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Facts > Liver > Flashcards

Liver Flashcards

1
Q

Cirrhosis histo

A

diffuse bridging fibrosis (via stellate cells) and regenerative nodules

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2
Q

Cirrhosis Etiologies include

A 
1 alcohol (60–70% of cases in the US), 
2 nonalcoholic steatohepatitis, 
3 chronic viral hepatitis, 
4 autoimmune hepatitis, 
5 biliary disease, 
6 genetic/metabolic disorders.
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3
Q

Portal hypertension 3 Etiologies

A 
1 cirrhosis (most common cause in Western countries), 
2 vascular obstruction (eg, portal vein thrombosis, Budd- Chiari syndrome), 
3 schistosomiasis.
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4
Q

Cirrhosis 4 sxs Integumentary

A

Jaundice
Spider angiomas
Palmar erythema
Purpura Petechiae

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5
Q

Cirrhosis 2 sxs Neurologic

A
  1. Hepatic encephalopathy

2. Asterixis (”flapping tremor”)

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6
Q

Cirrhosis 5 sxs GI

A 
Anorexia
Nausea, 
vomiting 
Dull abdominal pain 
Fetor hepaticus
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7
Q

Fetor hepaticus

A

breath has a strong, musty smell. It’s a sign that your liver is having trouble doing its job of filtering out toxic substances, usually due to severe liver disease. As a result, sulfur substances end up in your bloodstream and can make their way to your lungs.

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8
Q

Cirrhosis 3 sxs Hematologic

A

Thrombocytopenia
Anemia
Coagulation disorders

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9
Q

Metabolic Cirrhosis 2 sxs

A

Hyperbilirubinemia

Hyponatremia

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10
Q

Cardiovascular Cirrhosis 2 sxs

A

Cardiomyopathy

Peripheral edema

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11
Q

Reproductive Cirrhosis sxs. in men v women

A

Testicular atrophy
Gynecomastia
Amenorrhea

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12
Q

Cirrhosis swelling 4 sxs

A

Splenomegaly
Caput medusae
Ascites
Anorectal varices

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13
Q

2 bleeding Effects of Portal HTN

A

Esophageal varices = hematemesis

Gastric varices = melena

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14
Q

AST > ALT in nonalcoholic liver disease suggests progression to

A

advanced fibrosis or cirrhosis

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15
Q

Alkaline phosphatase v GGT

A

both incr in biliary obstruction

Alk phos only incr. in bone dz.

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16
Q

Alkaline phosphatase or GGT assoc. w/ ETOH use?

A

GGT

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17
Q

Bilirubin incr in which 3 liver diseases

A

biliary obstruction, alcoholic or viral hepatitis, cirrhosis

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18
Q

Why plts. decr. in liver dz.?

A

decr. thrombopoietin, liver sequestration

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19
Q

portal hypertension-why plts decr?

A

portal hypertension (splenomegaly/splenic sequestration)

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20
Q

fatal childhood hepatic encephalopathy

A

Reye syndrome

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21
Q

Reye syndrome 4 symptoms?

A

hypoglycemia,
vomiting,
hepatomegaly,
coma

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22
Q

Reye syndrome occurs with which 2 viral infections?

A

Associated with viral infection (especially VZV and influenza B) that has been treated with aspirin

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23
Q

Avoid aspirin in children, except in those with

A

Kawasaki disease.

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24
Q

Reye syndrome MOA

A

inhibition of mitochondrial enzymes

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25
Q

Hepatic steatosis from ETOH path changes?

A

Macrovesicular fatty change

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26
Q

Mallory bodies

A

Alcoholic hepatitis

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27
Q

Alcoholic hepatitis change to hepatocytes

A

Swollen and necrotic hepatocytes with neutrophilic infiltration.

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28
Q

Is any cirrhosis reversible?

A

No

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29
Q

Sxs.

of chronic liver disease

A

jaundice, hypoalbuminemia).

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30
Q

Non-alcoholic fatty liver disease can lead to

A

cirrhosis and HCC

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31
Q

Hepatic encephalopathy with cirrhosis due to decreased metabolism of?

A

NH3=Ammonia

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32
Q

Tx. of hepatic enceph.?

A

lactulose–incr. NH4=Ammonium production

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33
Q

Hepatocellular carcinoma associated with which virus?

A

Hep B virus

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34
Q

7 Causes of Cirrhosis?

A
  1. HBV
  2. HCV,
  3. alcoholic and
  4. non-alcoholic fatty liver disease,
  5. autoimmune disease,
  6. hemochromatosis,
  7. α1-antitrypsin deficiency
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35
Q

Carcinogen causes HCC

A

aflatoxin

from Aspergillus

36
Q

Cause of Budd-Chiari

syndrome.

A

HCC

37
Q

5 HCC Sxs.

A
  1. jaundice,
  2. tender hepatomegaly,
  3. ascites,
  4. polycythemia,
  5. anorexia.
38
Q

Diagnosis: HCC

A
  1. α-fetoprotein;
  2. ultrasound or contrast CT/MRI B ,
  3. biopsy
39
Q

Cavernous hemangioma is a

A

benign liver tumor

40
Q

Contraindicated in Cavernous hemangioma why?

A

because of risk of hemorrhage.

41
Q

Benign liver tumor, often related to oral contraceptive or anabolic steroid use

A

Hepatic adenoma

42
Q

Hepatic adenoma due to what in men v women?

A

Women-OCP

Men-Steroid

43
Q

Malignant Liver tumor of endothelial origin

A

Angiosarcoma

44
Q

Angiosarcoma due to exposure to what 3 ?

A

exposure to arsenic, vinyl chloride.

45
Q

Budd-Chiari syndrome sxs

A

congestive liver disease (hepatomegaly, ascites, varices, abdominal pain, liver failure

46
Q

Budd-Chiari syndrome associated with what 4 situations/dzs.?

A

hypercoagulable states,
polycythemia vera,
postpartum state,
HCC

47
Q

nutmeg liver (mottled appearance

A

Budd-Chiari

48
Q

cirrhosis with

PAS ⊕ globules A in liver

A

alpha1-antitrypsin deficiency

49
Q

Emphysemia in alpha1-antitrypsin deficiency due to?

A

In lungs, decreased α1-antitrypsin->uninhibited elastase in alveoli, decreased elastic tissue–>panacinar emphysema.

50
Q

Unconjugated (indirect) hyperbilirubinemia

A
  1. Hemolytic, physiologic (newborns),
  2. Crigler-Najjar,
  3. Gilbert syndrome.
51
Q

Conjugated (direct) hyperbilirubinemia due to what kind of dzs.?

A
  1. Biliary tract obstruction
  2. Biliary tract disease
  3. Excretion defect
52
Q

Biliary tract obstruction–5 types

A

gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke.

53
Q

Mixed (direct

and indirect) hyperbilirubinemia in what 2 conditions

A

Hepatitis, cirrhosis.

54
Q

Physiologic neonatal jaundice resolves when?

A

resolves without treatment in 1–2 weeks.

55
Q

At birth, immature UDP-glucuronosyltransferase

A

Physiologic neonatal jaundice

56
Q

Conjugated hyperbilirubinemia due to defective liver excretion 2 dzs

A

Dubin-Johnson syndrome

Rotor syndrome

57
Q

black liver

A

Dubin-Johnson syndrome

58
Q

Mutations in hepatocyte copper-transporting ATPase

A

Wilson disease

59
Q

Wilson disease other name

A

hepatolenticular degeneration)

60
Q

decr. serum ceruloplasmin, incr. urine copper

A

Wilson disease

61
Q

Kayser-Fleischer rings

A

Wilson disease

62
Q

Wilson Dz. 6 sxs.

A

=Liver, Brain, Eyes, Kidneys, Heme.

  1. Liver disease (eg, hepatitis, acute liver failure, cirrhosis),
  2. Neurologic disease (eg, dysarthria, dystonia, tremor, parkinsonism),
  3. Psychiatric disease,
  4. Kayser-Fleischer rings (deposits in Descemet membrane of cornea)
  5. Hemolytic anemia
  6. Renal disease (eg, Fanconi syndrome)
63
Q

Wilson disease Treatment (3)

A 
chelation with 
1. penicillamine or 
2. trientine, 
&
3. oral zinc.
64
Q

Wilson dz. =inadequate copper excretion into…

A

bile and blood

65
Q

Hemochromatosis due to mutations in

A

HFE gene

66
Q

increased intestinal absorption of Fe

A

Hemochromatosis

67
Q

Hemochromatosis:

􏰂ferritin,􏰂iron,􏰅TIBC–>􏰂transferrin saturation

A

incr. ferritin,
incr. iron,
decr. TIBC
incr. transferrin saturation

68
Q

Ferritin

A

store iron in the tissues

69
Q

Hemochromatosis can be due to 2 causes

A
  1. mutation 2. chronic Transfusion
70
Q

Prussian blue stain

A

Hemochromatosis (Fe)

71
Q

Where Fe accumulate in Hemochromatosis? 6 body parts

A 
liver, 
pancreas, 
skin, 
heart, 
pituitary, 
joints
72
Q

Hemochromatosis sxs.–triad plus 2 sxs.

A

Classic triad of
[1. cirrhosis,
2. diabetes mellitus,
3. skin pigmentation (“bronze diabetes”)]

  1. dilated cardiomyopathy (reversible),
  2. hypogonadism,
  3. arthropathy
    (calcium pyrophosphate deposition; especially metacarpophalangeal joints).
73
Q

Common cause of death in Hemochromatosis

A

HCC

74
Q

Hemochromatosis Tx.- 3 chelators?

A
  • repeated phlebotomy,
  • chelation with:
    1. deferasirox,
    2. deferoxamine,
    3. oral deferiprone.
75
Q

Biliary tract disease sxs.

A
  1. pruritus,
  2. jaundice,
  3. dark urine,
  4. light-colored stool,
  5. hepatosplenomegaly
76
Q

Increased bilirubin effect on cholesterol?

A

Increase

77
Q

cholestatic pattern of LFTs

A

all incr.:
􏰂conjugated bilirubin,
􏰂cholesterol,
􏰂ALP

78
Q

Transferrin

A

bind to and transport of Iron through blood

79
Q

concentric “onion skin” bile duct fibrosis

A

Primary sclerosing cholangitis

80
Q

alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP

A

Primary sclerosing cholangitis

81
Q

Biliary tract disease assoc. w/ UC

A

Primary sclerosing cholangitis

82
Q

antibody ⊕ in Primary sclerosing cholangitis

A

p-ANCA ⊕

83
Q

antibody ⊕ in Primary biliary cirrhosis

A

Anti-mitochondrial antibody ⊕

84
Q

Primary biliary cirrhosis assoc. with which dzs.?

A

other autoimmune conditions

85
Q

Biliary tract disease due to Autoimmune reaction:

lymphocytic infiltrate–>destroy ducts

A

Primary biliary cirrhosis

86
Q

Secondary biliary cirrhosis occurs due to

A

Extrahepatic biliary obstruction–>incr. pressure in intrahepatic ducts–>injury/ fibrosis and bile stasis.

87
Q

Secondary biliary cirrhosis complication

A

ascending cholangitis.

Facts (16 decks)

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