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Clin Med- GI > Hepatology Lecture > Flashcards

Hepatology Lecture Flashcards

1
Q

Valveless*
Pressure is 3-5 mmHg
75% of total liver blood supply by volume
Posterior to bile duct and hepatic artery
Formed by SMA

A

Portal vein

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2
Q

Venous drainage of the liver thru 3 valveless veins into infereior vena cava
*takes blood back to heart

made up of…R, middle, L

A

Hepatic veins

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3
Q

Parasympathetic innervation of the liver comes from the…

A

Vagus N

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4
Q

Parasympathetic and Sympathetic fibers into the liver come from the…

A

Celiac plexus

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5
Q

Make up the parenchyma of liver

Survive 200-300 days

If healthy..divide and replicate

A

Hepatocytes

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6
Q

“Stem cells” of liver

Allow for regeneration

A

Ovalcytes

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7
Q

Fxns of liver?

A

Metabolic

Catabolic

Storage

Excretory functions

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8
Q

Gluconeogenesis

Synthesis of phospholipids and cholesterol

Detox of meds and alcohol

A

Metabolic and catabolic fxns of liver

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9
Q

Glycogen
Protein
Triglycerides
Iron
Copper
Fat soluble vitamins

A

Storage in the liver

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10
Q

Synthesis and secretion of of bile

A

Excretory fxn of liver

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11
Q

Coag factors: PT/INR, PTT
Plasma proteins: albumin
Acute phase proteins: cytokines
Carb metabolism: glycogen, lactate
Lipid metabolism: cholesterol, TGs, lipoproteins
Bilirubin metabolism: bile excretion

A

Synthetic functions of liver

(in hepatocytes)

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12
Q

is AST elevated in acute or chronic conditions?

A

Acute

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13
Q

Is ALT elevated in acute or chronic conditions?

A

Chronic

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14
Q

ALT > AST in….

A

Viral, fatty liver

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15
Q

AST > ALT in…

A

Alcohol (2:1)

or drug toxicity

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16
Q

What labs do you want if you are checking for hepatocellular damage or inflammation?

A

AST

ALT

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17
Q

What labs do you want if you are checking for obstructive dz?

A

Bilirubin

Alk-Phos

GGTP (not part of LFTs)

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18
Q

Which is water soluble, which is not water soluble:

Direct (conjugated) bilirubin

Indirect (unconjugated) bilirubin

A

Direct (conjugated) bili is water soluble

Indirect (unconjugated) bili it NOT water soluble

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19
Q

Hemolysis of RBCs

Impaired hepatocyte function

..will result in elevation of?

A

Indirect bilirubin (pre-hepatic)

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20
Q

Obstruction of excretion of bilirubin, cholestasis

…will result in elevation of?

A

Direct bilirubin (post-hepatic)

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21
Q

Found in bone, liver, intestine, kidney, placenta and leukocytes

*can be fractionated to determine origin

A

Alk-Phos

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22
Q

**Liver specific!!

Will help differentiate if Alk Phos is elevated because of the liver

A

GGTP

(Gamma-glutamyltransferase)

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23
Q

Elevated alk phos (ALP) and elevated GGTP means…

A

obstruction!

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24
Q

Best first step diagnostic for looking at liver?

A

Ultrasound with doppler

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25
Q

MC hereditary cause of increased bilirubin
Results in impaired enzymatic conjugation of indirect bilirubin

A

Gilbert’s disease

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26
Q

S/S: icteric sclera and jaundice..esp at birth and acute illness

Labs:
elevated indirect bili
normal direct bili

Tx: only tx in infancy with bili lights to prevent liver failure

A

Gilbert’s disease

(normal ultrasound!)

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27
Q

No signs and symptoms unless cirrhosis has developed

Increased echotecture on U/S

Labs: ALT > AST (opposite of alcohol disease)

A

Non alcoholic fatty liver disease (NASH)

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28
Q

What is the relationship of ALT and AST in non alcoholic fatty liver disease (NASH)?

A

ALT>AST (opposite of ETOH disease)

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29
Q

Autosomal recessive genetic D/O resulting in iron deposition in organs

males > females, often onset 50 yo

A

Hemochromatosis

30
Q

Labs: high ferritin and high % saturation
HFE Gene analysis***
Liver biopsy with iron stain

Sxs: can be asymptomatic
arthralgias, hepatomegaly, gray skin, cardiomegaly, conduction D/O

Tx: phlebotomy

A

Hemochromatosis

31
Q

Rare genetic autosomal recessive DO
liver unable to excrete copper..OVERLOAD

A

Wilson’s disease

32
Q

Labs:

  • *low ceruloplasmin** (first thing to test)
  • *elevated 24H urine copper** (second thing to test)
Sx: 
Visual disturbances (**Kayser-Fleischer ring around iris**)
Neuro, psych changes

Tx:
Copper chelators, like zinc

A

Wilson’s disease

33
Q

MC cause of cirrhosis

A

Alcoholic hepatitis

34
Q

AST>ALT 2:1

A

Alcoholic hepatitis

(think alcohol when you see this 2:1 ratio!)

35
Q

Occurs with binging, heavy use

Can be fatal, pts often have encephalopathy

Hepatosplenomegaly with ascites

Jaundice

A

Acute phase of alcoholic hepatitis

36
Q

What do you give for tylenol OD

A

N-acetylcysteine

37
Q

Associated with autoimmune dzs
Females 14-50
Need biopsy to make diagnosis!

Tx= prednisone, Imuran

A

Autoimmune hepatitis

38
Q

75% of cases are pts with ulcerative colitis
mostly males
“beading” of bile ducts on MRCP

tx= Ursodiol
cure= transplant
A

Primary biliary cirrhosis

39
Q

65% of hepatitis cases in US
single stranded RNA enterovirus

fecal oral route!..think travel, contaminated food/water, close contact with infected individuals

A

Hep A

40
Q

Incubation pd= 2-6 weeks
Severity depends on age

Prodrome phase= flu like

Icteric phase= dark urine appears first (bilirubinuria)***
pale stools soon follow
RUQ pain
pruritus
arthalgias
hepatomegaly

A

Hep A

41
Q

Greatest shedding of virus is during days 14-21

A

Hep A

42
Q

Which Ig is present during acute infection? (pos for 3-6 mos)

Which Ig means youre immune?

A

IgM= acute infection

IgG= immunity

43
Q

Increase in ALT and AST (>8x norm)

Increase in bilirubin (5-15x norm)

labs in….

A

HAV

44
Q

HAV tx?

A

Usually self limiting. supportive care

45
Q

Transmission= perinatal, sexual, blood

80% of hepatocellular carcinoma (HCC) cases

3 categories:

  • immune (thru vaccine or natural infxn)
  • acute infxn
  • chronic infxn (active or inactive)
A

Hep B

46
Q

1-6 mo incubation pd

70% are subclinical

30% develop icteric hepatitis
-severe transaminitits and elevated bilirubin

A

Acute Hep B

47
Q

HBcIgM (core IgM)

…means?

A

Acute Hep B infection

48
Q

Hepatitis B surface antigen (HBsAg) indicates…

A

ongoing infection of any duration

49
Q

Hepatitis B core antibody (anti-HBc) indicates…

A

Acute hepatitis

50
Q

MC bloodborne infection in US

test everyone born between 1945-1965

*RNA virus…1a, 1b, 2, 3, 4 are MC in US

A

Hep C

51
Q

Transmission:

IV drug use
tattoos
needlsticks
pre 1990-transfusions

A

Hep C

52
Q

Most pts asymptomatic

80% go on to chronic state

**high risk of developing cirrhosis and HCC*****

A

Hep C

53
Q

Acute Hep C tx

A

Supportive care

Avoid hepatotoxic drugs

54
Q

Viral load
Genotype
Tx hx
LFTs
Coags
ETOH/drug screen
HIV screen
Staging of liver for fibrosis/cirrhosis with fibroscan or bx

A

Factors that determine best tx option for HCV

55
Q

Direct antiviral agents (DAAs)

Sovaldi, Harvoni, Vikiera Pak, Olysio, Daklina

*100% cure rate

*tx 12-24 weeks

A

treatment for Hep C

56
Q

Is there a vaccination or immunoglobulin (for post exposure) for Hep C?

A

NO! must screen!!

57
Q

Suddent onset deterioration of hepatocyte function resulting in coagulopathy

Causes:
Tylenol (45%)
Alcohol/drugs
Viral

A

Acute hepatic failure

58
Q

+/- jaundice
Increased transaminases (AST/ALT)
Coagulopathy INR >1.5
Encephalopathy due to increased ammonia

*may reuqire emergent transplant

A

Acute hepatic failure

59
Q

Chronic end stage dz of liver marked by degeneration of cells from inflammation resulting in fibrous thickening of tissue

A

Cirrhosis

60
Q

There are 4 stages of fibrosis, last being…..

A

cirrhosis

61
Q

Dx:

abdominal U/S with doppler:
nodular appearing liver
+/- hepatosplenomegaly
assess portal vein
ascites

liver biopsy:
able to stage the fibrosis

A

Cirrhosis

62
Q

Early: weakness, fatigue, insomnia, muscle cramps, wt loss

Late: N/V, abdominal pain, spider angiomas, palmar erythema, portal HTN, HSM, dilated veins in abdomen, ascited, encephalopathy

A

Cirrhosis

63
Q

Varices occur when portal pressure exceeds..?

A

10 mmHg

64
Q
  1. Upper GI bleeds from esophageal varices
  2. Ascites
  3. Encephalopathy (due to increase ammonia)
  4. Splenomegaly
  5. Hepatorenal syndrome (poor prognosis)
A

Consequences of portal HTN

65
Q

Nonselective beta blockers
banding for varices
diuretics and paracentesis for ascites
lactulose and Xifaxan for enceph.

A

Management for portal HTN

66
Q

What is the cure for cirrhosis?

A

Liver transplant

67
Q

associated with cirrhosis

weight loss
painless jaundice
+/- palpable mass
hepatomegaly

6x more common in males

A

Hepatocellular carcinoma (HCC)

68
Q

Dx:

Triple phase CT or MRI
percutaneous bx of lesion
increased LFTs

A

Hepatocellular carcinoma (HCC)

69
Q

Alpha fetoprotein tumor marker is elevated with….

A

HCC!

..may also be elevated with chronic Hep C and cirrhosis

70
Q

MC neoplasm of liver

A

Metastatic liver cancer

from: lung, colon, breast, prostate, pancreas, stomach

71
Q

how much of the liver can you remove?

A

80%

albumin, synthetic ability regained by 3rd week

Clin Med- GI (8 decks)

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