Hepatic Disorders Flashcards
True or false
In chronic disease, liver parenchyma is replaced by fibrous tissue, which separates the functioning hepatocytes into isolated nodules. This disruption of the normal tissue structure can become severe and lead to the central characteristics of cirrhosis and liver failure: loss of metabolic and synthetic function at the cellular level, and portal hypertension, ascites formation, and portal-systemic shunting at the gross level.
True
True or false
Hepatic disease impairs the liver’s synthetic functions, including production of albumin as well as coagulation and anticoagulation factors.
True
True or false
The liver is responsible for production of the vitamin K–dependent clotting factors II, VII, IX, and X; proteins C and S; and other elements of the clotting and thrombolytic processes.
True
True or false
Inadequate production of these clotting factors makes uncontrolled bleeding one of the life-threatening features of liver disease and a potentially serious complication of hepatic failure.
True
Portal hypertension
is the increased hydrostatic pressure in the portal vein and its feeder vessels caused by resistance to blood flow through the cirrhotic liver.
It eventually causes esophageal and gastric varices and portal-systemic shunting.
Pathophysio of ascites in the cirrhotic
Increased hydrostatic pressure in the intraperitoneal veins, hypoalbuminemia, and poor renal management of sodium and water
Prehepatic jaundice is caused by
any form of hemolysis, including inborn errors of bilirubin metabolism, which overwhelm the liver’s ability to conjugate bilirubin.
causes of hepatic jaundice
Viral infection and ingested toxins are typical
posthepatic jaundice produces a rise in
conjugated (direct) bilirubin
prehepatic and hepatic jaundice, which present with elevated
unconjugated (indirect) bilirubin
True or false
Parasitic infestation and biliary atresia are rare causes of posthepatic jaundice
True or false
Alanine aminotransferase is a more specific marker of hepatocyte injury than aspartate aminotransferase.
True
Aspartate aminotransferase is found not only in liver but also in heart, smooth muscle, kidney, and brain. Elevated aspartate aminotrans- ferase can be due to medications, including acetaminophen, NSAIDs, angiotensin-converting enzyme inhibitors, nicotinic acid, isoniazid, sulfonamides, erythromycin, griseofulvin, and fluconazole.
True or false
An elevated γ-glutamyl transpeptidase in the setting of hepatitis suggests an alcoholic cause.
True
This elevation is associated with biliary obstruction and cholestasis.
Alkaline phosphatase
____________ prolongation in liver disease reflects the decreased synthesis of the vitamin K–dependent coagulation factors II, VII, IX, and X and, as such, serves as a true measure of liver function.
Prothrombin time
An increased total and indirect bilirubin signifies
- overwhelming supply of unconjugated bilirubin to the hepatocytes (e.g., hemolytic anemia) or
- injury to the hepatocytes- damages their capacity to conjugate a normal supply of bilirubin (e.g., acute or chronic viral hepatitis)
Total and direct bilirubin is increased when
(+) OBSTRUCTION preventing the secretion of the conjugated bilirubin that is produced by normally functioning hepatocytes (e.g., obstructing gallstone, pancreatic mass, or biliary atresia).
Elevations in the hundreds of units per liter Transaminases (aspartate aminotransferase and alanine amino- transferase) suggest
mild injury, or smoldering inflammation
Levels in the thousands Transaminases (aspartate aminotransferase and alanine amino- transferase) suggest
extensive acute hepatic necrosis
True or false
Transaminases (aspartate aminotransferase and alanine amino- transferase) enzyme levels may be near normal in end-stage liver failure, when the hepatocytes are beyond the stage of acute injury
True
True or false
aspartate aminotransferase–to–alanine aminotransferase ratio of greater than 2 is common in alcoholic hepatitis because alcohol stimulates aspartate aminotransferase production.
True
True or false
transaminase elevations of three to five times normal and alkaline phosphatase of up to twice normal in diabetic or obese patients suggest the presence of nonalcoholic steatohepatitis in diabetic or obese patients
True
True or false
A total WBC count >1000/mm3 or a neutrophil count >250/mm3 diagnoses SBP
True
True or false
Low glucose or high protein values suggest infection
True
True or false
Gram stains and culture results can be falsely negative 30% to 40% of the time, so empiric antibiotics should be started in the ED based on clinical suspicion.
True
Hepatitis A virus transmission
transmitted by fecal–oral contamination
In Hep A, most common transmission occurs from
asymptomatic children to adults
Hep A incubation period and symptoms
incubation period of 15 to 50 days, followed by a prodrome of nausea, vomiting, and malaise. About a week into the illness, patients may note dark urine (bilirubinuria). A few days later, they develop clay-colored stools and jaundice.
Hep B patients can be infectious for ____________ after onset of symptoms if they clear the infection.
5 to 15 weeks
Hep B incubation
1 to 3 months
True or false
Individuals who develop chronic disease will remain infectious indefinitely.
Chronic infection occurs in only 6% to 10% of patients who contract hepatitis B virus
True
Hepatitis C virus transmission occurs primarily through
exposure to contaminated blood or blood products
In contrast to hepatitis A virus and hepatitis B virus, hepatitis C virus is
most often asymptomatic in the acute phase of infection
The most sinister side effect of Hep C treatment with direct-acting antivirals is the
reactivation of dormant hepatitis B infection.
True or false
Along with hepatitis B virus, hepatitis C virus is one of the most common causes of hepatocellular carcinoma.
True
True or false
Hepatitis D virus is uncommon and is typically seen in patients with preexisting chronic hepatitis B virus infection. Hepatitis D superinfection can result in a rapidly progressive or fulminant form of liver disease that carries a high short-term mortality rate. This variety of infection is most commonly associated with injection drug use
True
How to diagnose Spontaneous Bacterial Peritonitis
