Exam 4 - Chapter 13. Liver and Gallbladder Flashcards
1
Q
3
Heme is the substrate of _____.
A
2
Q
3
What is heme derived from?
A
3
Q
3
What does heme get degraded to by the enzyme heme oxygenase in mononuclear phagocytes?
A
4
Q
3
Biliverdin is reduced to bilirubin by the enzyme _____.
A
5
Q
3
Circulating bilirubin (_____) is bound to ____ and is subsequently taken up by the _____.
A
6
Q
3
To make bilirubin soluble, it undergoes _____, a reaction catalyzed by __________.
A
7
Q
3
Conjugated bilirubin (_____) is excreted into ____ and reaches the _____.
A
8
Q
3
Bilirubin glucoronides are deconjugated by _______ and eliminated in the ______.
A
9
Q
4
What are two other names for Jaundice?
A
10
Q
5
What is jaundice?
A
11
Q
5
Jaundice is not a diagnosis, but rather a _____________.
A
12
Q
5
Jaundiced patients often present with symptoms related to the underlying pathology, such as:
- _____
- ________
- _______
A
13
Q
6
What is scleral icterus?
A
14
Q
6
Clinical presentation of jaundice as scleral icterus is best appreciated only when the serum levels reach ________. Normal serum levels of bilirubin are ________.
A
15
Q
6
What ages are most commonly affected by jaundice?
A
16
Q
8
Why do sclerae have a high affinity for bilirubin?
A
17
Q
8
In jaundice, with further increase in serum bilirubin levels, the skin will progessively discolor ranging from ______ to ______, especially if the process is long-standing.
A
18
Q
8
Green color in jaundice is due to _____.
A
19
Q
8
Yellowing of the skin sparing the sclerae is indicative of ______ which occurs in healthy individuals who ________.
A
20
Q
9
What are 5 pathophysiologies of jaundice?
A
21
Q
9
What is one thing that could lead to excess production of bilirubin?
A
22
Q
9
What is one thing that can cause reduced hepatocellular uptake?
A
23
Q
9
What are two things that could lead to impaired conjugation?
A
24
Q
9
What are two things that can lead to decreased hepatic excretion of bile?
A
25
9
What are two things that can cause imapired bile flow?
26
10
What are two effects of prehepatic unconjugated hyperbilirubinemia?
27
10
What is one effect of hepatic unconjugated hyperbilirubinemia?
28
10
What is one effect of posthepatic conjugated hyperbilirubinemia?
29
11
What percent of babies have jaundice in the first week of life?
30
11
Why do 20% of babies have jaundice in the first week of life?
31
11
What are 4 reasons why infants and children would have jaundice?
32
11
Unconjugated hyperbilirubinemia can be _____ in neonates.
33
11
Unconjugated hyperbilirubinemia can be neurotoxic in neonates, causing _______ (_______) and _______.
34
12
How long does it take for mild infant jaundice to disappear on its own?
35
12
What are two treatment modalities for infants with jaundice?
36
12
How does light therapy (phototherapy) work as a treatment for jaundice in infants?
37
14
What are two things that jaundice in adults serve as a marker for?
38
14
Most adult cases of jaundice have a more ____ course.
39
14
Treatment of jaundice in adults varies according to the _____.
40
17
When does hepatic failure occur?
41
17
Hepatic failure can be _____ or _____, without any symptoms until there is ________.
42
17
What are the two most common causes of hepatic failure?
43
17
Which group does hepatic failure affect? What group is it rare in?
43
17
Eventually, liver failure can cause a variety of symptoms, including:
1. ______
2. ______
3. _____
4. ______ (________)
44
18
What is acute hepatic failure?
45
18
What is a commonly used cutoff between acute and chronic hepatic failure?
46
18
______ (_________) and _______ (________) are the two most common causes of acute liver failure worldwide.
47
20
What are 5 symptoms of acute hepatic failure?
48
22
What are three general treatments for acute hepatic failure?
49
22
When can you do specific treatments for acute hepatic failure treatment?
50
22
Acute hepatic failure treatment may involve ________.
51
22
Should all patients with acute hepatic failure be hospitalized?
52
23
In chronic liver failure, progressive deterioration of liver functions for more than 6 months results in the deterioration of:
1. ______
2. _____
3. _________
53
23
Chronic liver failure is a continuous process of inflammation, destruction, and regeneration of liver parenchyma that leads to _____ and ______.
54
23
What are 6 common etiologies for chronic liver failure?
55
24
Chronic liver failure results in:
1. ______
2. ________
3. _______
4. ________
56
24
While fibrosis associated with chronic liver failure is usually irreversible, when can it be reversible?
*Note that the transition time point of reversible fibrosis to irreversible fibrosis is still not completely understood.
57
24
What three things does the development rate of fibrosis depend on?
58
25
What does NAFL stand for?
59
25
What does NASH stand for?
60
26
Signs and symptoms of chronic liver failure can be ____.
61
26
What are the three nonspecific signs and symptoms of chronic liver failure?
62
29
What are two goals for chronic liver failure treatment?
63
31
What is hepatic encephalopathy and in what kind of patients does it occur in?
64
31
Though the precise pathophysiology for hepatic encephalopathy is still under discussion, what does the leading hypothesis focus on?
65
32
Hepatic Encephalopathy Clinical Features include:
1. ______
2. ______
3. _______
4. _______
66
32
What two motor system abnormalities do non-comatose patients with Hepatic Encephalopathy show?
67
32
What sign do non-comatose patients with Hepatic Encephalopathy show?
68
32
Describe the positive Babinski reflex.
69
35
What is cirrhosis of the liver?
70
35
The most common causes of cirrhosis of the liver are:
1. _____
2. _______
3. ________
71
39
What are the four general cirrhosis clinical features?
72
39
There are 4 specific cirrhosis clinical features:
1. _______
2. ______
3. _______
4. ________
73
39
What are three things seen in people with impaired protein synthesis due to cirrhosis?
74
39
What is seen in someone with impaired nitrogen metabolism due to cirrhosis?
75
39
What are 4 things seen in someone with impaired estrogen metabolism due to cirrhosis?
76
39
What are two things seen in someone with impaired biliary excretion due to cirrhosis?
77
42
For cirrhosis treatment, you need to treat the ________.
78
42
What are 4 complications that need to be treated and prevented in cirrhosis treatment?
79
42
With cirrhosis treatment, avoid ______ (_____).
80
42
Cirrhosis treatment requires regular ultrasound surveillance of _______.
81
44
What is hepatitis?
82
44
What are three causes of hepatitis?
83
44
What are the five most common forms of viral hepatitis?
84
45
What are the two forms of transmission for hepatitis A?
85
45
Is Hepatitis A a chronic infection?
86
45
What is the prevention for Hepatitis A?
87
45
What is the treatment for Hepatitis A?
88
45
What are the two forms of transmission for Hepatitis B?
89
45
Is Hepatitis B a chronic infection?
90
45
What is the prevention for Hepatitis B?
91
45
What is the treatment for Hepatitis B?
92
45
What are the two transmissions for Hepatitis C?
93
45
Is Hepatitis C a chronic infection?
94
45
What are two preventions for Hepatitis C?
95
45
What is the treatment for Hepatitis C?
96
45
What are three forms of transmission for Hepatitis D?
97
45
Is Hepatitis D a chronic infection?
98
45
What is the prevention for Hepatitis D?
99
45
What is the treatment for Hepatitis D?
100
45
What are two forms of transmission for Hepatitis E?
101
45
Is Hepatitis E a chronic infection?
102
45
What are two forms of prevention for Hepatitis E?
103
45
What is the treatment for Hepatitis E?
104
46
What are three alcoholic related liver diseases?
105
48
What is the primary site of ethanol metabolism?
106
48
What three things does chronic and excessive alcohol consumption result in?
107
48
What is steatosis?
108
48
What is fibrosis/cirrhosis?
109
49
Is steatosis reversible or irreversible?
110
49
Steatosis is associated with disturbance of metabolism by:
1. ______
2. ______
3. ________
4. ________
111
51
Alcoholic Hepatitis is characterized by rapid onset of:
1. ______
2. ______
3. ________
112
51
Alcholic hepatitis usually progresses to _____ if drinking is continued.
113
51
If alchol is discontibuted, hepatitis returns to normal within _____.
114
52
What is the final and irreversibel stage of alcohol abuse.
115
52
In alcoholic cirrhosis, initially the liver is _____. Thereafter, it becomes _____, _____, and _____.
116
52
End-stage cirrhosis looks the same regardless of ____.
117
54
What are three inherited liver and gallbladder disorders?
118
55
What is hemochromatosis?
119
55
What is the inheritance pattern for hemochromatosis?
120
55
Hemochromatosis results from what three gene mutations?
121
55
In hemochromatosis, over time excess iron is stored in body tissues and organs such as:
1. _______
2. _______
3. ______
4. ______
5. _______
122
56
These are the 5 early symptoms of hemachromatosis:
1. _____
2. _____
3. ______
4. ______
5. _______
123
56
These are the 5 late symptoms of hematochromatosis:
1. ______
2. ______
3. _______
4. ______
5. _______
124
58
Is hematochromatosis greater in males or females?
125
58
Why is hematochromatosis greater in males than people?
126
58
Hematochromatosis is greater in people with what ancestry?
127
58
What is the treatment for Hematochromatosis?
128
59
What is Wilson Disease?
129
59
What is the inheritance pattern of Wilson disease?
130
59
What is the mutation in Wilson Disease?
131
59
What does the ATP7B gene play a role in?
132
59
What may happen if Wilson is not recognized and treated when symptomatic?
133
59
What is Wilson Disease treated with?
134
60
At what age do the first signs and symptoms appear in Wilson disease?
135
60
What is typically the initial feature of Wilson disease?
136
60
What are four features of Liver disease that are typically seen in Wilson disease?
137
60
What are 8 nervous system psychiatric problems seen in Wilson Disease?
138
60
What are two eye problems of the cornea seen with Wilson disease?
139
62
What are two treatments for Wilson Disease?
140
63
Is Reye Syndrome fatal?
141
63
What is Reye Syndrome?
142
63
What is the cause of Reye Syndrome?
143
63
What age group is Reye Syndrome seen in?
144
63
What group does Reye Syndrome most commonly affect?
145
64
What are the 4 symtpoms of Reye Syndrome?
146
64
What is the treatment for Reye Syndrome?
147
67
What is the most common form of liver cancer?
148
67
What percent of the time is Hepatocellular Carcinoma seen for liver cancers?
149
67
What are the two main risk factors for Hepatocellular Carcinoma?
150
69
Diseases of the Biliary Tract:
1. _____
2. ______
3. _______
151
71
What is the common name for Cholelithiasis?
152
71
What is Cholelithiasis?
153
71
What percent of men and women in the US have gallstones?
154
71
Are most cases of Cholelithiasis symptomatic or asymptomatic? Is treatment required?
155
71
Approximately ___% of asymptomatic gallstones in Cholelithiasis will develop symptoms over ___ years of follow-up.
156
72
What are the 3 main pathways of stone formation for Cholelithiasis Pathogenesis?
157
72
What can bile normally do when cholesterol is excreted by the liver?
158
72
What does excess bilirubin cause?
159
72
What effect does gallbladder hypomotility or impaired contractility have?
160
72
What percent of cholelithiasis are cholesterol gallstones?
161
73
Cholelithiasis Risk Factors:
1. ____
2. ______
3. _______
4. ______
5. _____
6. _______ (____ and ______)
162
74
What are three symptoms associated with Cholelithiasis?
163
74
What is a common trigger for gallbladder contraction?
164
74
Cholelithiasis pain usually starts within _____ after a fatty meal.
165
74
How is the pain described in Cholelithiasis
166
74
How long may the constant, sharp pain in the upper right quadrant last for those with Cholelithiasis?
167
74
What are three treatments for Cholelithiasis?
168
76
What is Cholecystitis?
169
76
Causes of Cholecystitis:
1. _______
2. _______
170
76
Symptoms of Cholecystitis:
1. _________
2. ______ (especially _________)
3. ____ and _______
4. ________
171
76
What is the treatment for Cholecystitis?
172
78
What age group is carcinoma of the gallbladder seen in?
173
78
Causes of Carcinoma of the Gallbladder:
1. ______ (______)
2. _______ (________)
174
78
What is the prognosis of Carcinoma of the Gallbladder?
