Liver Flashcards
What is ammonia
Nitrogen waste (primarily from protein deamination)
What is ammonia converted to
urea via glucose/alanine cycle in the liver
*urea secreted in urine
Where is AST found
within the mitochondria of the liver
*ETOH more commonly effect mitochondria
Where is ALT found
within the cytosol of hepatocytes
*more specific to the liver
Where is ALT found
within the cytosol of hepatocytes
*more specific to the liver
What causes AST to elevate
when there is damage to hepatocytes
How much with AST elevate with viral hepatitis?
how about obstruction?
20x
10x
When is the AST/ALT ratio elevated
with alcoholic cirrhosis or Rhabdo
What do you think of if the AST/ALT ratio <1
acute hepatitis
When will Alk Phos be elevated
this will increase with an obstruction of the biliary tree and cholestatic hepatitis
When does LDH increase
with hypoxic damage and primary liver damage
When does unconjugated bili increase
with hemolysis
*70% of T-bili
When will conjugated bili increase
when there is damage to hepatocytes or with obstruction
What physically indicates hyperbilirubinemia
jaundice
What is the cause of conjugated hyperbilirubinemia
defect in bilirubin transport
biliary obstruction
intrahepatic cholestasis
What are the causes of unconjugated hyperbilirubinemia
increased bili production
increased breakdown of hgb
impaired bili uptake
decreased conjugation
What is the spectrum of disease caused by chronic ETOH
steatosis
steatohepatitis
fibrosis
cirrhosis
increased risk of HCC
What in ETOH damages hepatocytes
acetaldehyde
What is steatosis
reversible increased lipid deposition within the liver that begins in the central vein
What is occurring in the liver with cirrhosis
inflammation cause an activation of Kupffer cells and this releases inflammatory mediators and ultimately activation of fibrogenic hepatic stellate cells
What does the fibrosis in the liver cause with cirrhosis
it will change/block the flow of bile or blood within the liver lobule
What causes the liver to be nodular with cirrhosis
fibrotic bands
What are the common causes of intrahepatic portal hypertension
thrombosis
inflammation
fibrosis
infectious hepatitis
schistosomiasis
What are the causes of post hepatic portal hypertension
prosthetic thrombosis
RV failure
What are the main causes of ascites
portal HTN
malignancy
nephrotic syndrome
malnutrition
right heart failure
What is ascites
transudative effusion associated with change in hydrostatic pressure that outweighs capillary osmotic pressure
What is the physiologic cause of ascites
increased HTN + low albumin causes water to be forced into the peritoneal cavity
What is Hep A most commonly associated with
travel to endemic areas
*fecal-oral route
What type of virus is hep A
nonenvelgped RNA picornavirus
What type of virus is Hep B
double stranded DNA
What type of hepatitis is linked with HCC
Hep B
*blood borne
What type of virus is Hep C
Enveloped ssRNA
What is the most common cause of fulminant liver failure
acetaminophen
