Liver 1 Flashcards
In the classic hexagonal concept of the liver, what represents the center?
Central vein, surrounding is the portal triads
True or false, most liver diseases affect each lobule so even a small biopsy can tell you what is happening in the entire liver?
TRUE
What are the forms of intrahepatic biliary disease?
- primary biliary cirrhosis
- primary sclerosing cholangitis
What systemic viral infections cause hepatitis? [4]
CMV, EBV, HSV, Adenovirus
How high are the transaminases in acute liver damage? What can severe cases lead to?
- > 1000
- fulminant hepatic necrosis
What are the steps to cirrhosis in chronic diseases?
inflammation–> necrosis–> fibrosis
What is the most common cause of acute/fulminant hepatic necrosis in the US population?
acetaminophen
Does hepatitis A B or C have an acute/fulminant symptoms?
A and B and (sometime/rarely) C
Remember that A does not form chronic disease, but B and C do
Being itchy all over can be a sign of liver disease, but severe itchiness is very characteristic of what liver disease?
Primary biliary cirrhosis
With jaundice, what other color changes can we see (3)?
yellow mucous membranes, pale stool, dark urine
hemolysis and genetic problems with conjugation lead to what type of elevated bilirubin?
Unconjugated bilirubin
What leads to elevated levels of both unconjugated and conjugated bilirubin?
Liver damage- cirrhosis and hepatocellular carcinoma
Elevated outflow obstruction of bile leads to what type of elevated bilirubin?
conjugated bilirubin
What is the main thing the liver detoxifies?
ammonia from breakdown of protein in ingested food or blood
so elevated ammonia means the liver is failing
What are the two main biliary enzymes?
alk phos
GGT (gamma glutamyl transpeptidase)
When are alk phos or GGT elevated?
PBC
PSC
Adverse drugs
Obstruction of biliary tree
ALT and AST elevation occurs because of what basic thing in hepatocytes?
necrosis-(death and damage)
Review other important tests to measure besides ALT, AST, ALK phos, and GGT
Viral serologies Autoimmune serologies Glucose, HgbA1c, lipids iron ceruloplasmin alpha1-antitrypsin
What biliary disease is related to AMA serology?
PBC
What biliary disease is UC anca associated with?
primary sclerosing cholangitis
What are the signs of acute disease with viral A, B or the occasional C?
malaise, fatigue, jaundice
>1000 transaminases
- lasts several weeks
What percentage of HBV goes on to chronic viral hepatitis?
less than 10%
What percentage of HCV goes on to chronic viral hepatitis?
75%
Is HBV or HCV often transmitted with sexual contact? what about vertical transmission?
- HBV
2. HBV- very common in underprivileged countries
IS HCV and HBV fecal oral like hep A?
No- mostly parenteral
Is there a vaccine for hep C?
no
Is Hep C or Hep B more of a problem in US?
HEp C,
Hep B is a huge global problem
What is the histological hallmark for Hep C? Hep B?
- rounded portal lymphoid aggregates
2. Ground glass hepatocytes
A high degree of numerous plasma cells and activity is strongly suggestive of?
Autoimmune hepatitis
What sex predominates autoimmune hepatitis?
female 70-75%
True or false- we see hypergammaglobulinemia in autoimmune hepatitis ?
True
Is ANA or ASMA more specific in autoimmune hepatitis?
ASMA
T-F- Hep A histology often mimics autoimmune hepatitis?
True- plasma cells prominent
True or false- hep A screen is only positive if IgG is present?
False- IgM
Why is an adverse drug reaction not found on our huge algorithm chart?
can mimic virtually anything, a mixed picture that doesn’t fit with anything can often clue that a drug reaction is causing the damage
How do we recognize an adverse drug reaction?
temporal relationship
- when was the drug started
- when was the jaundice or abnormal test noted
when does acetaminophen toxicity occur?
hours to a few days. other idiosyncratic reactions can typically take 2 to 10 weeks (75% are less than 4 months)
T-F– herbal reactions can account for liver injury?
True- so if they say no medications but started a new herb etc.
Pay Attention!!
