Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(DIT) Rapid Fire + 4/5 Stars > Liver > Flashcards

Liver Flashcards

1
Q

Zones of liver lobule and susceptibility

A

Zone 1: highest O2 content, includes the portal triad
-Viral hepatitis

Zone 2: middle

Zone 3: closest to Central v.
-furthest from oxygenated blood - highest risk of ischemia
-toxic injury
highest p450 concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hepatocyte protein production

A 
coagulation factors
complement
albumin
apolipoproteins
CRP
antiotensinogen
transferrin
ceruloplasmin

Synthesis of cholesterol and phospholipids (non protein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hepatocyte drug/toxin metabolism

A

CYP450 enzymes
UDP-glucuronyltransferase
ALT and AST
Steroids –> inactive metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hepatocyte storage

A

glucose - glycogen
Chloesterol and TGs - VLDL particles
Minerals
Vit B12, A, D, E, K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hepatocyte bile function

A

breakdown fats

carrier for excretion of bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

UDP-glucuronyl transferase

A

transfers glucuronyl group to bilirubin
- conjugation –> direct bilirubin aka conjugated bilirubin

Low in newborns:
decreased bilirubin conjugation
causes physiologic jaundice (indirect bili)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Kernicterus

A

bilirubin buildup in the brain –> neurotoxicity

Chorea
cerebral palsy
hearing loss
gaze abnormalities

Tx: phototherapy - blue lights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gilbert Syndrome

A

AR - UDT1A1 mutation in promoter region of UDP-GT gene

Not much produced –> slow conjugation

Slight elevation of indirect bilirubin
benign, asx unless under stress –> mild jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Crigler Najjar Sn type I

A

complete absence of UDP-GT
unable to conjugate bilirubin and excrete it
Jaundice and elevated indirect bilirubin in first few days

w/o tx –> kernicteris –> death in couple years

Tx: phototherapy, plasmapheresis
Cure via liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Crigler Najjar Sn type II

A

mutated UDP-GT - not as effective

Less severe, clinically like Gilbert Sn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phenobarbital test for neonatal jaundice

A

induces production of hepatic enzymes
-distinguishes types

Crigler Najjar Type I - no change - no gene to induce

Crigler Najjar Type II reduced indirect bilirubin

Gilbert Sn reduced indirect bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dubin-Johnson Syndrome

A

Cannot excrete conjugated bilirubin in bile
elevated direct bilirubin

liver turns black (dark)

D’s - Dubin, direct up, dark liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rotor Syndrome

A

like Dubin Johnson - elevated direct bili

no black liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stages of Alcoholic liver disease

A

1: steatosis - fat droplets w/in liver cells
- reversible if stop drinking

2: alcoholic hepatitis - inflammation w/ fatty depostis
3: Cirrhosis - irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Alcoholic hepatitis

A

inflammation with fatty deposits
hepatocytes swollen and necrotic
neutrophils invade parenchyma

Mallory bodies - eosinophilic squiggly blobs

RUQ pain, anorexia, jaundice
low grade fever
>2:1 AST: ALT
-ALT low d/t B6 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cirrhosis

A

irreversible

scarring and fibrosis
nodular surface
hard and nodular on palpation if palpable
-shrunken and contracted

liver enzymes may be high, normal, or low - trashed hepatocytes

Hepatocytes pink and blue collagen (scarring /fibrosis)
necrotic

Sclerosis centralized around central v in zone 3 of lobule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Liver failure effects

A

Coagulopathy - increased PT and PTT
-bleeding and bruising

Decreased albumin production = lower osmotic pressure
-edema, ascites

Can’t metabolize ammonia –> hepatic encephalopathy

  • confusion, delirium, hypersomnia
  • -> coma and death
  • asterixis
  • Fetor hepaticus (musty odor to breath)

High estradiol - can’t metabolize steroids

  • -> testicular atrophy, gynecomastia
  • spider telangectasias (spider angiomas)
  • Palmar erythema

Jaundice
low LDL and HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Portal hypertension

A

HSM
Ascites –> paracentesis
-risk spontaneous bacterial peritonitis (potentially deadly)

Portosystemic anastomases dilate, become varicosed

  • caput medusae - abdominal wall veins
  • anorectal varices - rectal v.
  • esophageal varices
  • renal varices
  • paravertebral varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of esophageal variceal bleeding

A

Octreotide - somatostatin analog

propranolol, nadolol to prevent

endoscopic banding

Transjugular intrahepatic portosystemic shunt (TIPS)
-worsen risk of hepatic encephalopathy, bypass liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medications used in cirrhosis

A

diuretics - decrease ascites and edema

beta blocker - prevent esophageal varices bleeding

Vit K - maximize clotting potential

Laculose - trap ammonia in gut, excreted in stool

  • decrease serum ammonium levels
  • tx hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Aminotransferases

A

AST, ALT

ALT >= AST - viral hepatitis
AST > ALT - alcohol

Hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Gamma-glutamyl transpeptidase (GGT)

A

liver pathology
excess etOH
biliary tree disease

23
Q

Alkaline phophatase

A

biliary obstruction - gallstones, cancer

Active bone formation - kids, Paget dz of bone, bone cancer

24
Q

Nutmeg liver

A

back up of blood into liver d/t right sided HF
JVD

speckled liver section

can be due to Budd Chiari Syndrome

Long time –> central lobular congestion and necrosis
–> fibrosis (aka cardiac cirrhosis)

25
Q

Budd-Chiari

A

Obstruction of IVC and hepatic vs

Central lobular congestion and necrosis –> congestive liver disease

  • hepatomegaly
  • ascites
  • abdominal pain
  • Portal HTN –> esophageal varices, caput medusa

NO JVD

Assoc w/:
hyper coagulable stages
pregnancy
polycythemia
hepatocellular carcinoma
26
Q

Reye Syndrome

A

Potentially fatal

children w/ aspirin for viral infections
hepatoencephalopathy

Early: rash, V, HA, confusion
–> hypoglycemia, stupor, coma, death

Damage to cellular mitochondria –> decreased beta-oxidation
-aspirin metabolites reversible inhibitor of enzymes

Aspirin only okay in kids w/ Kawasaki disease

27
Q

Wilson disease

A 
AR
Defect in ATP7B
Inadequate copper excretion into bile
Impaired conversion of copper to ceruloplasmin
-low ceruloplasmin in serum
Copper accumulates in liver, brain, cornea, kidneys, joints
-Kayser-Fleischer rings
-Cirrhosis
--> increased risk of HCC
hemolytic anemia
Basal ganglia degeneration
Parkinson like sx
Hepaticencephalopathy --> dementia
Fanconi syndrome : proximal tubule dysfunction in kidney, decreased reabsorption

Tx: penicilliamine “copper penny”

28
Q

Hemochromatosis

A

excess iron deposition
Triad: cirrhosis, bronze DM, skin pigmentation

Other:
CHF
Testicular atrophy
increased risk of HCC

Labs: high ferritin (cellular storage of Fe), high total serum Fe, decreased total iron binding capacity (TIBC - all used up, can’t bind more), high transferrin saturation

Primary - AR
Secondary - excessive transfusions d/t chronic anemia

Tx: phlebotomy
Deferexamine - SQ
Oral: deferiprone, deferasirox

29
Q

Alpha1-antitrypsin deficiency

A

Autosomal codominant
Panacinar emphysema: too much elastase activity
Cirrhosis - mutated form of protein accumulates in liver cell, toxic

Early onset

30
Q

Hepatic adenoma

A

Females 20-44 yo - OCP years

Risk: OCP use, anabolic steroids, glycogen storage disease type I and III

Sx:
RUQ pain, usually asx

10% transform to HCC

Tx: dc OCP, serial imaging and AFP, +/- resection (esp over 5 cm)

31
Q

Hepatic angiosarcoma

A

Malignant endothelial neoplasm in liver

Risk: vinyl chloride, arsenic exposure

32
Q

Hepatocellular carcinoma

A

MC primary liver tumor

Risk:
HBV, HCV
Wilson dz
Hemochromatosis
a1-antitrypsin deficiency
alcoholic cirrhosis
Aflatoxin from aspergillus
Sx:
Jaundice
tender hepatomegaly
ascites
polycythemia
hypoglycemia

Marker: AFP - check serially

33
Q

General hepatitis

A

asx - transmit infection w/o knowing
Sx: malaise, arthralgias, fatigue, N/V, RUQ pain, scleral icteris, HSM, LAD

Labs:
high ALT and AST
High serum bilirubin
high alk phos
high urine bilirubin

Causes: viral infections, chronic alcohol use, toxins

Micro:
Councilman bodies
Mallory bodies (more common in etoh liver dz)

34
Q

Hepatitis A

A

ssRNA

Fecal/oral route, poor sanitation
30 d incubation

risk: international travel (Mexico, S. America)

labs:
HepA IgM during illness
HepA IgG after resolution or vaccination (1 dose 12 mo - 18 yrs, 1 booster 1 yr later)

Tx: supportive - self limited

35
Q

Hepatitis E

A

ssRNA

Fecal oral/route, contaminated water

more likely to cause fulminant hepatic failure in pregnant

Labs: PCR, HepE IgM

tx: supportive

36
Q

Fecal-oral transmitted hepatitis

A

“vowels come from the bowels”

HAV, HEV

37
Q

Hepatitis D

A

ssRNA

Delta virus, defective pathogen

Infections in presence of HBV

Transmission MC blood, sexual contact

20% mortality (highest)

Tx: pegylated IFN-a for 1 yr

prevention - HBV vaccine

38
Q

Hepatitis C

A

ssRNA

50-85% chronic infection; 5-35% –> cirrhosis

Increased risk of hepatocellular carcinoma - u/s q6mo for surveillance

Extrahepatic manifestations: membranoproliferative glomerulonephritis, essential mixed cryoglobinemia, lymphoma, thyroiditis, porphyria cutanea tarda, lichen planus, DM

Transmission: MC blood, sexual contact (rare)

Dx: HepC Ab, RNA

Tx:
Ledipasvir - sofosbuvir
Ombitasvir-paritaprevir-ritonavir + dasabuvir

39
Q

Hepatitis B characteristics

A

dsDNA!!!

Transmission: perinatally, sex MC, blood

Chronic infection

  • less than 5% acquire as adult
  • 90% acquire perinatally

Extrahepatic manifestations - d/t circulating immune complexes
-polyarteritis nodosa, membranous nephropathy, aplastic anemia

Increased risk of HCC - U/S every 6 mo, +/- AFP (high false +)
-more than HCV

40
Q

Significance of HBsAg

A

active disease

41
Q

Significance of HBsAb

A

recovery from active infection or immunization

42
Q

HBcAb significance

A

Hx of infection - IgM early; IgG late

43
Q

HBeAg significance

A

active viral replication = high transmissibility

44
Q

HBeAb significance

A

low transmissibility

45
Q

HBV DNA

A

active viral replicaiton

tx indicated when high and high LFTs

46
Q 
HBsAg+
HBsAb -
HBcAb + IgM
HBeAg +
HBeAb -
HBV DNA high
A

Active HBV infection

47
Q 
HBsAg-
HBsAb-
HBcAb+ IgM
HBeAg
HBeAb
HBV DNA high/low
A

Acute infection - Window period

  • Abs neutralize Ag
  • on the way to recovery
48
Q 
HBsAg-
HBsAb+
HBcAb+ IgG
HBeAg-
HBeAb+
HBV DNA -
A

Past infection - recovered

49
Q 
HBsAg -
HBsAb+
HBcAb-
HBeAg-
HBeAb-
HBV DNA-
A

vaccine

50
Q 
HBsAg+
HBsAb-
HBcAb+IgG
HBeAg+
HBeAb
HBV DNA high
A

Chronic infection - immune tolerance

still active HBV, little liver damage

51
Q 
HBsAg+
HBsAb
HBcAb+ IgG
HBeAg + --> -
HBeAb
HBV DNA high --> low
A

Chronic infection - immune clearance

high LFTs, damage happening

Likely to clear and respond to treatment

52
Q 
HBsAg+
HBsAb
HBcAb+ IgG
HBeAg-
HBeAb
HBV DNA Low
A

Chronic infection - inactive carrier

normal LFT
20-30% can reactivate

53
Q

treatment of HBV

A

MC: tenofovir
entecavir, telbivudine, lamivudine, adefovir

Pregnant women: if HBV DNA elevated w/ active liver involvement - lamivudine
-Give baby HBV vaccine and HBV immune globulin w/in 12 hours of birth

54
Q

Autoimmune hepatitis

A

elevated AST and ALT

Type 1: ANA, anti-smooth muscle Ab
Type 2: anti-liver-kidney microsomal Ab, anti-liver cytosol Ab

Other disease w/ autoimmune features:
hemolytic anemia
T1DM
thyroiditis
celiac sprue
UC

(DIT) Rapid Fire + 4/5 Stars (162 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions