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HSS 3305 > Lecture 17 > Flashcards

Lecture 17 Flashcards

1
Q

The Liver

A

Largest organ in body, right upper quadrant abdominal area, beneath the diaphragm, has a double blood supply

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2
Q

Function of the liver

A

Metabolism: Carbohydrates (glucose), protein, and fat delivered through the portal circulation
Synthesis: Plasma proteins (albumin), clotting factors, bile production
Storage: iron, vitamin B12 and other materials
Detoxification and catabolism: toxins (alcohol, drugs), hormones, ammonia (aa breakdown)
RBC/platelet maintenance and Immune surveillance (80% of Tissue Macrophages)

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3
Q

Portal vein

A

70% of blood, drains spleen and gastrointestinal tract, rich in nutrients absorbed from intestines, low in oxygen.

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4
Q

Hepatic artery

A

Rest of blood, high in oxygen, low in nutrients

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5
Q

What is the functional unit of the liver?

A

Liver lobule

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6
Q

Common types of liver injury

A

Viral infection, Fatty liver (metabolic syndrome or FLD), Toxins/ alcoholic liver disease or alcoholic hepatitis, and Leads to cirrhosis (scarring/fibrosis) of the liver and potential for cancer development

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7
Q

Manifestation of liver injuries

A

Cell necrosis or apoptosis, Fatty changes, and Mixed necrosis and fatty change

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8
Q

Diagnosis tests for viruses associated with hepatitis

A

Blood Tests - ALT (alanine aminotransferase) and AST (aspartate aminotransferase), Biliary tree - ALP (alkaline phosphatase) and GGT(gamma-glutamyl transferase) hepatocytes/biliary tree, ultrasounds (liver inflammation)

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9
Q

Hepatitis A (transmission and prevention)

A

RNA virus, Incubation period: 2 to 6 weeks, Excreted through nose, throat, stools (person-to-person or contamination)
Prevention/Treatment: Hepatitis A vaccine and Hepatitis A immune globulin: Given after exposure

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10
Q

Hepatitis B (transmission, Diagnosis, prevention/treatment)

A

ds DNAvirus, Incubation period: 6 weeks to 4 months, Transmission: Blood or body fluids (primarily sexual transmission)
Diagnosis: Antigen–antibody test results
Prevention/Treatment: Hepatitis B vaccine, Hepatitis B immune globulin: Given immediately after exposure, Antiviral drug treatment are also available (control/slow progression, not cure) – liver transplant

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11
Q

Hepatitis C

A

ssRNA virus - Incubation period: 3 to 12 weeks, Transmission: Blood and body fluids – primarily injection drug use, not as readily transmitted sexually, Diagnosis: Antigen–antibody test results, ultrasound or biopsy
Treatment: no vaccine, treated with antiviral drugs

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12
Q

Anti-HCV Ab

A

Indicates infection but does not confer immunity (only Anti-HBsAg in HepB indicates immunity)

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13
Q

Hepatitis D: Delta Hepatitis

A

Small, defective RNA virus and Only infects persons with acute or chronic hepatitis B virus (HBV) infection (uses HBsAg to produce virus coat), usually happens from sharing needles

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14
Q

Hepatitis E

A

RNA-containing virus, Transmission: Oral–fecal
and Contaminated water, No prevention of disease after exposure and no vaccine

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15
Q

Fatty Liver Disease + diagnosis

A

Caused by injury to liver that either: Increases fatty acid synthesis, Decreases oxidation of FA or impairs release of lipids from carrier proteins; Common in heavy drinkers and alcoholics and can be caused by drugs/chemicals and solvents (this is reversible if controlled)
FLD Diagnosis: Liver enzymes (AST/ALT), Ultrasound, CT/MRI, biopsy

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16
Q

Alcoholic Liver Disease

A

Refers to a group of structural and functional changes in the liver resulting from excessive alcohol consumption. Severity depends on amount and duration of alcohol consumption

17
Q

3 Stages of Alcoholic liver disease

A
  1. Alcoholic fatty liver: Mildest form – reversible
  2. Alcoholic hepatitis: Causes degenerative changes and necrosis of liver cells (inflammation – neutrophil infiltration)
  3. Alcoholic cirrhosis: Most advanced, progressive, diffuse scarring leading to disturbed liver function
18
Q

Mallory bodies

A

Irregularly shaped pink (cytokeratin filament) deposits in hepatocyte cytoplasm and are indicative of severe hepatic injury (irreparable)

19
Q

Cirrhosis

A

Diffuse scarring of the liver from any cause with derangement of liver function. Usually caused by Alcoholic liver disease, Chronic hepatitis, and Severe liver necrosis (sometimes liver injury (drugs), autoimmune disease, and long-standing bile obstruction). Outcomes include Liver failure, Portal hypertension, Ascites, collateral circulation formation

20
Q

Hepatic encephalopathy

A

Confusion, disorientation (decreased toxin clearance from blood – ammonia and bacterial breakdown products from gut)

21
Q

Portal hypertension causes…

A

Ascites – collection of fluid in abdomen

22
Q

Anastomoses

A

Circulatory bypass routes are formed to connect systemic-portal venous systems which cause blood to shunt away from high-pressure portal systems into low-pressure veins

23
Q

Treatment of Cirrhosis-portal hypertension

A

Drugs to reduce portal hypertension (octetride), Surgical procedures (Portal-systemic anastomoses to control varices) or Trans jugular intrahepatic portosystemic shunt (TIPS), liver transplants (5 year survival rate)

24
Q

Reye Syndrome

A

Caused from viral illness and use of Aspirin. Affects infants and children, Fatty liver with liver dysfunction, Cerebral edema with neurologic dysfunction, No specific treatment – mortality rate of 25%

25
Q

Bile

A

Aqueous solution with various dissolved substances that is secreted continually and stored in gallbladder to act as a biological detergent; Conjugated bilirubin

26
Q

Bile salts

A

A major constituent of bile; derivatives of cholesterol and amino acids; emulsify fat; function as detergents

27
Q

Substances present in bile

A

Lecithin (Lipid that also functions as a detergent), Cholesterol, Water, and Minerals

28
Q

Bilirubin

A

Bilirubin (non-iron portion of blood) is produced by the liver, from the breakdown of red blood cells in spleen and liver by resident macrophages through conjugation. It is eliminated in feces (stercobilin) and urine (urobilin)

29
Q

Jaundice

A

Yellow discoloration of skin and sclera from accumulation of bile pigment (bilirubin) in tissues and body fluids

30
Q

Hemolytic jaundice

A

Increased breakdown of red cells (prehepatic)

31
Q

Hepatocellular jaundice

A

Liver injury that impairs conjugation of bilirubin and downstream elimination (hepatic)

32
Q

Obstructive jaundice

A

Bile duct obstructed by tumor or stone that impairs delivery of bile into duodenum (post hepatic)

33
Q

Primary biliary cirrhosis

A

Slow and progressive autoimmune disease that attacks small intrahepatic bile ducts; has no specific treatment other than a liver transplant

34
Q

Secondary biliary cirrhosis

A

Obstruction of large extrahepatic bile ducts (Gallstone, carcinoma in pancreas, cancer from common bile duct) which causes increased pressure; Treatment includes Relieving or bypassing duct obstruction

35
Q

Cholelithiasis

A

Formation of stones in the gallbladder – excess cholesterol; estrogen can play a role therefore higher in women than men

36
Q

Factors influencing stone formation

A

Increased cholesterol in bile (obesity, high fat diet) and Decreased bile excretion (dieting)

37
Q

Cholangitis

A

Bile duct obstruction/inflammation

38
Q

Complications and Diagnosis of Cholelithiasis

A

Asymptomatic if remain in gall bladder, can cause Common duct obstruction (jaundice) and Cystic duct obstruction (no jaundice), and pancreatitis
Diagnosis: Elevated bilirubin, ALP, GGT elevated, Ultrasound, and CT

39
Q

Cholecystitis + treatment

A

Inflammation of gallbladder due to gallstone blockage
Treatment:
Antibiotics, analgesics, Removal of stone by endoscopy (Endoscopic Retrograde CholangioPancreatography -ERCP), Cholecystectomy (removal of gall bladder), and Chenodeoxycholic acid dissolves gallstones

HSS 3305 (21 decks)

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