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Patho test 3 > Liver > Flashcards

Liver Flashcards

1
Q

unconjugated bilirubin is from what

A

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

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2
Q

how does bilirubin get to the liver

A

bound to albumin in blood

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3
Q

what does unconjugated mean?

A

lipophilic

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4
Q

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

A

with glucuronic acid

adding a water soluble molecule to a lipophilic molecule

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5
Q

where does conjugated bilirubin go

A

to the bile canaliculi then to the duodenum

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6
Q

fibrosis in the liver happens how

A

inflamm, macrophages show up activating fibroblast which lay down collagen

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7
Q

bridging fibrosis

A

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

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8
Q

fibrosis causes what

A

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

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9
Q

AST and ALT tell what

A

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

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10
Q

AP, ALP, ALKP

A

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

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11
Q

unconjugated bilirubin

A

measured by the Total bilirubin - Direct conjugated bilirubin

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12
Q

serum albumin

A

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

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13
Q

PTT

A

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

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14
Q

serum ammonia

A

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

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15
Q

Jaundice

A

build up of bilirubin (un or conja)

eyes

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16
Q

Cholestasis

A

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

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17
Q

hepatic dysfunction get…12

A 
PS H^4 ForGet JC
Palmer erythema
Spider angiomas
HypOglycemia
HypERammonia
HypOalbuminemia
HypOgonadism
Fetor hepaticus
Gyneocomastic
Jaundice
Cholestasis
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18
Q

portal HTN bottom line

A

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

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19
Q

portal HTN–blood other “escape routes”

A

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

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20
Q

what results in increased unconjugated bilirubin

A

excess heme breakdown
decreased hepatic uptake
impaired conjugation

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21
Q

increased uncongugated bilirubin leads to what

A

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

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22
Q

what results in increased conjugated bilirubin?

A

decreased hepatocellular excretion

decreased bile blow

23
Q

increased conjugated bilirubin leads to what

A

this biliribin can be eliminated by urine.

mild level of jaundice

24
Q

What causes heptomegaly

A

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

25
Q

cirrhosis does what

A

scar tissue that impairs blood flow THROUGH the liver

26
Q

cirrhosis leads to what which then causes

A

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

27
Q

hepatits is what, 3 types

A

liver inflamm: viral, nonETOH, ETOH

28
Q

hep A E

A

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

29
Q

Vaccines for hep…

A

A, B

30
Q

Hep B, C, D

A

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)

31
Q

Hepatic steatosis

A

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

32
Q

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

A

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

33
Q

Alcoholic cirrhosis characteristic are…

A

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

34
Q

hemochromatosis what, who how

A

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

35
Q

hemochromatosis patho

A

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

36
Q

Hemochromatosis problem lead to

A

cirrhosis 100%
DM
skin turns gray

37
Q

hemochromatosis tx

A

blood donation **1 unit= 0.25g iron

38
Q

Iron diseases 4

A

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

39
Q

Bantu siderosis

A

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

40
Q

2nd biliary cirrhosis

A

due to obstruction
gallstones
biliary atresia
strictures

41
Q

primary biliary cirrhosis

A 
autoimmune
destruction of INTRAhepatic ducts
increase AP and cholesterol 
hyperbilirubinemia--late in disease
Antimitochondrial antibodies AMA
often fatal
42
Q

primary sclerosing cholangitis

A

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

43
Q

Circulatory problem: impaired flow through hepatic art

A

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

44
Q

Hepatocellular carcinoma (HHC) caused by

A 
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
45
Q

liver CA usually….

A

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

46
Q

Choletithiasis

A

gallstones

asymptomatic until stone moves or inflamm of gallbladder

47
Q

risk factors for cholesterol stones

A 
more common stone 80%
F's!!
fair
female
40
fat
fertile (more children more likely) 
gallstone stasis
hyperlipidemia
48
Q

risk factors for pigment stones

A

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

49
Q

Choledocholithiasis

A

gallstone on the move! in biliary tree

50
Q

Cholangitis

A

inflam of common bile duct

51
Q

Choledocholithiasis leads to 6

A 
biliary obstruction
pancreatitis 
cholangitis
hepatic abscess
chronic liver disease with biliary cirrhosis 
acute calculous cholecysitis
52
Q

cholecystitis

A

inflamm of GB

53
Q

acute pancreatitis

A

duct blocked

so then pancreatic enzymes become active and start autodigesting itself–Inflamm

54
Q

acute pancreatitis causes

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

Patho test 3 (4 decks)

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