Lecture 17: Hepatitis Flashcards
How does the liver get blood?
Portal Vein*
Hepatic Artery
True or False: The liver stores minerals and Vit B12 and detoxifies Bilirubin, Ammonia, Drugs, and Bacteria
True
What is the role of Kupffer cells in the liver?
Removes bacteria
True or False: The liver is important for synthesis of plasma proteins (albumin), clotting factors, bile salts, and hematopoesis
True
Sex hormones, cortisol/aldosterone, fat, and protein are metabolized by the ___
liver
Which part of the liver has blood flow differences? Which has the richest blood flow vs. limited?
Acinus
- Zone 1 = richest
- Zone 3 = limited ; more sensitive to injury
Fat containing stellate cells of the liver can be converted to ____, contributing to sclerosis
Macrophages
Hepatocellular carcinoma, NAFLD, alcoholic liver disease, and viral hepatitis are examples of….
A. Secondary Liver Disease
B. Major Primary Disease
B. Major Primary Disease
Cardiac decompensation, disseminated cancer, and extrahepatic infections are examples of…
A. Secondary Liver Disease
B. Major Primary Disease
A. Secondary Liver Disease
___ is the most severe clinical result of liver disease
Hepatic Failure
What are four signs/symptoms of acute liver failure?
- Nausea, vomit
- Jaundice
- Coag defects
- Liver enlarges, then shrinks
Elevated bilirubin leads to ___
jaundice
Patients with liver failure can have hypoalbuminemia due to impaired albumin production, which can cause….
- Peripheral Edema
- Ascites
Hyperammonemia is a clinical manifestation of liver failure and can result in…
- Confusion
- Rigidity
- Hepatic encephalopathy
- CNS Dysfunction
- Flapping tremor
- Hyper-reflexia
Palmar erythema, spider angiomas of skin, and hypogonadism/gynecomastia are clinical manifestations of…
Liver failure
Why can fector hepaticus develop during liver failure?
Mercaptans form due to GI bacteria
- Accompanied by shunting of portal blood to systemic circulation
- Goes directly to lungs
What can contribute to development of cirrhosis/liver scarring?
- ETOH abuse
- Viral Hepatitis
- Non-alcoholic steatohepatitis
- Bil disease/iron overload
True or False: Liver cirrhosis is associated with hepatocyte death, deposition of ECM, and vascular reoragnization
True
What are the three major consequences of liver cirrhosis?
- Collagen deposits in Space of Disse
- Blood shunted
- Impaired sinusoidal fxtion
Fibrosis is associated with increased vascular resistance within the level, as well as proliferation of ____ cells and their transition into fibrinogenic cells and fibroblasts (secrete collagen)
stellate
A patient has anorexia, weight loss, and ascites. What does he most likely have?
A. Liver failure
B. Portal Hypertension
C. Cirrhosis
C. Cirrhosis
True or False: Portal HTN is associated with increased resistance to portal blood flow
True
A patient with splenomegaly, narrowing of portal vein, or obstructive thrombosis has which kind of portal hypertension?
A. Post-Hepatic
B. Pre-Hepatic
C. Intra-Hepatic
B. Pre-Hepatic
Obstruction of hepatic v outflow, as well as pericarditis, and right sided heart failure is associated with which type of portal hypertension?
A. Post-Hepatic
B. Pre-Hepatic
C. Intra-Hepatic
A. Post-Hepatic
Clinical manifestations of portal hypertension?
- Ascites
- Portosystemic shunt
- Splenomegaly
- Testicular atrophy/infertile
What’s the difference between unconjugated and conjugated bilirubin?
Conjugated Bilirubin is non-toxic and excreted in the urine
Non-conjugated bilirubin is toxic, insoluble in water, and can diffuse into tissues
Pro-thrombin time, serum ammonia, galactose elimination test, and aminopyrine breath test can test for..
A. Hepatocyte Function
B. Biliary Excretory Function
A. Hepatocyte Function
Total, direct, and delta bilirubin levels are used to test for….
A. Hepatocyte Function
B. Biliary Excretory Function
B. Biliary Excretory Function
What are these serological markers of Hep B?
HBsAg
Anti-HBs
Anti-HBc
IgM anti-HBc
HBsAg: hep B surface antigen
Anti-HBs: hep b surface antibody
Anti-HBc: total hep b core antibody
IgM anti-HBc: IgM antibody to hep B core antigen
True or False: HBeAg and HBV-DNA specify active viral replication
True
True or False: In acute and chronic hepatic infection, anti-HB’s don’t rise until acute infection is on the wane; render protection for life
True
What are the routes of transmission for Hepatitis?
- IV drug use
- intercourse
- cuts, scrapes
How is an acute infection of hep different from chronic, seriologically?
Acute Hep B Infection
- IgM (+)
- Anti hep B surface ab (-)
Chronic Hep B Infection
- IgM (-)
- Anti hep B surface ab (-)
- Both have positive hepatic B surface antigens and total hep B core antibody
What does it mean if total antibody level is elevated, but IgM fraction is negative
Chronic infection of Hep B
