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Systemic Final > Liver > Flashcards

Liver Flashcards

1
Q

What is the structure of a liver lobule?

A

Hepatic vein in the center of the lobule with hepatocytes surrounding it funneling endocrine, secretory and metabolic hormones into the vein.
There are about 50-100k lobules per liver

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2
Q

What are the vessels that run into and out of the liver and where do they come from?

A

Hepatic artery runs from heart to liver
Hepatic portal vein runs from intestines to liver
Hepatic vein runs from liver back to heart

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3
Q

What is the role of the liver?

A

Secrete glycogen for glucose homeostasis
Metabolize fats, proteins, bilirubin and drugs and hormones
Detox blood
Produce prothrombin

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4
Q

What lab tests can you do for liver damage? Which are most commonly used and which one is most specific?

A

AST and ALT most common
ALT most specific (Liver damage only)
AST: liver, heart and skeletal muscle damage
ALP: Liver, bile ducts and bone damage
GGT: liver, heart, kidney and brain damage
Serum/urine bilirubin concentration (Conj and unconj)
Prothrombin time and INR

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5
Q

What causes the yellowing of the skin seen in jaundice?

A

Bilirubin buildup in blood

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6
Q

Where would you see yellowing in jaundice

A

Fornices of eyelids and conj
Skin
Mucous membranes (like inside of cheeks)

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7
Q

What’s the normal path of bilirubin starting as old hemoglobin?

A

Old hemoglobin to spleen to become unconjugated bilirubin to liver to become conjugated bilirubin to stool

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8
Q

What symptoms do you see if the bilirubin path is dysfunctional?

A

Pale stools (no bilirubin) and dark urine (Bilirubin spillover)

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9
Q

What gene abnormality leads to Wilson’s Disease? What inheritance pattern is it?

A

ATP7B copper transport dysfunction. Autosomal recessive

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10
Q

What is dysfunctional in Wilson’s Disease?

A

ATP7B copper transport

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11
Q

Where does the copper tend to build up in Wilson’s Disease?

A

Liver, brain and eyes

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12
Q

When does Wilson’s disease manifest?

A

Between ages 12-20

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13
Q

Wilson’s disease leads to disease of the eye, brain and liver. What liver symptoms do you see in Wilson’s?

A

Liver failure, hepatitis and cirrhosis

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14
Q

Wilson’s disease leads to disease of the eye, brain and liver. What eye symptoms do you see in Wilson’s?

A

Sunflower cataract (PSC and ASC)
Kaiser flescher ring
50% likely if only liver affected
100% if brain affected too

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15
Q

Wilson’s disease leads to disease of the eye, brain and liver. What neurological symptoms do you see in Wilson’s?

A

Parkinson’s like symptoms + drooling

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16
Q

What clinical manifestations would you note for Wilson’s disease?

A

Liver biopsy, psych changes, ocular manifestations

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17
Q

What lab tests could you do to test for Wilson’s disease?

A

Decrease serum ceruloplasmin (100mcg/day)
Poor ALT and AST
Gene tests

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18
Q

What are treatments for Wilson’s disease

A

Chelate copper with EDTA
Increase zinc in diet
Decrease copper in diet (mushrooms, shellfish, liver, nuts harder for vegetarians)
Check drinking water

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19
Q

What is the route of transmission for Hepatitis A?

A

Fecal oral

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20
Q

In whom is Hepatitis A more prevalent

A

Low socioeconomic status

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21
Q

Can you be vaccinated for Hep A?

A

Yes

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22
Q

How long does it take for HepA to incubate?

A

30 days

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23
Q

What are symptoms of HepA?

A

Prodromal = fatigue, fever, nausea, anorexia, upper right quadrant pain
Jaundice

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24
Q

How would you test for HepA?

A

HAV antibodies

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25
Q

Treatment for HepA?

A

Supportive therapy
Self limiting disease
Most recover in 3 months
Almost all recover in 6 months

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26
Q

True or false? HepB is typically Chronic

A

False. HepB is typically acute

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27
Q

How is HepB transferred?

A

Sex, drugs (and rock and roll)

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28
Q

Where is HepB found in the world?

A

Africa and SE Asia

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29
Q

Symptoms of acute HepB?

A

Typically asymptomatic
May have flulike symptoms
Rarely get jaundice or liver failure

30
Q

What’s serum sickness?

A

Body allergic to Hepatitis B. Get hives, fever and joint pain

31
Q

Symptoms of chronic HepB?

A

Cirrhosis, carcinoma, liver failure

32
Q

What are the antigen tests for HepB?

A

HB(s)Ag, HB(e)Ag, HB(c)Ag

IgM or IgG test for acute or chronic testing for HB(c)Ag

33
Q

How would you test to differentiate acute and chronic HepB?

A

IgM or IgG test for acute or chronic testing for HB(c)Ag

34
Q

How do you treat acute HepB?

A

Supportive therapy

35
Q

How do you treat chronic HepB?

A

Antivirals
“-Vudine”
“-Ovir”
“-voxil”

36
Q

What’s the most common cause of liver disease and transplant?

A

HepC

37
Q

Is HepC more often acute or chronic?

A

Chronic. 30% end up getting cirrhosis within 30 years

38
Q

Symptoms of acute HepC?

A

Asymptomatic
Fatigue, myalgia, N/V and poor appetite
Upper right abdominal pain

39
Q

Symptoms of chronic HepC?

A

Asymptomatic until liver damage

40
Q

True or false? HepC can also be coinfection with HepD and HepE

A

False. Coinfection with HepA and HepB

41
Q

What tests can you run for HepC?

A

ALT and AST
HAV antigen test
RT PCR for HAV RNA
Liver Biopsy

42
Q

Treatment for HepC?

A 
Antivirals
"-evir"
"-virin"
peginterferons
Check at the end of therapy and 6 months later to ensure still good
43
Q

What drugs are choice but very expensive for HepC?

A

Sofosbuvir and ribavirin

44
Q

What eyesigns are associated with which drugs for HepC?

A

Interferon retinopathy. Get cottonwool spots, ONH edema and BRAO that can lead to RD

45
Q

What is required for a HepD infection to take hold?

A

HepB in body as well

46
Q

Differene between HepD and HepB coinfection vs superinfection?

A 
Coinfection = acute
Superinfection = chronic
47
Q

How do you test for HepD?

A

HBV antigen test

HepD RT-PCR

48
Q

Treatment for HepD? What doesn’t it do?

A

Interferon alpha. Doesn’t treat viral or liver disease

49
Q

Prognosis for HepD?

A

75% chance progressive liver disease

50
Q

How is HepE spread?

A

Poo water

51
Q

There are 4 genotypes with 24 subtypes of HepE. A higher mortality exists in pregnant women. The presentation’s not yet understood

A

Free card

52
Q

Similar to HepA in tx and symptoms

A

HepE

53
Q

How would you diagnose HepE?

A

HepE antigen test (IgM)

HEV detection

54
Q

How many drinks may result in alcohol liver disease?

A

Women: 14 drinks per week
Men: 21 drinks per week

55
Q

What liver problems occur with alcohol liver disease?

A

Hepatic steatosis

56
Q

Symptoms of hepatic steatosis?

A

asymptomatic

57
Q

Symptoms of alcoholic hepatitis?

A

Ascities, jaundice, anorexia

Fever, muscle wasting and pain

58
Q

What’s cirrhosis?

A

Fibrosis of liver and regenerative nodules

59
Q

What are some general symptoms of cirrhosis that you may notice with alcohol liver dz?

A

Finger clubbing, palm erythema, asterixis
Gynecomastia
Jaundice, ascities, splenomegaly

60
Q

What diagnostic tests can you run for alcohol liver dz?

A

Elastography

MRI to quantify steatosis

61
Q

What are causes of cirrhosis?

A

HepB and HepC, alcohol liver disease, hepatic steatosis

62
Q

What’re the symptoms of cirrhosis?

A

Ranges from itching to liver dysfunction to infertility

63
Q

How would you diagnose cirrhosis?

A

Imaging

ALT/AST

64
Q

Treatment for cirrhosis?

A

Protect liver

Liver transplant

65
Q

Prognosis for cirrhosis?

A

40x increase in hepatocellular carcinoma

66
Q

Epidemiology for hepatocellular carcinoma?

A

Black or asian males 50-60yo

67
Q

What tests would you NOT do for hepatocellular carcinoma?

A

Lab tests not definitive

68
Q

What tests would you do to test for hepatocellular caricnoma?

A

Biopsy and ultrasound
If nodules greater than 1 cm, do MRI or CT scan
PET scan to monitor metastases

69
Q

What is hepatocellular carcinoma?

A

Fibrosis/nodular regeneration of liver

70
Q

Symptoms of hepatocellular carcinoma?

A

No symptoms other than chronic liver disease. Similar to cirrhosis

71
Q

Risk factors/reasons to screen for hepatocellular carcinoma?

A

Fhx, alcoholic, HepB/C, autoimmune hepatitis, Primary biliary cirrhosis, nonalcoholic steatohepatitis, hemochromatosis

72
Q

How would you treat hepatocellular carcinoma?

A

Liver resection/transplant

Radiofrequency or transarterial chemoembolization ablation

Systemic Final (8 decks)

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