Liver Flashcards
Liver Anatomy
- portal triad
- Kupffer cells = liver macrophages
Bilirubin metabolism
- Heme catabolism
- unconjugated bilirubin binds to albumin
- conjugated bilirubin binds with glucuronic acid
Hyperbilirubinemia
Normal = 0.3 - 1.2 mg/dL jaundice = bilirubin > 2 - 2.5 mg/dL cholestasis = thick bile kernicterus = bilirubin > 20 mg/dL
Cholestasis
- decreased bile flow
- obstruction: gallstones, bile duct cancer, etc.
- severe itching
Acute Liver Failure
- encephalopathy
- AST/ALT»_space; 1,000
- 50% from excess acetaminophen ingestion
Liver Failure Complications: portal hypertension
- increased portal venous pressure due to obstruction in portal circuit
- esophagogastric varices
ascites
Liver failure complications: ascites
- tense skin
Liver Failure Complications: endocrine
- Males undergo feminization
- compression of central area causes the entire lesion to blanch
Cirrhosis
- end stage of chronic liver disease
Hepatitis A Virus
- no carrier state
Hepatitis B Virus
- core antigen (HBcAg)
- e antigen (HBeAg)
- indicates ongoing viral replication; infectivity
- surface antigen: envelope glycoprotein (HBsAg) (immunologic but not infectious)
- 2 billion infected worldwide
- 400 million chronic carriers worldwide
Chronic Hepatitis B
- 2-3% hepatocellular carcinoma
- 0.1-0.5% develop fulminant hepatitis
Hepatitis C Virus
170 million worldwide
Hepatitis D Virus
- HDV infection requires HBV coinfection
Chronic Viral Hepatitis
- cirrhosis
Alcoholic Liver Disease
- 60% of alcoholics develop chronic liver disease
- females often experience more severe outcomes
- spectrum: hepatic steatosis, alcoholic hepatitis, cirrhosis
Fatty Liver Disease
- steatosis (accumulation of fat in hepatocytes)
Alcoholic Hepatitis
- 5-year (90%) if stop drinking AND without jaundice, ascites, hematemesis (vomit blood)
- causes of death: hepatic failure, GI bleed, infection, renal failure, hepatocellular carcinoma (3-6%)
Nonalcoholic Fatty Liver Disease
- resembles alcoholic liver disease
Liver Transplantation
MELD score (model for end-stage liver)
Hemochromatosis
- excessive iron accumulation
- 200X risk for hepatocellular carcinoma
Wilson Disease
- excessive copper accumulation
alpha1-anti-trypsin deficiency
- most common genetic cause of liver disease in infants/children
- with cirrhosis 2-3% risk for hepatocellular carcinoma
Gilbert Syndrome
- jaundice
- medications: Irinotecan (camptosar), protease inhibitors
- any patient who has jaundice needs to undergo a comprehenseive medical assessment
Primary Biliary Cholangitis
increase in serum cholesterol: severe
Primary Scleorsing Cholangitis
- inflammation and fibrosing of bile ducts
Cholestatic Syndromes of Infancy
- giant cell hepatitis
Cavernous Hemangioma
- most common benign liver tumor
Hepatocellular Adenoma
- benign
- oral contraceptives, anabolic steroids
- usually solitary encapsulated expanding mass
- some risk for malignant transformation
Hepatocellular Carcinoma
- malignant; primary liver cancer
Cholangiocarcinoma
- intrahepatic/extrahepatic bile duct cancer
- endemic liver fluke = parasite
Metastatic Carcinoma to the Liver
- most common malignant liver tumor
Relevant Information Needed for a Patient with Liver Disease
- current lab values for: PT INR CBC LFTs (ALT, AST)
Gallbladder features
- release of bile
Cholecystitis
- severe abdominal pain (upper right quadrant) lasts greater than 6 hours
Pancreas general information
- only 2% of pancreas maintains glucose homeostasis
Acute Pancreatitis
- abdominal pain (cardinal symptom)
- pseudocysts (50% of cases)
- increase serum amylase within first 24 hours
- increased serum lipase next 72 hours - 96 hours
Chronic Pancreatitis
- chronic alcoholism (most common cause)
- increased risk of pancreatic cancer
- 40-55% in hereditary pancreatitis
Pancreatic Cystic Neoplasms
- increased malignant potential
Pancreatic Cancer
- highly invasive/rapidly progressive
- # of cases in US in the past 50 years tripled
