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Gastro & Abdomen 02.15 > Hepatitis and Liver > Flashcards

Hepatitis and Liver Flashcards

1
Q

Portal Tracts in the liver cells contain what (3)

A

Portal veins
Hepatic arteries
Bile ductules

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2
Q

Bile is formed in hepatocytes and drains to bile ductules via what

A

Bile canaliculi

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3
Q

This is where portal venous and arterial blood mix, providing blood supply to hepatocytes

A

Sinusoids

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4
Q

These cells line the sinusoid and are phagocytic (they break down RBCs)

A

Kupffer cells

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5
Q

These cells produce reticulin fibres (support) and are involved in fibrosis of the liver. They are found in the space of Disse (between sinusoid and hepatocyte)

A

Stellate cells

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6
Q

Support fibres in space of disse - produced by stellate cells

A

Reticulin

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7
Q

This is a section of liver tissue contains a hexagon of portal tracts surrounding a central vein

A

Lobule

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8
Q

This part of the lobule is best oxygenated, and furthest from the central vein

A

Peri-portal zone

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9
Q

This area of lobule is worst oxygenated - closest to central vein

A

Central / perivenular zone

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10
Q

Basic functions of liver (6)

A
  1. Carbohydrate metabolism
  2. Protein metabolism
  3. Lipid metabolism
  4. Production of bile
  5. Metabolism (CYP450) of substances from portal system e.g. drug/ toxin metabolism
  6. Vitamin D activation (= first stop after skin production)
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11
Q

What are the 3 key mechanisms of liver carbohydrate metabolism

A
  1. Glycogen storage
  2. Glycolysis - produce glucose
  3. Gluconeogenesis - from fat / AA breakdown, lactate
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12
Q

3 egs of proteins produced by the liver

A
  1. Albumin - osmotic pressure & conjugate bilirubin etc
  2. Alpha 1 antitrypsin - transport protein
  3. Clotting factors (except VIII)
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13
Q

Alcohol is a CNS depressant in 4 main ways

A

Inhibits Ca++ entry via channels
GABA synaptic inhibition
Antagonist of excitatory AAs
Inhibits neurotransmitter release

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14
Q

Often the first stage in alcoholic liver disease (ie what happens to the liver)

A

Fatty liver

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15
Q

This causes anorexia, malaise, jaundice, hepatomegaly and RUQ pain - in 10-35% of alcohol abusers

A

Alcoholic hepatitis

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16
Q

What is happening at a cellular level in fibrosis of the liver

A

Stellate cells in space of Disse produce excess collagen - blocks blood from sinusoid to hepatocyte, hepatocytes die.

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17
Q

Patient with fetor hepaticus (sweet smelling breath) asterixix, red. LOC, confusion, slurring. Heavy alcohol drinker

A

Encephalopathy - toxins build up in brain not metabolised by liver

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18
Q

These 2 types of viral hepatatis are faecal/oral spread, 2-3 weeks incubation, UNRELATED to liver cancer/chronic liver disease. There is NO carrier state for this.

A

Hep A & E

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19
Q

This is blood borne / sex transmitted hep, mother-baby transmission, 1-5 months incubation. RELATED to liver cancer. carrier state possible.

A

Hep B (b for Baby and blood)

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20
Q

This hep is blood borne, RARELY sex or maternal - baby. RELATED to chronic liv disease & cancer (popular with needle users)

A

Hep C

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21
Q

This hep is blood borne in the presence of Hep B

A

Hep D

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22
Q

At least 4 symptoms of hepatitis PRODROME

A 
Malaise / fatigue
Nausea / vomiting
Fever >39.5
Headache
Myalgia
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23
Q

At least 4 symptoms of icteric phase of hepatitis

A 
Dark urine
Jaundice
RUQ pain
Pale stool
Itch (pruritis)
Arthralgia / rash
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24
Q

Diff Diag for symptoms of hepatitis (4)

A

Acute liver injury (drugs)
Viral - CMV / H simplex / Yellow fever
Acute HIV
Hypersensitivity - sulfasalazine allergy

25
Vaccination is available for these 3 hep type
A, &E, B
26
When might you give Hep B immunoglobulin (HBIG)
Post exposure to Hep B (eg needlestick)
27
WHat can be given in acute Hep illness for 2 types
Anti viral Hep B & C
28
Commonest acute Hep in Wales
E (genotoype 3)
29
This cytokine focused treatment has a 90% cure rate for Hep B
Peg interferon
30
Entecavir and tenofovir are expensive treatments for what hep
B
31
Shrunken liver and enlarged spleen is a result of what aspect of liver disease
Portal hypertension
32
Most common Hep worldwide, kills 1mill pa
B
33
Most common hep in Egypt, treatable with 8 week trtmt
C
34
Telaprevir may cause what as a side effect
DRESS - (Drug Reaction with Eosinophilia & Systemic symptoms)
35
Sofosbuvir, simeprevir, daclatasvir are all DAAs - Direct acting anti virals. What stage of management would they be used
After trying with peg interferon / ribavarin combo as they are expensive
36
Why would you not give Ribavarin to preg women
Teratogenic
37
What can interferon cause in neck & bones
Thyroid dysfunction | Bone marrow suppression
38
What causes Wernickes's encephalopathy
Thiamine (Vit B1) deficiency
39
What disease esp. in poor countries can cause thiamine deficiency
Beriberi
40
Triad of symptoms for Wernickes encep.
1. Opthalmoplegia (weakness of eye muscles) 2. Ataxia 3. Confusion
41
This syndrome causing memory impairment, confabulation, confusion and personality changes, has a strong and recognised link with is closely associated with Wernicke's encephalopathy.
Korsakoff syndrome (combined = Wernicke - Korsakoff syndrome)
42
Treatment for Wernicke's encephalopathy
Thiamine supplementation / improved diet
43
2 signs of alcoholic liver disease found on the hands
Palmar erythema | Duptryens' contracture
44
What type of med might be used in treating alcohol withdrawal symptoms
Bezodiazepines -Chlordiazepoxide
45
This enzyme is significantly increased in alcohol abuse
GGT - Gamma glutamyl transferase
46
Himmelsbach hypothesis suggests that neuro receptors are increased to balance the excessive impact of alcohol on GABA receptors. Give an example of receptor that is increased
NDMA (exicatatory)
47
What opiod receptor do most addictive opiate drugs act on? Mu, Delta or Kappa
Mu
48
What do psychostimulants such as Amphetamines, Methamphetamine & Cocaine do with what neurotransmitter
Dopamine - maintain dopamine in synapse (preventer transporter removing it)
49
Haloperidol acts as a treatment by blocking what receptors
Dopamine
50
These two liver enzymes are elevated in Hepatocellular damage
ALT - Alanine Aminotransferase | AST - Aspartate aminotransferase
51
ALT and AST are slightly elevated in chronic or acute probs
Chronic
52
AST and ALT are highly elevated in chronic or acute probs
Acute
53
These 2 liver enzymes are raised in cholestatic injury/disease
GGT (also in alcohol use) | ALP - Alkaline phosphatase
54
If this marker is above 50umol/L usually get jaundice
Bilirubin
55
This is a common, harmless congenital condition, inability to process bilirubin in liver - leads to jaundice (often only expressed when person is bit ill)
Gilbert's syndrome
56
Congenital copper disorder - deposits copper in liver can cause cirrhosis
Wilsons
57
Excess iron e.g multiple transfusions, excessive IV iron can cause this
Acquired haemochromatosis
58
INHERITED disease, involving excess iron deposition in various organs, eventually leading to organ fibrosis.
Hereditary haemochromatosis
59
Signs of this disease: pigmentation of skin, hepatomegally, diabetes, may have reduced libido / hypogonadism.
Haemochromatosis - excess iron levels and stored iron in organs

Gastro & Abdomen 02.15 (5 decks)

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