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Clinical Pathology II > Liver > Flashcards

Liver Flashcards

1
Q

Liver Function Tests: Most Useful

A

Serum bilirubin, ALP, aminotransferases (AST, ALT)

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2
Q

Bilirubin is seen clinically at:

A

> 2.5mg/dL

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3
Q

Newborn Jaundice: Physiological vs. Pathological

A

-Physiological: 2 days-2 weeks
-Pathological: First 24 hours

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4
Q

Prehepatic Jaundice Causes

A

-Excessive hemolysis*
-Extravascular hematomas
-Pulmonary infarct

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5
Q

Hepatic Jaundice Causes:

A

-Conjugation failure
-Bilirubin Transport Distrubances

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6
Q

Conjugation Failure

A

• Neonatal physiological jaundice – 50% full-term newborns

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7
Q

Bilirubin Transport Disturbances

A

-Dubin-Johnson Syndrome
-Gilbert’s Syndrome
-Diffuse Hepatocellular Damage or necrosis
-Intrahepatic obstruction

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8
Q

Dubin-Johnson Syndrome

A

Post-conjugation bilirubin transport failure (post-hepatic)

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9
Q

Gilbert’s Syndrome

A

-Pre-conjugation bilirubin transport failure
-Fast: 24-48 hours
-Unconjugated bilirubin (2x)

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10
Q

Diffuse Hepatoceullular Damage or Necrosis: Acute vs. Chronic

A

-Acute: Viral hepatitis & Alcohol/drug induced liver cell injury
-Chronic: Active cirrhosis, liver tumor, biliary cirrhosis

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11
Q

Post-hepatic jaundice causes

A

-Common bile duct obstruction (Stone, stricture, spasm or Cancer @ head of the pancreas)

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12
Q

Bilirubin: Interfering Factors

A

• Sample hemolysis
• Protect the blood sample from bright light
• Long list of drugs that can increase total bilirubin

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13
Q

Bilirubin: Interfering Factors

A

• Sample hemolysis
• Protect the blood sample from bright light
• Long list of drugs that can increase total bilirubin

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14
Q

Bilirubin: Normal Levels

A

• Total: 0.1-1.0 mg/dL
• Direct: 0-.2 mg/dL
• Indirect: 0.2-0.8 mg/dL
• Newborn total: 1-12 mg/dL

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15
Q

Bilirubin: Decision Levels

A

• 1.4 mg/dL
• 2.5 mg/dL: Jaundice
• 20 mg/dL – in baby – associated with kernicterous

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16
Q

Liver plays a major role in:

A

Liver Metabolism

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17
Q

Disease of the hepatobiliary system affects:

A

Plasma cholesterol

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18
Q

What serum proteins are synthesized in liver:

A

Albumin, fibrinogen and majority of globulins

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19
Q

Enzymes related to liver function

A

• Transaminases - ALT/AST
• Alkaline phosphatase
• LDH
• GGT

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20
Q

AMA are important for which disorder

A

Primary biliary cholangitis

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21
Q

ASMA are important for which disorder

A

Autoimmune hepatitis

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22
Q

Fetal liver produced:

A

Alpha fetoprotein (AFP)

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23
Q

AFP levels are _____ in adults

A

Very low

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24
Q

Increased AFP is useful in diagnosis of

A

Primary hepatocellular cancers

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25
Q

Acute Hepatitis: Types

A

-Viral (A-C)
-Viral: CMV, herpes simplex
-Bacterial
-Parasitic

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26
Q

How to differentiate between acute and chronic hepatitis based on duration

A

-Acute Hepatitis: <6 months
-Chronic Hepatitis: >6 months

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27
Q

Chronic Hepatitis: Types

A

-Hepatitis B &C
-Non-alcoholic steatohepatitis (NASH)
-Alcohol-related liver disease/alcoholic hepatitis
-Autoimmune liver disease
-Drug induced

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28
Q

Chronic Hepatitis can lead to increased risk of: (2)

A

-Cirrhosis
-Hepatocellular carcinoma

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29
Q

Acute Viral Hepatitis: Progression

A
  1. Incubation: No Symptoms
  2. Prodromal (Pre-icteric)
  3. Icteric
  4. Recovery: 2-4 weeks
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30
Q

Acute Viral Hepatitis: Prodromal (pre-icteric)

A

Main
• Anorexia
• Malaise
• Nausea/vomiting

Others
• RUQ pain
• New distaste for cigarettes
• Urticaria and arthralgia-Hep B

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31
Q

Acute Viral Hepatitis: Icteric

A

Hepatomegaly Persisits

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32
Q

Acute Viral Hepatitis: Lab Findings (Enzymes)

A

• Notable increases in ALT (5x) and AST (3x)
• Mild/moderate elevations in ALP, GGT, LDH

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33
Q

Acute Viral Hepatitis: Lab Findings (Bilirubin)

A

• Bilirubinuria
• Positive urine urobilinogen
• Hyperbilirubinemia (mixed)

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34
Q

Acute Viral Hepatitis: Lab Findings (CBC)

A

• Leukopenia with lymphocytosis

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35
Q

Hepatitis A (HAV): Epidemiology

A

Spread by fecal-oral route

36
Q

Hepatitis A: Signs/Symptoms

A

• Young children may be asymptomatic
• Adults may have severe symptoms

37
Q

Hepatitis A: Antibodies

A

HAV IgM antibody
• Appears 3-4 wks after exposure
• Peak 1 week later
• Normal at 2-3 months

HAV IgG
• Appears 2-4 weeks after IgM increase
• Peak 1-2 months later
• Slowly falls (detectable for >10 years)

38
Q

Hepatitis A (HAV): Prognosis and Management

A

• Resolves spontaneously in most cases
• Lasts 6-12 weeks
• Treatment – supportive

39
Q

Hepatitis B

A

Transmitted parenterally (needles) and through sexual intercourse

40
Q

Hepatitis B: Signs/Symptoms

A

• Urticarial eruptions (Hives) and arthralgia (joint pain) possible

41
Q

Hepatitis B: Serological Findings

A

1.HBsAg: 1st test to become abnormal
2. Anti-HBs (HBsAb): 2-6 weeks following diappearance of HBsAg
3. HBcAb: IgM and IgG tests available

42
Q

.Acute HBV infection: Serological Findings

A

-HBsAg: Positive
-Anti-HBs: Negative
-IgM anti-HBc: Positive
-IgG anti-HBs: Negative

43
Q

Chronic HBV infection: Serological Findings

A

-HBsAg: Positive
-Anti-HBs: Negative
-IgM anti-HBs: Negative
-IgG anti-HBc: Positive

44
Q

Hepatitis C: Transmission

A

• Transmitted parenterally – blood and other bodily fluids
• Symptoms typical of viral hepatitis

45
Q

Hepatitis C becomes chronic in ____ of cases

A

75%

46
Q

Hepatitis C: Lab Findings

A

• Anti-HCV and HCV RNA do no differentiate between acute and chronic

47
Q

Hepatitis C: Lab Findings

A

• Anti-HCV and HCV RNA do no differentiate between acute and chronic

48
Q

First indication of chronic hepatitis

A

Abnormal aminotransferase levels

49
Q

Chronic Hepatitis: Signs/Symptoms

A

-Many patients asymptomatic
-If undiscovered, first signs/symptoms may be those of cirrhosis

-Jaundice is rare
-Mild symptoms: Malaise, Anorexia, Fatigue, Low-grade fever, non-specific upper abdominal discomfort

50
Q

Chronic Hepatitis: Signs/Symptoms

A

-Many patients asymptomatic
-If undiscovered, first signs/symptoms may be those of cirrhosis

-Jaundice is rare
-Mild symptoms: Malaise, Anorexia, Fatigue, Low-grade fever, non-specific upper abdominal discomfort

51
Q

Chronic Hepatitis: Lab Findings

A

-Mild elevations of ALT and AST*
-ALP: Normal or elevated
-Bilirubin: normal until severe or advanced disease

52
Q

Chronic Hepatitis: Serological Tests

A

-HBV and HCV

53
Q

Chronic Hepatitis: Management & Treatment-Chronic HBV/HCV, Autoimmune, NASH, Alcoholic Hepatitis

A

-Chronic HBV/HCV: Antivirals
-Autoimmune: Corticosteroids
-NASH: Weight loss
-Alcoholic Hepatitis: Stop drinking immediately

54
Q

NAFLD/NASH

A

-NAFLD: Accumulation of lipids in hepatocytes (asymptomatic)
-NASH: Accumulation of lipids in hepatocytes, leading to sustained inflammation and cell damage

55
Q

Lipid accumulation is not associated with _______

A

Alcohol intake

56
Q

NAFLD/NASH: Risk Factors

A

-Metabolic Syndrome
-Type 2 DM
-High triglycerides, low HDL

57
Q

NAFLD/NASH: Lab Findings

A

-ALT/AST: May be only elevations
-Risk factors may be more indicative of disease than LFTs

58
Q

NAFLD/NASH: Lab Findings

A

-ALT/AST: May be only elevations
-Risk factors may be more indicative of disease than LFTs

59
Q

Differentiation of NAFLD/NASH requires:

A

Liver Biopsy
-NASH will have inflammation

60
Q

Hepatic Steatosis: Lab Findings

A

-Notable GGT elevation
-Other liver enzymes can be normal or mildly elevated

61
Q

Alcoholic Liver Disease/Alcoholic Hepatitis: S/Sx

A

-Fever, jaundice, fatigue
-RUQ pain, tender hepatomegaly

62
Q

ALD/Alcoholic Hepatitis: Key Lab Findings

A

-WBCs increased
-Decreased serum albumin, increased serum globulin
-Increased prothrombin time
-Increased GGT (significant)

63
Q

ALD/Alcoholic Hepatitis: Treatment

A

*Stop drinking alcohol
-Bed rest

64
Q

Autoimmune Hepatitis: Symptoms

A

Acne, amenorrhea, arthralgia…

65
Q

Autoimmune Hepatitis: Lab findings

A

Anti-smooth muscle antibodies (ASMA) often positive

66
Q

Cirrhosis: Etiology

A

-Alcohol
-NASH
-Chronic Hepatitis
-Prolonged cholestasis

67
Q

Cirrhosis: Signs/Symptoms

A

*Portal Hypertension: Ascities, esophageal variaces, hepatorenal syndrome, symptoms of heart failure
-Peripheral neuropathies (B12)
-Malabsorption Conditions
-Hormone Imbalalnces: Gynecomastia, hirsuitism

68
Q

Cirrhosis: Key Exam Findings

A

Palpable, firm, smooth liver with blunt edge

69
Q

Cirrhosis: Key Lab Findings

A

*Albumin significantly decreased
*Serum cholesterol decreased
*BUN decreased
*Uric Acid Decreased
-WBC normal

70
Q

Cirrhosis: Definitive Diagnosis

A

Liver Biopsy

71
Q

Primary Liver Cancer is usually a complication of:

A

Cirrhosis

72
Q

Primary Liver Cancer: S/Sx

A

-Oftentimes asymptomatic
-Abdominal pain
-Weight loss
-RUQ mass
-Fever
-Jaundice (late)

73
Q

Primary Liver Cancer: Lab Findings

A

*AFP (4x)-Warrants imaging
-Imaging: Ultrasound, MRI, contrast-enhanced CT

74
Q

Metastatic Carcinoma of the Liver: Primary Sites

A

GI Tract, Breast, Lung, and pancreas

75
Q

Metastatic Carcinoma of the Liver: S/Sx

A

-Hepatomegaly
-Non-specific cancer symptoms (weight loss, anorexia, fever)

76
Q

Metastatic Carcinoma of the Liver: Lab Findings

A

-ALP, GGt, LDH tend to elevate
-ALT and AST findings are variable
-Bilirubin typically normal

77
Q

Primary Biliary Cholangitis

A

-Inflammation and destruction of small bile dcuts within liver portal areas

78
Q

PBC: S/Sx

A

Asymptomatic or may have symptoms of cholestasis (Pruritis, mild jaundice, steatorrhea)

79
Q

PBC: Lab Findings (4)

A

-ALP and GGT increased
-Minimally increased AST and ALT
-Increase serum cholesterol
-AMA elevated

80
Q

Cholestasis (Intrahepatic): Etiology

A

-Viral hepatitis, alcoholic liver disease, metastatic carcinoma, pregnancy, primary biliary cirrhosis, drugs

81
Q

Cholestasis (Extrahepatic): Etiology

A

-Common bile duct stone, pancreatic carcinoma, stricture of CBD, Pancreatitis

82
Q

Cholecystitis: Clinical Findings

A

-Colicky RUQ pain & tenderness
-Muscle guarding
-Pale Stool
-Intense pruritis

83
Q

Cholecystitis: Clinical Findings

A

-Colicky RUQ pain & tenderness
-Muscle guarding
-Pale Stool
-Intense pruritis

84
Q

Cholecystitis: Key Lab Findings

A

-High ALP/GGT (4x)
-High Serum Cholesterol: Acute (300-400)/Chronic (700-800)
-Total serum bilirubin moderately or considerable increased
-Leukocytosis with neutrophilia

85
Q

Cholecystitis: Management

A

-Definitive Diagnosis: Abdominal ultrasound
-Vitamins A, D, E, K Supplementation

Clinical Pathology II (10 decks)

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