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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
Acute Hepatitis: Types
-Viral (A-C) -Viral: CMV, herpes simplex -Bacterial -Parasitic
26
How to differentiate between acute and chronic hepatitis based on duration
-Acute Hepatitis: <6 months -Chronic Hepatitis: >6 months
27
Chronic Hepatitis: Types
-Hepatitis B &C -Non-alcoholic steatohepatitis (NASH) -Alcohol-related liver disease/alcoholic hepatitis -Autoimmune liver disease -Drug induced
28
Chronic Hepatitis can lead to increased risk of: (2)
-Cirrhosis -Hepatocellular carcinoma
29
Acute Viral Hepatitis: Progression
1. Incubation: No Symptoms 2. Prodromal (Pre-icteric) 3. Icteric 4. Recovery: 2-4 weeks
30
Acute Viral Hepatitis: Prodromal (pre-icteric)
Main • Anorexia • Malaise • Nausea/vomiting Others • RUQ pain • New distaste for cigarettes • Urticaria and arthralgia-Hep B
31
Acute Viral Hepatitis: Icteric
Hepatomegaly Persisits
32
Acute Viral Hepatitis: Lab Findings (Enzymes)
• Notable increases in ALT (5x) and AST (3x) • Mild/moderate elevations in ALP, GGT, LDH
33
Acute Viral Hepatitis: Lab Findings (Bilirubin)
• Bilirubinuria • Positive urine urobilinogen • Hyperbilirubinemia (mixed)
34
Acute Viral Hepatitis: Lab Findings (CBC)
• Leukopenia with lymphocytosis
35
Hepatitis A (HAV): Epidemiology
Spread by fecal-oral route
36
Hepatitis A: Signs/Symptoms
• Young children may be asymptomatic • Adults may have severe symptoms
37
Hepatitis A: Antibodies
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
Hepatitis A (HAV): Prognosis and Management
• Resolves spontaneously in most cases • Lasts 6-12 weeks • Treatment – supportive
39
Hepatitis B
Transmitted parenterally (needles) and through sexual intercourse
40
Hepatitis B: Signs/Symptoms
• Urticarial eruptions (Hives) and arthralgia (joint pain) possible
41
Hepatitis B: Serological Findings
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
.Acute HBV infection: Serological Findings
-HBsAg: Positive -Anti-HBs: Negative -IgM anti-HBc: Positive -IgG anti-HBs: Negative
43
Chronic HBV infection: Serological Findings
-HBsAg: Positive -Anti-HBs: Negative -IgM anti-HBs: Negative -IgG anti-HBc: Positive
44
Hepatitis C: Transmission
• Transmitted parenterally – blood and other bodily fluids • Symptoms typical of viral hepatitis
45
Hepatitis C becomes chronic in ____ of cases
75%
46
Hepatitis C: Lab Findings
• Anti-HCV and HCV RNA do no differentiate between acute and chronic
47
Hepatitis C: Lab Findings
• Anti-HCV and HCV RNA do no differentiate between acute and chronic
48
First indication of chronic hepatitis
Abnormal aminotransferase levels
49
Chronic Hepatitis: Signs/Symptoms
-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
Chronic Hepatitis: Signs/Symptoms
-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
Chronic Hepatitis: Lab Findings
-Mild elevations of ALT and AST* -ALP: Normal or elevated -Bilirubin: normal until severe or advanced disease
52
Chronic Hepatitis: Serological Tests
-HBV and HCV
53
Chronic Hepatitis: Management & Treatment-Chronic HBV/HCV, Autoimmune, NASH, Alcoholic Hepatitis
-Chronic HBV/HCV: Antivirals -Autoimmune: Corticosteroids -NASH: Weight loss -Alcoholic Hepatitis: Stop drinking immediately
54
NAFLD/NASH
-NAFLD: Accumulation of lipids in hepatocytes (asymptomatic) -NASH: Accumulation of lipids in hepatocytes, leading to sustained inflammation and cell damage
55
Lipid accumulation is not associated with _______
Alcohol intake
56
NAFLD/NASH: Risk Factors
-Metabolic Syndrome -Type 2 DM -High triglycerides, low HDL
57
NAFLD/NASH: Lab Findings
-ALT/AST: May be only elevations -Risk factors may be more indicative of disease than LFTs
58
NAFLD/NASH: Lab Findings
-ALT/AST: May be only elevations -Risk factors may be more indicative of disease than LFTs
59
Differentiation of NAFLD/NASH requires:
Liver Biopsy -NASH will have inflammation
60
Hepatic Steatosis: Lab Findings
-Notable GGT elevation -Other liver enzymes can be normal or mildly elevated
61
Alcoholic Liver Disease/Alcoholic Hepatitis: S/Sx
-Fever, jaundice, fatigue -RUQ pain, tender hepatomegaly
62
ALD/Alcoholic Hepatitis: Key Lab Findings
-WBCs increased -Decreased serum albumin, increased serum globulin -Increased prothrombin time -Increased GGT (significant)
63
ALD/Alcoholic Hepatitis: Treatment
*Stop drinking alcohol -Bed rest
64
Autoimmune Hepatitis: Symptoms
Acne, amenorrhea, arthralgia…
65
Autoimmune Hepatitis: Lab findings
Anti-smooth muscle antibodies (ASMA) often positive
66
Cirrhosis: Etiology
-Alcohol -NASH -Chronic Hepatitis -Prolonged cholestasis
67
Cirrhosis: Signs/Symptoms
*Portal Hypertension: Ascities, esophageal variaces, hepatorenal syndrome, symptoms of heart failure -Peripheral neuropathies (B12) -Malabsorption Conditions -Hormone Imbalalnces: Gynecomastia, hirsuitism
68
Cirrhosis: Key Exam Findings
Palpable, firm, smooth liver with blunt edge
69
Cirrhosis: Key Lab Findings
*Albumin significantly decreased *Serum cholesterol decreased *BUN decreased *Uric Acid Decreased -WBC normal
70
Cirrhosis: Definitive Diagnosis
Liver Biopsy
71
Primary Liver Cancer is usually a complication of:
Cirrhosis
72
Primary Liver Cancer: S/Sx
-Oftentimes asymptomatic -Abdominal pain -Weight loss -RUQ mass -Fever -Jaundice (late)
73
Primary Liver Cancer: Lab Findings
*AFP (4x)-Warrants imaging -Imaging: Ultrasound, MRI, contrast-enhanced CT
74
Metastatic Carcinoma of the Liver: Primary Sites
GI Tract, Breast, Lung, and pancreas
75
Metastatic Carcinoma of the Liver: S/Sx
-Hepatomegaly -Non-specific cancer symptoms (weight loss, anorexia, fever)
76
Metastatic Carcinoma of the Liver: Lab Findings
-ALP, GGt, LDH tend to elevate -ALT and AST findings are variable -Bilirubin typically normal
77
Primary Biliary Cholangitis
-Inflammation and destruction of small bile dcuts within liver portal areas
78
PBC: S/Sx
Asymptomatic or may have symptoms of cholestasis (Pruritis, mild jaundice, steatorrhea)
79
PBC: Lab Findings (4)
-ALP and GGT increased -Minimally increased AST and ALT -Increase serum cholesterol -AMA elevated
80
Cholestasis (Intrahepatic): Etiology
-Viral hepatitis, alcoholic liver disease, metastatic carcinoma, pregnancy, primary biliary cirrhosis, drugs
81
Cholestasis (Extrahepatic): Etiology
-Common bile duct stone, pancreatic carcinoma, stricture of CBD, Pancreatitis
82
Cholecystitis: Clinical Findings
-Colicky RUQ pain & tenderness -Muscle guarding -Pale Stool -Intense pruritis
83
Cholecystitis: Clinical Findings
-Colicky RUQ pain & tenderness -Muscle guarding -Pale Stool -Intense pruritis
84
Cholecystitis: Key Lab Findings
-High ALP/GGT (4x) -High Serum Cholesterol: Acute (300-400)/Chronic (700-800) -Total serum bilirubin moderately or considerable increased -Leukocytosis with neutrophilia
85
Cholecystitis: Management
-Definitive Diagnosis: Abdominal ultrasound -Vitamins A, D, E, K Supplementation

Clinical Pathology II (10 decks)

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