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Emma GI > LFTs, Liver Diseases I/II > Flashcards

LFTs, Liver Diseases I/II Flashcards

1
Q

non-specific LFTs

A
  • low albumin

- high bilirubin

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2
Q

LFTs may be normal in

A

cirrhosis or metastatic cancer

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3
Q

-alkaline phosphatase
-5’-nucleotidase
bilirubin-severe

A

cholestatic

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4
Q
  • AST/ALT
  • protein synthesis
  • Ig
  • removal of ammonia- severe
  • clotting fx - severe
  • glucose homeostasis - severe
A

hepatocellular

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5
Q

measures of excretion and detoxification

A

bilirubin

NH3

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6
Q

dec serum ceruloplasmin

A

Wilson’s disease

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7
Q

inc UC bilirubin

A
  • hemolysis

- Gilbert’s syndrome

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8
Q

inc C bilirubin

A
  • Dublin-johnson

- hepatocyte injury

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9
Q

inc UC bilirubin via inc production

A
  • hemolysis
  • pernicious anemia
  • thalessmia
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10
Q

inc UC bilirubin via dec conjugation

A
  • Gilbert’s syndrome

- Crigler-Najjar syndrome

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11
Q

inc C and UC bilirubin via dec excretion

A

all types of liver disease

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12
Q

T/F serum NH3 is reliable for dc of hepatic encephalopathy or urea cycle disorders

A

F

2/3 Cl by striated m.
inc w/ tourniquets, poor circumstance
less sensitive for encephalopathy than exam

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13
Q

albumin is a better indicator of (acute/chronic) disease

A

chronic

half life of ~18 d

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14
Q

cytokines (TNF, IL-4) inhibit ____ synthesis

A

ALBUMIN

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15
Q

single best measure of hepatic synthetic fxn

A

factor VII (6 hr half life)

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16
Q

ALT

A

primarily in liver
inc w/ high BMI, lipids, glucose
M>F
CYTOPLASMIC

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17
Q

AST

A

less specific for liver injury

found in cardiac m//skeletal m./ kidneys/brain/pancreas/lungs/wbc

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18
Q

AST>ALT

A

alcoholic liver disease, hepatoma

AST=MITOCHONDRIAL, EtOH= mito toxin

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19
Q

Primary AST:ALT pattern with liver disease

A

ALT>AST

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20
Q

alcohol-induced deficiency of _____ leads to alcoholic liver disease

A

pyridoxal phosphate

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21
Q

differentiate alkaline phosphatase elevation by testing for

A

gamma-glutamyl transferase (GGT)

5’-nucleotidase

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22
Q

GGT

A

endoplasmic reticulum and bile duct cells

less specific

also elevated in pancreatic disease, MI, renal failure, COPD, DM, phenytoin

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23
Q

elevated GGT

A

cholestasis

alc liver disease

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24
Q

diffuse polyclonal IgG inc seen in

A

AI Hepatitis

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25
Q

AMA (antimitochondrial Ab)

A

primary biliary cholangitis

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26
Q

ASMA (Anti-smooth muscle Ab)

A

AI hepatitis

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27
Q

ANA (anti-nuclear Ab)

A

AI hepatits

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28
Q

alpha-fetoprotein

A

if inc w/ underlying cirrhosis, worry about hepatocellular CA

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29
Q

causes of low albumin

A

chronic liver disease
malnutrition
cytokines

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30
Q

alkaline phosphatase has isoenzymes in

A

liver
bone
placenta

31
Q

liver zone __ is most susceptible to hypoxia

A

zone 3

32
Q

The definition of acute liver failure is the onset of hepatic encephalopathy from severe liver injury which develops w/i ______ of the onset of sx (usually jaundice) in a person without pre-existing liver disease

A

8 weeks

33
Q

acute liver failure due to toxic/ischemic injury results in _______ necrosis

A

centrizonal necrosis

34
Q

acetaminophen OD, zone _ necrosis

A

3

where p450 enzymes are located

35
Q

AI hepatitis histo

A

plasma cells

interface hepatitis

36
Q

mixed LFTs (elevated alk phos and AST/ALT)

A

drug-induced hepatitis (augmentin)

37
Q

alcoholic hepatitis
(steatohepatitis)

histo

A
  • steatosis
  • ballooning degeneration (&Mallory’s hyaline)
  • inflammation
  • cholestasis
38
Q

progression from chronic alcohol abuse to hepatocellular carcinoma

A

EtOH–> steatosis –> fibrosis –> cirrhosis –> HCC

39
Q

metabolic causes of NAFLD/NASH

A

obesity
Diabetes/insulin resistance
HLD

40
Q

nutmeg liver

A

severe CHF

41
Q

hepatic circulatory disorders via outflow obstruction

A
  • Budd-Chiari syndrome
  • Sinusoidal obstructive syndrome (after bone marrow transplant)
  • passive congestion (constrictive pericarditis, CHF)
42
Q

hereditary hemochromatosis

MOA

A

usu homozygous C282Y/C282Y
(tyrosine for aspartate)

  • reduced HEPCIDIN –> uncontrolled SI Fe absorption
  • inc serum transferrin saturation
  • inc serum ferritin
43
Q

hereditary hemochromatosis

presentation

A

5-6th decade

classic triad: cirrhosis, diabetes, skin pigmentation

other organ dysfunction

  • cardiac
  • arthritis
  • hypOgonadism
  • others
44
Q

hereditary hemochromatosis

A
  • phlebotomy

- NO alc/vitC/multivitamins w/ minerals Fe

45
Q

Kayser Fleischer Ring

A

Wilson’s disease

46
Q

Wilson’s Disease

MOA, clinical features

A

AR
chrom 13 ATP7B gene (encodes Cu transporter)
^mut –> Cu accumulation

“hepatolenticular degeneration”
liver disease from late childhood onward
neuro disease by mid adulthood

47
Q

hepatolenticular degeneration

A

Wilson’s disease

48
Q

Wilson’s disease labs

A

dec serum ceruloplasmin
inc urinary Cu excretion
inc hepatic Cu

49
Q

Wilson’s tx

A
  • Cu chelation w/ penicillamine or Tridentine

- maintenance therapy w/ zinc

50
Q

primary biliary tract diseases

A

AI cholangiopathies

  • primary biliary cholangitis/cirrhosis
  • primary sclerosis cholangitis
51
Q

IBD (ulcerative colitis) associated biliary disorder

A

primary sclerosis cholangitis

52
Q

primary biliary cholangitis

MOA

A

florid duct lesion

  • granulomatous
  • non-suppurative”
  • chronic inflamm of INTRAhepatic bile ducts
  • middle aged women
  • insidious onset
  • progressive liver disease
53
Q

primary biliary cholangitis labs

A

inc alk phos
inc bilirubin
inc HDL
anti-mitochondrial Abs

54
Q

granumolatous hepatitis

A

PBC

  • mycobacteria, other bacteria, systemic mycosis, parasites
  • noninfectious (sarcoid, drugs, foreign material)
55
Q

primary biliary cholangitis

sx

A

ITCHING
osteoporosis (vitamin D malanbsorp)
sick syndrome -dry eyes, mouth

56
Q

UC plus cholestatic labs

A

primary sclerosis cholangitis

57
Q

primary sclerosis cholangitis

histo

A

concentric periductal fibrosis (onion-skin)

58
Q

primary sclerosis cholangitis

MOA

A

inflammatory fibrosis, involving both intra and extra hepatic bile ducts

strictures in biliary tree, beading

middle aged males

assoc w/ UC

59
Q

primary sclerosing cholangitis is a risk fx for which malignancies

A

bile duct (cholangiocarcinoma), GB and colon cancers

60
Q

PSC tx

A

no proven therapy

support/surveillance

61
Q

Sjogren syndrome is associated with 70% of cases of which biliary disorder?

A

primary biliary cholangitis

62
Q

strictures and beading of large bile ducts

A

primary sclerosis cholangitis

63
Q

hepatocellular masses

benign, non-neoplastic

A

nodular hyperplasias

  • FNH (focal nodular hyperplasia)
  • NRH (nodular regenerative hyperplasia)
64
Q

hepatocellular masses

benign, neoplastic

A

hepatocellular adenoma

65
Q

hepatocellular masses

malignant

A

hepatocellular carcinoma

hepatoblastoma

66
Q

biliary masses

benign

A

bile duct hamartoma

bile duct adenoma

67
Q

biliary masses

malignant

A

choliangiocarcinoma

68
Q

metastatic tumors of the liver

A

vascular (hemangioma, angiosarcoma)
hematopoietic tumors (lymphoma, leukemia)
misc mesenchymal tumors (angiomyolipoma, embryonal sarcoma, others)

69
Q

hepatocellular adenoma

A
  • benign neoplasm of hepatocytes
  • non-cirrhotic liver
  • young women, OCPs (men, anabolic steroids)
  • may rupture, bleed
  • rare malignant transformation (beta-catenin mutation)
70
Q

focal nodular hyperplasia

A

-hyperplastic tumor-like growth of hepatocytes (not a true neoplasm)

nodular regenerative response to localized vascular perfusion abnormalities

central stellate scar

non-cirrhotic liver

young/middle aged adults (F>M)

71
Q

cirrhosis

common hepatic mass lesion

A

hepatocellular carcinoma

72
Q

non-cirrhotic, <50 y/o

common hepatic mass lesion

A 
hepatocellular adenoma
FNH
HCC
other primary liver tumors
metastases
73
Q

non-cirrhotic, >50 y/o

common hepatic mass lesion

A

METS

Emma GI (18 decks)

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