Liver

Question 1

unconjugated bilirubin is from what

Answer 1

heme broken down to iron and porphyrin ring. the porphyrin ring is then broken down to biliverdin–then to bilirubin
*unconjugated canNOT be cleared by kidneys

Question 2

how does bilirubin get to the liver

Answer 2

bound to albumin in blood

Question 3

what does unconjugated mean?

Answer 3

lipophilic

Question 4

how does the liver conjugate bilirubin? and what does conjugate mean

Answer 4

with glucuronic acid

adding a water soluble molecule to a lipophilic molecule

Question 5

where does conjugated bilirubin go

Answer 5

to the bile canaliculi then to the duodenum

Question 6

fibrosis in the liver happens how

Answer 6

inflamm, macrophages show up activating fibroblast which lay down collagen

Question 7

bridging fibrosis

Answer 7

when the fibrosis stands of the liver link regions of the liver

Question 8

fibrosis causes what

Answer 8

irreversible consequence of hepatocyte damage, impedes blood flow and hepatocyte perfusion

Question 9

AST and ALT tell what

Answer 9

serum aspartate aminotransferase (AST)
serum alanine aminotransferase (ALT)
damage to hepatocyte
these should be in the liver not the blood, so if in blood know theres damage

Question 10

AP, ALP, ALKP

Answer 10

serum alkaline phosphatase
damage to biliary tract/duct cells
AP- is also in bone, can indicate bone breakdown

Question 11

unconjugated bilirubin

Answer 11

measured by the Total bilirubin - Direct conjugated bilirubin

Question 12

serum albumin

Answer 12

made in liver
decreased albumin and decreased total protein = liver damage
is ONLY abnormal is albumin could be a kidney problem

Question 13

PTT

Answer 13

measures clotting time
liver makes clotting factors and things that breakdown clots
get coagulopthy: either too much clotting or not enough

Question 14

serum ammonia

Answer 14

liver deaminates amino acids and sticks them together to form urea.
if failing and can’t do this then increase ammonia which can cross BBB..encephalopathy

Question 15

Jaundice

Answer 15

build up of bilirubin (un or conja)

eyes

Question 16

Cholestasis

Answer 16

simple def: unable to move bile
1bile canaliculi get clogged bile can’t get out damage hepatocyte
2biliary atresia: bile duct doesn’t connect -liver failure in kids

Question 17

hepatic dysfunction get…12

Answer 17

PS H^4 ForGet JC
Palmer erythema
Spider angiomas
HypOglycemia
HypERammonia
HypOalbuminemia
HypOgonadism
Fetor hepaticus
Gyneocomastic
Jaundice
Cholestasis

Question 18

portal HTN bottom line

Answer 18

if blood can’t get through liver it is going to back up.

Question 19

portal HTN–blood other “escape routes”

Answer 19

lower esophagus: e. varies
umbilicus: caput medusae
hemorrhoids
splenomegaly

Question 20

what results in increased unconjugated bilirubin

Answer 20

excess heme breakdown
decreased hepatic uptake
impaired conjugation

Question 21

increased uncongugated bilirubin leads to what

Answer 21

this bilirubin canNOT be eliminated by kidneys
produces toxic injury- may lead to neurologic damage.
-hemolytic disease of newborns-uv light conjugates get dark urine

Question 22

what results in increased conjugated bilirubin?

Answer 22

decreased hepatocellular excretion

decreased bile blow

Question 23

increased conjugated bilirubin leads to what

Answer 23

this biliribin can be eliminated by urine.

mild level of jaundice

Question 24

What causes heptomegaly

Answer 24

impaired blood flow out of the liver
NOT cirrhosis
ex: thrombus in vena cava, or most common R sided HF

Question 25

cirrhosis does what

Answer 25

scar tissue that impairs blood flow THROUGH the liver

Question 26

cirrhosis leads to what which then causes

Answer 26

Portal HTN which causes ascites splenomegaly portosystemic shunts: e.varices, hem, c.m.

Question 27

hepatits is what, 3 types

Answer 27

liver inflamm: viral, nonETOH, ETOH

Question 28

hep A E

Answer 28

oral-fecal non carrier, chronic, CA A: common in kids, worse for adults E: seen in travels 20% mortality for preg

Question 29

Vaccines for hep...

Answer 29

A, B

Question 30

Hep B, C, D

Answer 30

sex, blood D only if have B so if exposed to D, get B&D cause Carrier, Chronic, CA B-transfered mother to child (china)

Question 31

Hepatic steatosis

Answer 31

fatty liver Heptaocyctes take up ETOH canNOT get rid of Fat enlarged liver reversible: stop drinking go back to normal **this is a inflamm process so keep drinking--collagen laid down forming nodules can develop cirrhosis

Question 32

it you got the ETOH liver disease you have a __% chance of getting... 3 things

Answer 32

hepatic steatosis 90-100% chance ETOH hepatitis 10-35% Cirrhosis 8-20%

Question 33

Alcoholic cirrhosis characteristic are...

Answer 33

diffuse nodules from fibrous scarring average size 3mm can have greenish tint from bile stasis impairs blood flow!

Question 34

hemochromatosis what, who how

Answer 34

iron overload males, shows up late 50+yo autosomal recessive most common metabolic genetic disorder

Question 35

hemochromatosis patho

Answer 35

normal: regulate iron storage(in liver) by limiting iron uptake---this doesn't happen so excess build up of iron damages liver

Question 36

Hemochromatosis problem lead to

Answer 36

cirrhosis 100% DM skin turns gray

Question 37

hemochromatosis tx

Answer 37

blood donation **1 unit= 0.25g iron

Question 38

Iron diseases 4

Answer 38

Bantu siderosis B Thalassemia (ineffective erythropoiesis) Siderblastic anemia Transfusion!

Question 39

Bantu siderosis

Answer 39

genetic mutation-african recessive take up iron at too high of a rate

Question 40

2nd biliary cirrhosis

Answer 40

due to obstruction gallstones biliary atresia strictures

Question 41

primary biliary cirrhosis

Answer 41

``` autoimmune destruction of INTRAhepatic ducts increase AP and cholesterol hyperbilirubinemia--late in disease Antimitochondrial antibodies AMA often fatal ```

Question 42

primary sclerosing cholangitis

Answer 42

effects INTRA and EXTRAhepatic bile ducts develops after UC (70% chance) increase AP usually no AMA

Question 43

Circulatory problem: impaired flow through hepatic art

Answer 43

complications of transplants, if not connected properly can get decreased flow--decreased O2 **ischemia to hepatocytes and bile ducts don't usually see atherosclerosis

Question 44

Hepatocellular carcinoma (HHC) caused by

Answer 44

``` Hep B Chronic liver disease (Hep c, ETOH) Cirrhosis (not necessary a cause 85-90%) Aflatoxin Tyrosinemia-rare but 40% get HHC *7 month mean survival ```

Question 45

liver CA usually....

Answer 45

metastatic from colon CA....liver getting lots of blood from colon

Question 46

Choletithiasis

Answer 46

gallstones | asymptomatic until stone moves or inflamm of gallbladder

Question 47

risk factors for cholesterol stones

Answer 47

``` more common stone 80% F's!! fair female 40 fat fertile (more children more likely) gallstone stasis hyperlipidemia ```

Question 48

risk factors for pigment stones

Answer 48

made of bilirubin chronic hemolytic syndrome biliary infection asian, black, sickle cell

Question 49

Choledocholithiasis

Answer 49

gallstone on the move! in biliary tree

Question 50

Cholangitis

Answer 50

inflam of common bile duct

Question 51

Choledocholithiasis leads to 6

Answer 51

``` biliary obstruction pancreatitis cholangitis hepatic abscess chronic liver disease with biliary cirrhosis acute calculous cholecysitis ```

Question 52

cholecystitis

Answer 52

inflamm of GB

Question 53

acute pancreatitis

Answer 53

duct blocked | so then pancreatic enzymes become active and start autodigesting itself--Inflamm

Question 54

acute pancreatitis causes

Answer 54

``` I GET S idiopathic gallstone at ampulla of water ETOH trauma Steroids ```