Liver Flashcards
how big is the liver?
Size of a football
what is one of the primary products of the liver?
Bile (80% or > cholesterol)
2 forms of bile
conjugated and unconjugated
What are the LFTs?
Transamin (SGOT/AST, SGPT/ ALT)
Alkaline phosphatase
What are 2 serum proteins to measure?
albumin
prealbumin
what is a coagulation indicator?
Prothrombin
what is a good measure of someones nutritional status. Can show if they need artificial nutrition.
Prealbumin
Ways to look at the liver
Plain films
US (good for hallow vs. solid)
CT of RUQ and abdomen
What is percutaneous transhepatic cholangiograph? (PTC)
Puncture through the liver to one of the major vessels and put dye in there to show biliary drainage system.
What is an MRI choloangiopancreatography
High resolution, close-up of the main junctions where the cystic ducts and common bile duct join into the ampulla
Invasive tests for liver issues.
Needle biopsy
open biopsy
ERCP
surgical exploration & excision
a yellow green coloration of the skin, sclera & mucous membranes. May be associated w/ pruritis
Jaundice
Jaundice is detected when bilirubin levels are above what?
2.5 mg/100 mL
Mechanisms that can cause jaundice. 6 causes
Excessive bilirubin production (pre conjugation)
Decreased hepatic uptake (pre conjugation)
Impaired conjugation
Intrahepatic cholestasis
Extra-hepatic obstruction
Hepatocellular injury
What does indirect bilirubin mean?
Unconjugated
if bilirubin is unconjugated will be in the urine?
No, urine will be free of bilirubin
What are ways to get excess unconjugated bilirubin (bilirubinemia)?
RBC destruction, decreased uptake, concurrent illness
impaired conjugation, hereditary
what can cause conjugated (direct) bilirubinemia?
Intracellular, canalicular, ductule, septal, intralobular problems
What is the onset with direct bilirubinemia?
Gradual with pruritis
what symptoms will you have with conjugated bilirubinemia?
pale stools
dark urine
steatorrhea (odor, float) from lack of fat absorption
What will labs look like with conjugated bilirubinemia?
^ Alk phos
mild LFT
normal albumin
coagulopathy
what are symptoms of indirect bilirubinemia
anemia on CBC due to RBC destruction
jaundice
How do you revere the coagulopathy found with conjugated bilirubinemia.
Vitamin K
what causes extrahepatic obstruction?
Stone, stricture, tumor block biliary tree
Signs of extrahepatic obstruction.
GB may be palpable, painless
What is a sudden onset of extrahepatic obstruction often associated w/
Colangitis
What does extrahepatic obstruction look similar to?
intrahepatic cholestasis
What do you see on labs for extrahepatic obstruction
High direct biliruin
High alk phos
moderate high LFTs
What symptoms will someone with extrahepatic obstruction have?
Dark urine
pale stools
possible coagulopathy
Hepatitis picture with prodromal anorexia, nausea, abd pain, malaise. Hepatomegaly, ecchymoses, tender
Hepatocellular dz
what will labs look like with hepatocellular dz?
alk phos 2-4x upper limit of normal
LFTs >5x (ULN) (except with Hep C or alcoholism)
After 7 days of hepatocellcular dz what will happen?
Coagulopathy due to decreased clotting factors
What will happen after 10-14 days of hepatocellular dz?
hypoalbuminemia
What can you see with chronic hepatocellular dz.
chronic fibrosis portal HTN ascites gynecomastia atrophy of the testes encephalopathy
Why do you get encephalopathy with hepatocellular dz?
unconjugaeted bilirubin is lipophilic so it can cross the BBB
How much of alcoholic cirrhosis is silent?
Up to 40%
what do the majority of people with cirrhosis have?
portal HTN
what is a codition with excessive levels of iron in blood and body than can damage liver, testes, ovaries, heart.
hemochromatosis
What are heredity and metabolic cuases of cirrhosis
Wilson’s, Gaucher’s
Primary biliary cirrhosis (PBC)
Faconi’s
Cardiac
what is an inflammatory biliary dz common in women. Need a liver tranplant.
Primary biliary cirrhosis (PBC)
signs of chronic viral and alcoholic hepatitis
Varices Ascities Hypersplenism peripheral edema encephalopathy
why is there peripheral edema with chronic hepatitis?
such low protein in blood, so fluid part of blood isn’t held in by osmotic pressure and seeps into soft tissue
what is the leading cause of death with chronic viral and alcoholic hepatitis
bleed- esophageal varcieal or gastric
infection
encephalopathy
What is there a chronic morality risk of with chronic viral and alcoholic hepatitis?
hepatocellular carcinoma
Progressive fibrotic liver disease
Associated with other autoimmune disorders
Cholestatic and fibrotic manifestations
primary biliary cirrhosis
Labs to get with primary biliary cirrhosis
Alk Phos
SED/ CRP
Anti-Mitochondrial Ab
IgM (high)
what is the key finding with primary biliary cirrhosis
positive anti-mitro Ab
Patient presents with dypnea, arthritis, skin discoloration, fatigue.
hemochromatosis
what is a TIPS
Trans hepatic intraperiotoneal shunt
artificial connection b/w portal circulation and systemic circulation to take pressure off portal system
how do you treat wilson’s
d-penicillamine (chelator)
Txs for primary biliary cirrhosis
ursodiol colchicine MTX Vit ADK cholestyramine zinc transplant diet
treatment for hemochromatosis
phlebotomy
what are signs of alcoholic liver dz
caput medusa
parotid gland enlargement
what is a chemical toxin that farm workers may encounter. causes tumors of the liver
aflatoxin
drugs that can cause tumors of the liver
Estrogens
anabolic steroids
alcohol
what type cancer is almost always in someone with hep c
hepatocellcular carincoma
what lab is diagnostic for a hepatocellcular carcinoma
alpha fetoprotein
How do you get HAV (hepatitis A virus)?
Fecal-oral
child care
NICU
men having sex with men
How do you get HAB?
percutaneous
perinatal
sexual
How do you get HCV?
Percutaneous
primarily IVDA
What is HDV like?
HBV
What is HEV like?
HAV
how many binge drinkers develop fatty liver?
90% of binge drinkers
who are more susceptible to liver injury with less intake.
women
what type hepatitis has a 4-24 week incubation is has an insidious/acute onset
HBV
what type hepatitis has a 2-6 week incubation and onset is acute
HAV
What type of hepatitis has a 5-10 weeks incubation on insidious onset
HCV
do the hepatitis viruses actually kill cells?
No, the body’s rxn to the viruses actually do harm
what is the pathologic picture of hepatitis
monocyte infiltration
cell necrosis
hyperplasia & cholestasis
Patient presents with Fever, spider angioma, hepatomegaly, splenomegaly, ascites, caput medusa,
malnutrition, ecchymoses, parotid enlarge-ment, jaundice, nausea
what do you suspect
alcohol harm to the liver
what ratio is elevated in alcoholic hepatitis?
ALT/AST >1
what will be elevated with chronic alcoholic hepatitis.
MCV (mean corpuscular volume)
cell size is large
what drugs can cause cholestatic liver problems?
OCP
Erythromycin
Tegretol
Chloropro
What can outdated tetracycline lead to?
Problem with liver
what drugs can give you fatty liver
methotrexate
protease inhibitor
what drugs can lead to hepatitis
halothane
INH
keocon
verapmail
what can you get miex hepatitis/ cholesterol from
azathi
niacin
statins
what drugs can lead to necrosis of liver cells
Acetaminophen Carbon Tetetrachloride Amanita (mushrooms) DMF Yellow phosphorus
What drugs can cause granulomas in the liver?
Sulfonamide
allopruinol
quinidine (off market)
how much time do you have to give antidote for acetamenophen OD?
17 hours
treatment for hep b and D
Interferon, Lamuvidine
treatment for hep c
Interferon, Ribavirin
treatment for hep A and E
supportive
ABCDEF pneumonic for fulminant hepatitis
Acetaminophen Hep A autimmune hept
Het B
Hep C cryptogenic
Hep D, drugs
Esoteric causes- wilson’s Budd-Chiar syndrome
Fatty infiltration- acute fatty liver preggo, Reye’s
