)
What liver lab is the primary chemical driver of LOC changes?
Ammonia
(never diagnosis w/ only ammonia labs)
What is Acute liver failure-ALF (fulminant liver failure)?
Separate liver failure (NOT) caused by cirrhosis
What is the most common cause of ALF?
Acetaminophen overdose
How is acute liver failure r/t acetaminophen overdose treated?
Acetylcysteine
What is the patho of ALF?
edematous hepatocytes and pathy areas of necrosis and inflammatory cell infiltrates & disrupts the liver tissue
ALF occurs _____ after a viral hepatitis or metabolic liver disease or ______ after a acetaminophen overdose?
6-8 wks
5days to 8 weeks
Treatment of ALF?
Not much, liver transplatn
