Lecture 7.2 Highlights Flashcards
* = also MJ slide
Chronic liver failure: Hepatorenal syndrome
1) Systemic vasodilation → decreased systemic vascular resistance, which causes _______________ to decrease
2) What does this cause?
(side note: if you see an out of place * on any of these slides, it’s also an MJ/ mick jagger slide, so extra important)
1) renal perfusion ↓
2) → ↓UOP & ↑BUN/Cr
Acute liver failure: Hepatic Encephalopathy
1) Has a range of neuro symptoms, often see ___________
2) Also see ↑ _____________ levels
1) asterixis
2) ammonia
*Define net effect
Accumulation of intracellular lipids
*Alcoholic hepatitis (10-35%):
1) Acetaldehyde (metabolite of ETOH) disrupts _____________ and _____________ function.
2) ETOH affects what two things?
3) What damages membranes and proteins in this condition?
1) cytoskeleton and membrane function
2) Mitochondrial function and membrane fluidity
3) ROS, generated during oxidation of ETOH
NAFLD may show all the changes associated with alcoholic liver disease; list 3
*Nonalcoholic Fatty Liver Disease
1) Steatosis
2) Nonalcoholic steatohepatitis (NASH)
3) Cirrhosis
Drug & Toxin-Induced Liver Injury: What are the 2 types? Give examples of each
1) Predictable (intrinsic): Acetaminophen
2) Unpredictable (idiosyncratic): Chlorpromazine + Halothane
Acetaminophen is a classic example of what type of liver injury?
“definitely know”
Predictable (intrinsic)
Hemochromatosis causes Hepatic Injury (after 20 g of stored Fe accumulated) through what 3 mechanisms?
1) Lipid peroxidation
2) Collagen formation after activation of stellate cells
3) DNA damage by ROS
*Wilson Disease pathogenesis:
1) What is the inheritance pattern?
2) What decreases? What is there a failure of?
3) What is there a secondary accumulation of as a result?
1) Autosomal recessive mutation in ARP7B gene
2) ↓ copper excretion into the bile and failure to incorporate copper into ceruloplasmin
3) Toxic levels of copper in tissues and organs
-
Wilson disease clinical manifestations:
1) What organ takes the brunt of it? What are the 2 ways it can present?
2) What causes the potential Neuropsychiatric complications?
3) What is a common Sx?
1) Liver takes the brunt, may present as acute or chronic liver disease
2) Copper in basal ganglia
3) Kayser Fleischer rings
*α1-Anti-Trypsin Disease causes liver injury because of what?
“should know”
Hepatocellular build up of misfolded α1AT
Hepatic bile serves 2 functions, which are what?
1) Emulsification of intra-luminal fat via detergent action of bile salts
2) Elimination of bilirubin, cholesterol, xenobiotics, and other waste not removed from urine
There are 3 ways to disturb the equilibrium between bilirubin production and clearance.
List them and give an example of each.
1) Increased bilirubin production (e.g. extravascular hemolysis)
2) Hepatocyte dysfunction (e.g. hepatitis)
3) Obstruction of bile (e.g. impacted gallstone)
Predominately unconjugated hyperbilirubinemia:
1) What is a Sx of excess production of bilirubin?
2) What are at least 2 conditions of impaired bilirubin conjugation?
1) Hemolytic anemias
2) Physiologic jaundice of the newborn
-Diffuse hepatocellular disease (ex: viral/ drug induced hepatitis, cirrhosis, etc)
Predominately conjugated hyperbilirubinemia: List 2 causes
1) Decreased hepatocellular excretion
2) Impaired intra/extraheptic bile flow
Predominately conjugated hyperbilirubinemia:
Give 3 examples of causes of Impaired intra/extrahepatic bile flow
1) Primary biliary cirrhosis
2) Primary sclerosing cholangitis
3) Gallstones
What are the causes of cholestasis? List the 2 types and the subtypes
1) Obstruction of bile channels
a) Intrahepatic or extrahepatic
b) Inflammatory or mechanical
2) Defects in hepatocyte bile excretion
What would be the lab findings in Cholestasis? (hint: 2 things increase)
↑ alk phos & ↑ GGT
(enzymes present in membranes of hepatocytes and cholangiocytes; they help make bile)
List 2 kinds of Autoimmune Cholangiopathies
1) Primary Biliary Cholangitis
2) Primary Sclerosing Cholangitis
Non-spurrative, inflammatory destruction of ________________ intrahepatic bile ducts occurs in Primary Biliary Cholangitis
small & medium-sized
Cirrhosis Causes: What is the mnemonic to remember these? What are they?
VW’s Happen
Virus (hepatitis)
Wilson’s
Hemochromatosis
Alpha-1
PSC
PBC
Etoh
NASH
What is the main reason to have your gallbladder removed?
Acute Calculous Cholecystitis (most common)
In what circulatory disorder of the liver is there no direct damage to liver cells, so no aminotransferases?
Intestinal congestion
Hepatocellular Adenoma (Benign):
1) What does it develop from?
2) What is a key aspect of the presentation?
1) Hepatocytes
2) Pain
One cause of Hepatocellular Carcinoma (Malignant) (but not the main cause) is ________________; 90% develop in ___________ livers
Alcoholic Cirrhosis; cirrhotic
What is the most common cause of Hepatocellular Carcinoma (Malignant)?
Chronic liver disease
Cholangiosarcoma (Malignant) is a tumor involving intrahepatic or extrahepatic ______________
bile ducts
1) Chronic inflammation & cholestasis are a risk factor for what malignant condition?
2) Give examples of chronic inflammations & cholestasis
1) Cholangiosarcoma (Malignant)
2) Primary sclerosing cholangitis
Hepatolithiasis
Fibropolycystic liver disease
Hep B & C
NAFLD
Advanced age (>40), female, pregnancy, and obesity are are all risk factors for what condition that involves crystallization?
Cholesterol stones
Acute Calculous Cholecystitis (most common) can be caused initially from chemical irritation and inflammation from __________________.
obstructed bile outflow
List 4 important S/ Sx of Acute Calculous Cholecystitis
1) Biliary pain >6 hours
2) Leukocytosis
3) RUQ pain
4) US: gallstones
Acute Calculous Cholecystitis could be complicated by a bacterial superinfection, leading to ____________ or ______________
cholangitis or sepsis
Acute Calculous Cholecystitis is the most common reason for a ___________________
cholecystectomy
*Things to remember: Cholangitis
(not actually highlighted, but emphasized in class)
1) Charcot’s Triad
-RUQ pain
Jaundice
Fever
2) Reynold’s Pentad (even worse)
-Hypotension
AMS
*1) What is Charcot’s Triad?
2) What is it indicative of?
(not actually highlighted, but emphasized in class)
1) RUQ pain
Jaundice
Fever
2) Cholangitis
1) What is the most important risk factor carcinoma of the gallbladder?
2) What is it likely secondary to?
1) Gallstones
2) Inflammation
True or false: acute pancreatitis is an emergency
True
Full blown acute pancreatitis is the result of what?
Systemic release of pancreatic enzymes and ↑↑↑ inflammatory response
*Infiltrating ductal carcinoma is also called what?
“Pancreatic cancer”
*What are typically silent until their extension impinges on some other structure?
Pancreatic carcinomas
