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GI > Liver > Flashcards

Liver Flashcards

1
Q

LFT: Bilirubin gen

A

Breakdown of RBC destruction
Removed by liver, excreted by bile
2 form: direct/conj and indirect/unconj (NOT water soluble so carried by albumin)
CONJ in liver

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2
Q

LFT: bilirubin INC

A

INC in conj BR: biliary obs
INC in unconj BR: hemolysis, hepatocellular dz, drugs
Gilbert’s: BR can’t get into liver to become water soluble so INC unconj, DEC conj
Dubin-Johnson: hyperbilirubinemia

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3
Q

LFT: AST

A

found in liver, cardiac musc, sk musc, kidneys, brain, pancreas, lungs, leukocytes, and erythrocytes
AST:ALT ratio > 2:1 suggests alcoholic liver dz

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4
Q

LFT: AST INC

A

elev. w/ tissue damage

elev. in hepatitis, cholestasis, OH, drug tox.

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5
Q

LFT: ALT

A

More specific for liver damage than AST

INC in tissue damage, cholestasis, hepatitis, OH, drug tox

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6
Q

LFT: AST and ALT

A

drug tox –> extreme elev. of both enz
mild elev: CMN in NML nonwhites
ELEV in DM, obese and hyperlipidemic – related to fatty liver

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7
Q

LFT: elev AST and ALT in asx pt

A

Autoimmune hepatitis, hep b and c, drug/toxins, EtOH, Fatty liver, tumors, hemodynamic d/o (CHF), Fe (hemochromatosis), Cu (Wilson’s Dz), alpha1-antitrypsin deficiency, muscle injury

HIGHEST ELEV: toxic/ischemic inj, acute viral hep, chronic hep, cirrhosis

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8
Q

LFT: alkaline phosphatase

A

In liver, bone, placenta, and less CMN: SI
Isoenz can tell you if it’s coming from bone/liver
If only AP is elev, and no other LFT, then probably coming from bone

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9
Q

LFT: alk phos INC

A

INC in INC bone production
INC nml in kids, preg (d/t placental prod of AP)
Elev in biliary tract dz,
EXT elev in cmn bile duct obs, bone carcinoma, metastatic bone dz, 1’ hepatic dz

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10
Q

LFT: lactic dehydrogenase

A
  • not cmnly for LFT, LDH also appears in lung tissue
  • total LDH and LDH05 elev in hepatic congestion/ inflamm or injury/ skel. musc inj
  • heart and lung dz elev different LDH isoenzymes
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11
Q

LFT: Gamma Glutamyl Transpeptidase (GGT)

A

SPECIFIC FOR LIVER ONLY

  • used to differentiate source of INC AP
  • NOT found in bone
  • Very SENSITIVE to OH abuse, elev w/ 3+ drinks/d
  • elev in ALL forms of liver dz
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12
Q

LFT: alpha-fetoprotein

A

screening for hepatocellular carcinoma
ELEV in chronic hepatitis
ELEV in testicular tumors

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13
Q

LFT: Albumin

A

synthesized in liver, SENSITIVE for liver fxn

  • prealbumin sensitive for nutrition
  • bad cirrhosis –> NOT PROD albumin
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14
Q

LFT: INC and DEC albumin

A

DEC – in malnutrition, protein loss from GI tract = malabsorption, protein loss from renal loss = nephrotic syndrome, LIVER CIRRHOSIS

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15
Q

Child-Pugh score based on

A

serum BR, serum albumin, INR, ascites, encephalopathy

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16
Q

Drugs/toxins/viruses that cause hepatitis

A

Carbon Cl4, acetaminophen, phenytoin, isoniazid, OH, amamita, EBV, CMV, autoimmune hep

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17
Q

s/sx of hepatitis

A

fatigue, drowsiness, anorexia, nausea, fever, abd pain, myalgias, arthralgias
sx IMPROVE w/ onset of jaundice (and dark urine, 1-2wk after sx begin)
hepato and spleno-megaly

SEVERE: confusion, stupor, coma

18
Q

hepatitis labs

A

mild anemia, lymphocytosis
ELEV bilirubin, AST/ALT, alk phos
abumin and PT affected in severe dz

19
Q

fulminant hep more CMN in…

A

hep B, D, E

20
Q

chronic hep more CMN in…

A

hep B and C

NOT in A or E

21
Q

most CMN cause of chronic hep in US is…

A

hep C

22
Q

Predisposes to hepatocellular CA

A

hep B and C

23
Q

hep A virus gen

A

PICOMAVIRUS (rna)
humans only natural host
inactivated @ 185’+, formalin, Cl
fecal oral/food/daycare/SNF/shellfish

24
Q

hep A patho

A

enters mouth
viral rep in liver
virus in blood/feces 10-12d post infxn
Can excrete 3+wks after sx onset (communicable 2 wks before to 1 wk post)

25
Q

hep A Ab

A

IgM detectable at onset until 60-120d

IgG high during convalescence/recovery til indefinitely

26
Q

hep A prevention

A

Ig

preexposure and postexposure w/in 14d

27
Q

hep B virus gen

A 
HEPADNAVIRIDAE family (dna)
humans only known host
Retains infectivity for 7+d at rm temp
350m chronically infected in world
human carcinogen, causes up to 80% HC CA
600k deaths in 2002
5% risk of being chronic, higher risk w/ earlier infxn
28
Q

hep B clinical

A

incubation: 60-150d (avg: 90d)
Nonspecific prodrome: malaise, fever, HA, myalgia
50%+ infxn are asx

29
Q

HBsAG (hep b surface Ag)

A

+ in acute phase

can signal chronic or carrier state

30
Q

ANTI-HBs (Ab to HBsAG)

A

+ after clearance of HBsAG and post-immunization, implies immunity

31
Q

ANT-HBc (Ab to Hep B core Ag)

A

IgM against HBc during ACUTE ifxn after HBsAG occurs during the window after clearance of HBsAG and before ANTI-HBsAG

32
Q

HBeAG (secretory form of HBcAG)

A

ACTIVE viral replication and infectivity

33
Q

factors promoting progression/severity of hep C

A 
INC OH intake
> 40y/o at time of infxn
HIV co-infxn
MALE
Co-infxns (HBV)
34
Q

transmission of hep C

A

percutaneous (IV drug, transfusion/transplant, dirty needles, contaminated equip– hemodialysis, endoscopy, phlebotomy)
permucosal (perinatal, sexual)

35
Q

hep C gen

A

4x more CMN than HIV
1.8% transmission following needle stick from HCV+ source (w/ hollow bore needles)
Rare reports of blood splash to eye, none from skin exposures to blood
1-2% among healthcare workers
sexual transmission – 15-20% of acute/chronic HCV in US

36
Q

HCV screening ques

A
  1. inected illegal drugs
  2. clotting factors before 1987
  3. blood/organs before july 1992
  4. on chronic hemodialysis
  5. evidence of liver dz
  6. healthcare/ER/public safety worker after needle stick exposure
  7. kids born to HCV mom
37
Q

hep D epidemiology

A

ONLY in pts w/ hep B

transmitted via percutaneous

38
Q

hep D patho

A

ss-RNA

39
Q

hep E epidemiology

A

large epidemics of acute in developing countries

HIGH mortality in preg women

40
Q

herpesvirus and hep

A

EBV = herpesvirus – produces mild hep assoc w/ N/V
10-20% of pts

CMV also herpesvirus, causing mild hep

41
Q

HEP pre/post-exposure immuniz

A

Hep A, B, and D

42
Q

hep estimates in US

A

acute infxn: HBV most then A then C
fulminant deaths: HBV most then HAV
chronic: HCV most then HBV then HDV
chronic liver dz deaths: HCV then HBV then HDV

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