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Pathophysiology 1 > Jan 29 - Liver Disease: Hepatitis > Flashcards

Jan 29 - Liver Disease: Hepatitis Flashcards

1
Q

What is the difference between the blood supply to the liver and the other organs?

A

The liver has two sources where it receives blood: the hepatic artery and the hepatic portal vein. The hepatic artery delivers oxygenated blood from the general circulation. The hepatic portal vein delivers deoxygenated blood from the small intestine containing nutrients (75% of blood flowing through the liver arrives via the hepatic portal vein)

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2
Q

Describe the blood flow through the liver

A

Blood flows through the liver tissue to the hepatic cells where many metabolic functions take place. The blood drains out of the liver via the hepatic vein. The liver tissue is not vascularized with a capillary network as most other organs; however it consists of blood filled sinusoids surrounding the hepatic cells

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3
Q

What does the liver manufacture?

A

Albumin, bile, urea and blood proteins

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4
Q

What is albumin?

A

A protein that regulates the fluid balance in our body’s blood clotting factors

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5
Q

What is bile?

A

It is used for digestion

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6
Q

How is urea produced?

A

Deamination of amino acids and conversion of ammonia to urea via the urea cycle

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7
Q

What is the role of blood proteins?

A

They aid in clotting, oxygen transport and immune system function

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8
Q

What does the liver transform?

A

Bilirubin, cholesterol, carbohydrates, saturated fats

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9
Q

What is bilirubin?

A

A pigment released when red blood cells die and becomes a water-soluble substance excreted in the bile

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10
Q

What does the liver do with cholesterol and fatty acids??

A

It synthesizes cholesterol from acetate, it synthesizes triglycerides from fatty acids. It secretes both in VLDL particles. It takes up cholesterol and triglycerides via endocytosis of HDL and LDL particles, then it excretes cholesterol in bile, beta-oxidizes fatty acids and converts excess acetyl-CoA into ketones

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11
Q

What does the liver do to carbohydrates?

A

The liver converts sugars into glucose (via gluconeogenesis and glycogenolysis)
It also used glucose for glycogen synthesis, fatty acid synthesis, glycolysis and the tricarboxylic acid cycle

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12
Q

What does liver clean and detoxify?

A

Bacteria, ammonia, alcohol, both prescription and over the counter drugs, other toxins

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13
Q

What does the liver store?

A

Glycogen, for energy
Iron
Other vitamins

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14
Q

What are the five functions of the liver?

A 
Energy metabolism and substate interconversion
Protein synthesis (clotting factors)
Solubilization, transport and storage
Detoxification and clearance
Bile production
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15
Q

Why does hypoglycemia occur?

A

Hypoglycemia occurs primarily due to a decrease in “functional hepatocyte mass” (ability to produce and release stored glucose is impaired)

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16
Q

Why does hyperglycemia occur?

A

Hyperglycemia can occur due to portal-systemic shunt

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17
Q

What are clinical consequences of liver disease?

A

Hepatocyte dysfunction - manifests as failure of one or more of the main liver functions
Portal hypertension - cirrhosis is often a primary cause, but can also be caused by portal-systemic shunt

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18
Q

What are tests of liver injury?

A 
Aspartate aminotransferase (AST) - indicates hepatocyte death
Alanine aminotransferase (ALT) - indicates liver injury
Alkaline phosphatase (ALP) - this is also found in the bone, intestine and placenta, which is why GGT is required
Gamma glutamyl transpeptidase (GGT) + ALT = liver or biliary tract disease
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19
Q

What are tests of liver function?

A 
Bilirubin
-direct bilirubin (conjugated)
-total bilirubin (unconjugated)
Albumin
Prothrombin time (international normal ratio - INR)
20
Q

What is the leading cause of liver transplants?

A

Hepatitis C virus

21
Q

How is Hepatitis A virus spread?

A

Oral fecal transmission

22
Q

How is Hepatitis B virus spread?

A

Spread through blood or body fluids

23
Q

What is hepatocellular disease?

A

Injury to hepatocytes, leading to decrease synthetic/metabolic functions (AST/ALT)

24
Q

What is cholestatsis?

A

Impaired bile formation (hepatocytes)

Impaired bile flow (bile ducts)

25
Q

What is liver disease? What are the causes? What are the consequences?

A

Non-alcoholic fatty liver disease (NAFLD)
NAFLD + inflammation + fibrosis = Non-alcoholic steatohepatitis (NASH)
Some individuals eventually leads to fibrosis and subsequent cirrhosis
75% of obese individuals are at risk of developing simple fatty liver
First stage in alcoholic liver disease

26
Q

What are the causes of hepatitis?

A

Immune cells in the body attacking the liver and causing autoimmune hepatitis
Infections from viruses (Hep A, B or C), bacteria or parasites
Liver damage from alcohol, poisonous mushrooms or other poisons
Medications, such as an overdose of acetaminophen which can be deadly

27
Q

What is hepatitis?

A

Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ

28
Q

What is the most common symptom of hepatitis?

A

Hepatitis may occur with limited or no symptoms, but often leads to yellow discoloration of the skin, mucus membranes and conjunctivae (whites of the eyes), poor appetite and malaise (tiredness)

29
Q

What is the difference between acute and chronic hepatitis? How does the condition progress?

A

Hepatitis is acute when it lasts less than six months and chronic when it persists longer. The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis

30
Q

What are the types of of hepatitis?

A 
Viral hepatitis
Alcoholic hepatitis
Toxic and drug-induced hepatitis
Autoimmune
Non-alcoholic fatty liver disease (NAFLD)
Ischemic hepatitis
Giant cell hepatitis
31
Q

Describe viral hepatitis

A

The most common cause of viral hepatitis are five unrelated hepatotropic viruses hepatitis A, hepatitis B, hepatitis C, hepatitis D (which requires hep B to cause disease) and hepatitis E

32
Q

Describe alcoholic hepatitis

A

Excessive alcohol consumption is a significant cause of hepatitis and liver damage (cirrhosis). Alcoholic hepatitis usually develops over years-long exposure to alcohol

33
Q

Describe toxic and drug-induced hepatitis

A

A large number of medications and other chemical agents can cause hepatitis. In the United States, acetaminophen, antibiotics and central nervous system medications are among the most common causes of drug-induced hepatitis

34
Q

Describe autoimmune hepatitis

A

A chronic disease caused by an abnormal immune response against liver cells

35
Q

Describe NAFLD

A

The occurrence of fatty liver in people who have little or no history of alcohol use. In the early stage there are usually no symptoms, as the disease progresses symptoms typical of chronic hepatitis may develop. NAFLD is associated with metabolic syndrome, obesity, diabetes and hyperlipidemia. Severe NAFLD leads to inflammation, fibrosis and cirrhosis, a state referred to as non-alcoholic steatohepatitis (NASH)

36
Q

What are symptoms of hepatits

A

Abdominal pain or distension, breast development in males, dark urine and pale or clay-coloured stools, fatigue, fever (usually low grade), general itching, jaundice (yellowing of the skin or eyes), loss of appetite, nausea and vomiting, weight loss

37
Q

Describe HAV

A

Small RNA virus, spread via fecal-oral transmission

Recovery results in immunity

38
Q

Describe HBV

A

Mostly asymptomatic or mild symptoms
Body fluid and sexual transmission
Hepatocyte death via immune response to infection

39
Q

Describe HCV

A

Body fluid and sexual transmission

Mostly asymptomatic or mild symptoms

40
Q

Describe the pathogenesis of acute hepatitis

A 
Hepatocyte infection
Viral replication
Viral components illicit immune response (inflammation, hepatocyte death)
Changes in LFT's appear
Manifestations of liver disease
41
Q

Describe the prodrome of acute hepatitis

A 
Early sypmtoms
Last 3-4 days
Nonspecific signs and symptoms
GI symptoms
Extrahepatic symptoms
42
Q

Describe the icteric phase

A

Actual phase of illness

Last 1-4 weeks

43
Q

Describe the convalescent phase

A

Gradual recovery phase

Constitutional signs and symptoms resolve

44
Q

Describe acute toxic hepatitis

A

Most cases of drug-induced liver disease present as acute hepatitis, some as cholestasis.
Toxicity may be predictable and dose related or unpredictable and not dose related (idiosyncratic)
Acetaminophen overdose is the leading cause of fulminant hepatitis in the US and the UK
Some drug regimens may warrant monitoring of LFTs (thiazolidinedions, statins)

45
Q

Describe acute alcoholic hepatitis

A

Ethanol has direct and indirect hepatotoxic effects
Ethanol increases the fluidity of cellular membranes
Byproducts of its metabolism (NADH) inhibit gluconeogenesis and fatty acid oxidation
Fatty acid synthesis is promoted
Toxicity is unpredictable and the “dose” required to produce acute toxicity is variable

Pathophysiology 1 (11 decks)

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