HEPATIC DISORDERS Flashcards
The __ is the largest gland of the body and is a major organ.
liver
- The liver can be considered a ___ that manufactures, stores, alters, and excretes a large number of substances involved in __.
- The liver is especially important in the regulation of __ and __ metabolism.
- The liver manufactures and secretes __.
- The liver removes waste products from the __ and secretes them into the __.
- The bile produced by the liver is stored temporarily in the ___.
chemical factory
metabolism
glucose
protein
bile
bloodstream
bile
gallbladder
The liver is located behind the ribs in the upper right portion of the abdominal cavity.
- It weighs between 1200 and 1500 g in the average adult and is divided into __ lobes.
- Its functional units are called __.
- Approximately 80% of the blood supply comes from the portal vein and the rest from the __.
*___ Cells are present in the liver.
four
lobules
hepatic artery
Phagocytic cells (Kupffer cells)
FUNCTIONS
- Glucose Metabolism
- After a meal, glucose is taken up from the portal venous blood by the liver and converted into __ (stored in __).
- The glycogen is converted back to glucose (_) and released as needed into the bloodstream.
- Additional glucose can be synthesized by the liver through a process called ____ (the liver uses amino acids from protein breakdown).
glycogen
hepatocytes
(glycogenolysis)
gluconeogenesis
FUNCTIONS
- Ammonia Conversion
- ___ results in the formation of __ as a by-product.
- The liver converts this metabolically generated ammonia into __ (excreted in the urine).
Gluconeogenesis
ammonia
urea
FUNCTIONS
- Protein Metabolism
- The liver synthesizes almost all of the __ (albumin, alpha-globulins, beta-globulins, etc.).
- _ are used by the liver for protein synthesis.
plasma proteins
Amino acids
- Fat Metabolism
- __ can be broken down for the production of energy and ketone bodies.
- Fatty acids and their metabolic products are also used for the synthesis of __, lecithin, lipoproteins, and other complex ___.
Fatty acids
cholesterol
lipids
- Vitamin and Iron Storage
- Vitamins __ and several of the __ vitamins are stored in large amounts in the liver.
- Certain substances, such as ___, are also stored in the liver.
A, B, and D
B-complex
iron and copper
- __ is continuously formed by the __ and collected in the canaliculi and bile ducts.
- The functions of bile are __ (excretion of bilirubin).
- Bile salts are then reabsorbed, primarily in the distal ileum into the portal blood (__).
Bile
hepatocytes
excretory
enterohepatic circulation
- __ is a pigment derived from the breakdown of __.
- __ remove bilirubin from the blood and chemically modify it through conjugation to glucuronic acid.
Bilirubin
hemoglobin
Hepatocytes
- The liver metabolizes many __, such as barbiturates, opioids, sedatives, anesthetics, and amphetamines.
- __ generally results in drug __, although activation may also occur.
- One of the important pathways for medication metabolism involves __ (binding) of the medication with a variety of compounds.
- __ is the fraction of the given medication that actually reaches the systemic circulation (__)
medications
Metabolism
inactivation
conjugation
Bioavailability
first-pass effect
involuntary flapping movements of the hands
asterixis
Liver Function Tests
* More than __ of the parenchyma of the liver may be damaged before liver function test results become abnormal.
70%
___ is the removal of a small amount of liver tissue, usually through needle aspiration.
- It permits examination of __.
- Done to evaluate diffuse disorders of the parenchyma and to diagnose space-occupying __.
Liver biopsy
liver cells
lesions
__ are used to identify normal structures and abnormalities of the liver and biliary tree.
- __ is used to examine the liver and other pelvic structures.
Ultrasonography, computed tomography (CT) scans, and magnetic resonance imaging (MRI)
Laparoscopy
GIVE 9 MANIFESTATION OF HEPATIC DYSFUNCTION
- Jaundice
- Portal Hypertension
- Ascites
- Esophageal Varices
- Hepatic Encephalopathy and Coma
- Edema and Bleeding
- Vitamin Deficiency
- Metabolic Abnormalities
- Pruritus and Other Skin Changes
- the sclerae and the skin become __
- Jaundice becomes clinically evident when the serum bilirubin level exceeds __ mg/dL (__ mmol/L).
- The bilirubin concentration in the blood may be increased in the presence of liver disease.
tinged yellow or greenish-yellow.
2.0
34
Types of jaundice:
__ - result of an increased destruction of the red blood cells.
a. Hemolytic Jaundice
- increased pressure throughout the portal venous system.
- Manifests as __ (enlarged spleen), ascites and varices.
Portal Hypertension
splenomegaly
- movement of fluid into the peritoneal cavity.
- Marked by increased abdominal girth and rapid weight gain.
- Caused by the failure of the liver to metabolize __ and decreased synthesis of __
Ascites
aldosterone
albumin
is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure.
- Transjugular intrahepatic portosystemic shunt (TIPS)
- varicosities that develop from elevated pressure in the veins that drain into the portal system.
- They are prone to rupture and often are the source of massive hemorrhages from the upper GI tract and the rectum.
. Esophageal Varices
Injection of sclerosing agent into esophageal varices through an endoscope promotes thrombosis and eventual sclerosis, thereby obliterating the varices.
Endoscopic or injection sclerotherapy
A, A rubber band–like ligature is slipped over an esophageal varix via an endoscope.
B, Necrosis results, and the varix eventually sloughs off
Esophageal Banding Therapy (Variceal Band Ligation)
A, Normal portal system.
B–D, Examples of portal shunts to reduce portal pressure.
Surgical Bypass Procedures
is a life-threatening complication of liver disease that occurs with profound liver failure.
Hepatic Encephalopathy and Coma
- __ (Normal level of consciousness with periods of lethargy and euphoria; reversal of day–night sleep patterns)
Effects of constructional apraxia. Deterioration of handwriting and inability to draw a simple star figure occurs with progressive hepatic encephalopathy.
Stage 1 Hepatic Encephalopathy and Coma
is the characteristic breath which has been said to resemble the odor of a mixture of rotten eggs and garlic or ‘breath of the dead’, is a condition in which the breath of the patient is sweetish, musty
- Fetor hepaticus
(Stuporous; difficult to rouse; sleeps most of time; marked confusion; incoherent Speech)
Hepatic Encephalopathy and Coma
- Stage 3
(Comatose; may not respond to painful stimuli)
- Stage 4
- caused by hypoalbuminemia and decreased production of blood clotting factors.
Edema and Bleeding
VITAMIN DEFICIENCY
- deficient absorption of vitamin _ from the GI tract
Fat soluble vitamins are also affected vitamins
- __, resulting in night blindness and eye and skin changes.
- __, leading to beriberi, polyneuritis, and Wernicke–Korsakoff psychosis
- __, resulting in characteristic skin and mucous membrane lesions
- __, resulting in the hemorrhagic lesions of scurvy
- __ , resulting in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses
- __, resulting in macrocytic anemia
- __, resulting in skin and mucous membrane lesions and neurologic changes
K
A D E
Vitamin A deficiency
Thiamine deficiency
Riboflavin deficiency
Pyridoxine deficiency
Vitamin C deficiency
Vitamin K deficiency
Folic acid deficiency
__ develop due to retention of bile salts
* Patients may develop vascular (or arterial) __ on the skin
* Patients may also develop reddened palms (_)
- severe pruritus
spider angiomas
(liver palms” or palmar erythema).
a systemic, viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical, and cellular changes.
five types have been identified: hepatitis (5)
Hepatitis __ are similar in mode of transmission (__), whereas hepatitis ____ share many other characteristics.
VIRAL HEPATITIS
A, B, C, D, and E.
A and E
fecal–oral route
B, C, and D
HEPATITIS A VIRUS
Previous names - ___
Mode of transmission
* ___ route
* oral–anal contact during sex
Incubation (days) Immunity
* 15–50 days
* Average: 30 days
* Homologous
Infectious hepatitis
Fecal–oral
- __ antibodies are detectable in the serum in hepa a
HAV
Hepatitis B
Previous names - __
Mode of transmission
* ___;
* Perinatal transmission
Incubation (days) Immunity
* 28–160 days
* Average: 70–80 days
* Homologous
Serum hepatitis
Parenterally
__ antibodies are detectable in the serum in hepa b
HV
Prevention
* Preventing Transmission
* Active Immunization: __
* Passive Immunity: __
HBV (three doses)
Hepatitis B Immune Globulin (HBIG)
HEPATITIS C VIRUS
Previous names - __
Mode of transmission
* Transfusion of __ and blood products;
* Transmission possible with __ with infected partner;
* Risk increased with STD
Incubation (days) Immunity
* 15–160 days
* Average: 50 days
Signs and symptoms
* Similar to __
Assessment and Diagnostic Findings
* ___ antibodies are detectable in the serum.
Non-A, non-B hepatitis
blood
sex
HBV
HCV
HEPATITIS D VIRUS
Previous names - __
Mode of transmission
* Same to __
Incubation (days) Immunity
* 21–140 days
* Average: 35 days
Signs and symptoms
* Similar to ___
Assessment and Diagnostic Findings
* __ antibodies are detectable in the serum.
Non-A, non-B hepatitis
HBV
HBV
HDV
HEPATITIS E VIRUS
Previous names - ___
Mode of transmission
* ___
Incubation (days) Immunity
* 15–65 days
* Average: 42 days
Signs and symptoms
* Similar to ___
Assessment and Diagnostic Findings
* ___ antibodies are detectable in the serum.
Non-A, non-B hepatitis
Fecal–oral route;
HAV
HEV
____
* Certain chemicals have toxic effects on the liver and produce acute liver cell necrosis or toxic hepatitis when inhaled, injected parenterally, or taken by mouth.
- Some chemicals commonly implicated in this disease include ___ &___
- Many medications can induce hepatitis but are only sensitizing rather than toxic.
NONVIRAL HEPATITIS
carbon tetrachloride and phosphorus.
__ resembles viral hepatitis.
Toxic hepatitis
- DRUG-INDUCED HEPATITIS
- The use of ___ has been identified as the leading cause of acute liver failure.
- Manifestations of sensitivity to a medication may occur on the ___ day of its use or not until several ___ later.
acetaminophen
first
months
___ is an option for drug-induced hepatitis, but outcomes may not be as
successful as with other causes of liver failure.
Liver transplantation
- The clinical syndrome of sudden and severely impaired liver function in a previously healthy person.
- Develops within 8 weeks after the first symptoms of __.
- Three categories are frequently cited:
1. ____ (the duration of jaundice before the onset of encephalopathy is 0 to 7 days)
2. ____ (8 to 28 days)
3. ____ (28 to 72 days).
FULMINANT HEPATIC FAILURE
jaundice
Hyperacute
Acute
subacute liver failure
__ is a common cause of fulminant hepatic failure.
- Other causes include toxic medications and chemicals, metabolic disturbances and structural changes.
- The key to optimized treatment is __ of acute liver failure and intensive intervention.
- The use of antidotes for certain conditions may be indicated such as __ for acetaminophen toxicity and __ for mushroom poisoning.
Viral hepatitis
rapid recognition
N-acetylcysteine
penicillin
● A chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.
HEPATIC CIRRHOSIS
Management of the patient with cirrhosis is usually based on the presenting symptoms.
● __ are prescribed to decrease gastric distress.
● Vitamins and nutritional supplements promote healing of damaged liver cells.
● ___ may be indicated to decrease ascites.
Antacids or H2 antagonists
Potassium-sparing diuretic agents
LIVER ABSCESSES
● Two categories of liver abscess have been identified:
amebic and pyogenic.
___, guided by ultrasound, CT, or MRI, may be performed to assist in diagnosis and to obtain cultures of the organism.
Aspiration of the liver abscess
● Used to treat life-threatening ESLD for which no other form of treatment is available.
● Total removal of the diseased liver and replacement with a healthy liver from a cadaver donor.
● The success of liver transplantation depends on successful __.
● Immunosuppressant agents are prescribed (cyclosporine (Neoral), tacrolimus (Prograf), corticosteroids etc.).
● General indications for liver transplantation include irreversible advanced chronic liver disease, fulminant hepatic failure, metabolic liver diseases, and some hepatic malignancies
LIVER TRANSPLANTATION
immunosuppression
– increases primarily in liver disorders
- Alanine aminotransferase (ALT) / SGPT
- increased if there is damage or death of tissues
- Aspartate aminotransferase (AST) / SGOT
- Increased levels are associated with cholestasis and alcoholic liver disease.
- Gamma-glutamyl transferase (GGT)
__ - caused by the inability of damaged liver cells to clear normal
amounts of bilirubin from the blood caused by hepatitis viruses, chemical toxins or alcohol.
b. Hepatocellular Jaundice
- caused by occlusion of the bile duct from a gallstone, an inflammatory process, a tumor, or pressure from an enlarged organ.
c. Obstructive Jaundice
- Increased serum bilirubin levels (hyperbilirubinemia), resulting from any of several inherited disorders.
d. Hereditary Hyperbilirubinemia
(Increased drowsiness; disorientation; inappropriate behavior; mood swings; agitation)
* Asterixis;
* fetor hepaticus
Hepatic Encephalopathy and Coma
Stage 2
abscesses are most commonly caused by Entamoeba histolytica.
● Amebic liver
is a pocket of pus that forms in the liver due to a bacterial infection.
● A pyogenic liver abscess
● There are three types of cirrhosis or scarring of the liver:
- ____, in which the scar tissue characteristically surrounds the portal areas. This is most frequently caused by chronic alcoholism and is the most common type of cirrhosis.
- ___, in which there are broad bands of scar tissue. This is a late result of a previous bout of acute viral hepatitis.
- ___, in which scarring occurs in the liver around the bile ducts. This type of cirrhosis usually results from chronic biliary obstruction and infection (_); it is much less common.
Alcoholic cirrhosis
Postnecrotic CIRRHOSIS
Biliary cirrhosis
(cholangitis)
is similar to acute viral hepatitis, but ___ destruction tends to be ___.
- Drug-induced HEPATITIS
parenchymal
more extensive
