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HEPATIC DISORDERS Flashcards

1
Q

The __ is the largest gland of the body and is a major organ.

A

liver

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2
Q
  • 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 ___.
A

chemical factory

metabolism

glucose
protein

bile

bloodstream
bile

gallbladder

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3
Q

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.

A

four

lobules

hepatic artery

Phagocytic cells (Kupffer cells)

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4
Q

FUNCTIONS

  1. 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).
A

glycogen

hepatocytes

(glycogenolysis)

gluconeogenesis

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5
Q

FUNCTIONS

  1. Ammonia Conversion
  • ___ results in the formation of __ as a by-product.
  • The liver converts this metabolically generated ammonia into __ (excreted in the urine).
A

Gluconeogenesis
ammonia

urea

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6
Q

FUNCTIONS

  1. Protein Metabolism
  • The liver synthesizes almost all of the __ (albumin, alpha-globulins, beta-globulins, etc.).
  • _ are used by the liver for protein synthesis.
A

plasma proteins

Amino acids

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7
Q
  1. 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 ___.
A

Fatty acids

cholesterol

lipids

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8
Q
  1. 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

A, B, and D
B-complex

iron and copper

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9
Q
  • __ 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 (__).
A

Bile
hepatocytes

excretory

enterohepatic circulation

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10
Q
  • __ is a pigment derived from the breakdown of __.
  • __ remove bilirubin from the blood and chemically modify it through conjugation to glucuronic acid.
A

Bilirubin
hemoglobin

Hepatocytes

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11
Q
  • 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 (__)
A

medications

Metabolism
inactivation

conjugation

Bioavailability
first-pass effect

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12
Q

involuntary flapping movements of the hands

A

asterixis

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13
Q

Liver Function Tests
* More than __ of the parenchyma of the liver may be damaged before liver function test results become abnormal.

A

70%

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14
Q

___ 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 __.
A

Liver biopsy

liver cells

lesions

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15
Q

__ are used to identify normal structures and abnormalities of the liver and biliary tree.

  • __ is used to examine the liver and other pelvic structures.
A

Ultrasonography, computed tomography (CT) scans, and magnetic resonance imaging (MRI)

Laparoscopy

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16
Q

GIVE 9 MANIFESTATION OF HEPATIC DYSFUNCTION

A
  1. Jaundice
  2. Portal Hypertension
  3. Ascites
  4. Esophageal Varices
  5. Hepatic Encephalopathy and Coma
  6. Edema and Bleeding
  7. Vitamin Deficiency
  8. Metabolic Abnormalities
  9. Pruritus and Other Skin Changes
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17
Q
  • 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.
A

tinged yellow or greenish-yellow.

2.0

34

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18
Q

Types of jaundice:

__ - result of an increased destruction of the red blood cells.

A

a. Hemolytic Jaundice

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19
Q
  • increased pressure throughout the portal venous system.
  • Manifests as __ (enlarged spleen), ascites and varices.
A

Portal Hypertension

splenomegaly

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20
Q
  • 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 __
A

Ascites

aldosterone

albumin

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21
Q

is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure.

A
  • Transjugular intrahepatic portosystemic shunt (TIPS)
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22
Q
  • 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.
A

. Esophageal Varices

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23
Q

Injection of sclerosing agent into esophageal varices through an endoscope promotes thrombosis and eventual sclerosis, thereby obliterating the varices.

A

Endoscopic or injection sclerotherapy

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24
Q

A, A rubber band–like ligature is slipped over an esophageal varix via an endoscope.
B, Necrosis results, and the varix eventually sloughs off

A

Esophageal Banding Therapy (Variceal Band Ligation)

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25
Q

A, Normal portal system.
B–D, Examples of portal shunts to reduce portal pressure.

A

Surgical Bypass Procedures

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26
Q

is a life-threatening complication of liver disease that occurs with profound liver failure.

A

Hepatic Encephalopathy and Coma

27
Q
  1. __ (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.

A

Stage 1 Hepatic Encephalopathy and Coma

28
Q

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

A
  • Fetor hepaticus
29
Q

(Stuporous; difficult to rouse; sleeps most of time; marked confusion; incoherent Speech)

A

Hepatic Encephalopathy and Coma

  1. Stage 3
30
Q

(Comatose; may not respond to painful stimuli)

A
  1. Stage 4
31
Q
  • caused by hypoalbuminemia and decreased production of blood clotting factors.
A

Edema and Bleeding

32
Q

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
A

K

A D E

Vitamin A deficiency

Thiamine deficiency

Riboflavin deficiency

Pyridoxine deficiency

Vitamin C deficiency

Vitamin K deficiency

Folic acid deficiency

33
Q

__ develop due to retention of bile salts
* Patients may develop vascular (or arterial) __ on the skin
* Patients may also develop reddened palms (_)

A
  • severe pruritus

spider angiomas

(liver palms” or palmar erythema).

34
Q

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.

A

VIRAL HEPATITIS

A, B, C, D, and E.

A and E
fecal–oral route

B, C, and D

35
Q

HEPATITIS A VIRUS
Previous names - ___
Mode of transmission
* ___ route
* oral–anal contact during sex
Incubation (days) Immunity
* 15–50 days
* Average: 30 days
* Homologous

A

Infectious hepatitis

Fecal–oral

36
Q
  • __ antibodies are detectable in the serum in hepa a
A

HAV

37
Q

Hepatitis B
Previous names - __
Mode of transmission
* ___;
* Perinatal transmission
Incubation (days) Immunity
* 28–160 days
* Average: 70–80 days
* Homologous

A

Serum hepatitis

Parenterally

38
Q

__ antibodies are detectable in the serum in hepa b

A

HV

39
Q

Prevention
* Preventing Transmission
* Active Immunization: __
* Passive Immunity: __

A

HBV (three doses)

Hepatitis B Immune Globulin (HBIG)

40
Q

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.

A

Non-A, non-B hepatitis

blood
sex

HBV

HCV

41
Q

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.

A

Non-A, non-B hepatitis

HBV

HBV

HDV

42
Q

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.

A

Non-A, non-B hepatitis

Fecal–oral route;

HAV

HEV

43
Q

____
* 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.
A

NONVIRAL HEPATITIS

carbon tetrachloride and phosphorus.

44
Q

__ resembles viral hepatitis.

A

Toxic hepatitis

45
Q
  1. 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.
A

acetaminophen

first

months

46
Q

___ is an option for drug-induced hepatitis, but outcomes may not be as
successful as with other causes of liver failure.

A

Liver transplantation

47
Q
  • 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).
A

FULMINANT HEPATIC FAILURE

jaundice

Hyperacute
Acute
subacute liver failure

48
Q

__ 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.
A

Viral hepatitis

rapid recognition

N-acetylcysteine
penicillin

49
Q

● A chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.

A

HEPATIC CIRRHOSIS

50
Q

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.

A

Antacids or H2 antagonists

Potassium-sparing diuretic agents

51
Q

LIVER ABSCESSES

● Two categories of liver abscess have been identified:

A

amebic and pyogenic.

52
Q

___, guided by ultrasound, CT, or MRI, may be performed to assist in diagnosis and to obtain cultures of the organism.

A

Aspiration of the liver abscess

53
Q

● 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

A

LIVER TRANSPLANTATION

immunosuppression

54
Q

– increases primarily in liver disorders

A
  • Alanine aminotransferase (ALT) / SGPT
55
Q
  • increased if there is damage or death of tissues
A
  • Aspartate aminotransferase (AST) / SGOT
56
Q
  • Increased levels are associated with cholestasis and alcoholic liver disease.
A
  • Gamma-glutamyl transferase (GGT)
57
Q

__ - 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.

A

b. Hepatocellular Jaundice

58
Q
  • caused by occlusion of the bile duct from a gallstone, an inflammatory process, a tumor, or pressure from an enlarged organ.
A

c. Obstructive Jaundice

59
Q
  • Increased serum bilirubin levels (hyperbilirubinemia), resulting from any of several inherited disorders.
A

d. Hereditary Hyperbilirubinemia

60
Q

(Increased drowsiness; disorientation; inappropriate behavior; mood swings; agitation)
* Asterixis;
* fetor hepaticus

A

Hepatic Encephalopathy and Coma

Stage 2

61
Q

abscesses are most commonly caused by Entamoeba histolytica.

A

● Amebic liver

62
Q

is a pocket of pus that forms in the liver due to a bacterial infection.

A

● A pyogenic liver abscess

63
Q

● There are three types of cirrhosis or scarring of the liver:

  1. ____, 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.
  2. ___, in which there are broad bands of scar tissue. This is a late result of a previous bout of acute viral hepatitis.
  3. ___, 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.
A

Alcoholic cirrhosis

Postnecrotic CIRRHOSIS

Biliary cirrhosis
(cholangitis)

64
Q

is similar to acute viral hepatitis, but ___ destruction tends to be ___.

A
  • Drug-induced HEPATITIS

parenchymal

more extensive

MS (8 decks)

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