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Pathology Block 12 > Liver And Biliary Tract Disorders > Flashcards

Liver And Biliary Tract Disorders Flashcards

1
Q

Liver enzymes released from damaged hepatocytes

A

ALT and AST

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2
Q

Between ALT and ASP, which is better

A

ALT

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3
Q

If ALT or ASP is high

A

Something damaging the cells of the liver

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4
Q

ALP and GGT found where

A

Bile duct-lining cells

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5
Q

Where is ALP found

A

In membrane between the while ducts and the liver

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6
Q

If either ALP and GGT are high

A

Something damaging the ducts of the liver

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7
Q

GGT and alcoholism

A

glug glug test, can detect excessive alcohol consumption

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8
Q

RBC degradation product

A

Bilirubin

Cleared by the liver

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9
Q

LFTs found in hepatocytes

A

ALT and AST

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10
Q

LFTs found in the intrahepatic canalicular cells

A

ALP and GGT in bile duct lining cells

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11
Q

Elevation of AST and ALT

A

Something damaging cells of the liver

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12
Q

Elevation of ALP and GGT

A

Something damaging the ducts of the liver

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13
Q

The LFT most commonly elevated by excessive alcohol consumption

A

GGT

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14
Q

Why is ALT considered more liver specific than AST and ALP

A

Because AST and ALP are found in may other organs (ALP in bone)

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15
Q

Which hepatitis viruses are transmitted via blood

A

BCD

-parenteral, IV, tattoos

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16
Q

Which hepatitis viruses are transmitted fecal/orally?

A

A and E

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17
Q

Hepatitis A

A
  • transmitted orally/fecally
  • short lived jaundice
  • acute nad self limiting, dont need to treat
  • never has a carrier status
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18
Q

Carrier status of hep A

A

Never has a carrier status

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19
Q

Which two hepatitis infections can be synergistic together and cause a very bad infection

A

B and D

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20
Q

Most easily transmitted hepatitis virus

A

B

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21
Q

Carrier status of hep B

A

5-10% of adults go to carrier status, the younger you are when you are infected, the more likely you will be a carrier (90%)
-means they never clear the virus from their body

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22
Q

Chance of becoming a carrier in HBV

A

20%

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23
Q

If you are a chronic carrier of HBV, what is the chance you will get cirrhosis of the liver

A

20%

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24
Q

If you have liver cirrhosis from being a chronic carrier of HBV, what is the chance of getting liver cancer

A

20%

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25
Q

What causes the most liver cancer and deaths in the world

A

HBV, a lot of places in the world do not vaccinated against this

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26
Q

Only Ab that will clear someone from HBV

A

The Ab that the vaccine produces

  • anti-HBs
  • carriers never produce this
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27
Q

What can HBV cause

A

Acute hepatitis, liver pain, and yellow eyes

  • can go to fulminant hepatitis which leads to death
  • can lead to chronic hepatitis, carrier that does not clear the virus from the blood stream
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28
Q

HDV

A
  • defective, needs B
  • will not get a D infection without B
  • if vax against B, will protect against D
  • transmitted by everything
  • can lead to fulminant hepatitis in B or carrier status
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29
Q

90% of people infected with this hepatitis become carriers

A

HCV
-follows the 20/20 rule, 20% chance the carriers will develop liver cirrhosis, 20% chance the liver cirrhosis patients will develop liver cancer

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30
Q

Is HCV chronic or acute

A

Chronic

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31
Q

HCV

A
  • chronic
  • asymptomatic for a cast majority of those years
  • treatment is very effective
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32
Q

Number one cause of chronic hepatitis, cirrhosis, and liver cancer

A

HCV

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33
Q

HbsAG

A

HBV virus

  • acute or chronic HBV present
  • if absent, recovered or immunized
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34
Q

Anti-HBsAG

A

Ab that clears the body of HBV

  • not present in acute or chronic HBV
  • present when recovered or immunized
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35
Q

Anti-HbcAg

A

Everyone that gets HBV develops this, but you will not clear the virus unless you develop HbsAG
-not present in immunized

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36
Q

Largest internal organ

A

Liver

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37
Q

Produces the most clotting factors and proteins

A

Liver

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38
Q

Bilirubin elimination

A

Liver eliminates bilirubin by converting fit to bile

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39
Q

Site of cholesterol and glucose metabolism

A

Liver

40
Q

Exocrine pancreas

A

Digestive

41
Q

Endocrine pancreas

A

Insulin, glucagon

42
Q

Inflamed liver

A

Hepatitis

  • other viruses can cause hepatitis, not just HEp ABC
  • acetaminophen and Tylenol most common reason for accidental liver failure
43
Q

Acute viral hepatitis

A
  • illness that usually resolves
  • incubation and prodrome with flu like symptoms
  • increase bilirubin levels, jaundice, first place you see it is in the eyes
  • increased LFTs
  • usually resolves
44
Q

Chronic viral hepatitis

A

Virus not being removed from the body

45
Q

The best, most specific livertest

A

ALT

46
Q

Why is AST not very specific

A

It is found in a lot of other tissues, more abundantly in muscle than liver so its not very specific

47
Q

If liver enzymes are elevated, can you recover from it or not?>

A

Yes

48
Q

Kills hepatocytes, causes high levels of AST and ALT. GGT and ALP are slightly elevated

A

Viral hepatitis

49
Q

Blocked bile duct and bilirubin

A

If the bile duct is blocked, cant get rid of bile, so bilirubin will start rising pretty quickly if blocking bile duct

50
Q

Stoping bilirubin metabolism

A

Have to damage a lot of liver cells to be able to stop bilirubin metabolism

51
Q

Bilirubin, GGT, and ALP levels in gallstones

A

Very high

52
Q

AST and ALT levels in gallstones

A

Slightly elevated

53
Q

Primary hepatitis

A

Hepatocytes rupture and spill AST and ALT 8x

54
Q

Secondary hepatitis

A

Liver swells/narrows/damages canaliculi

-ALP/GGT/bilirubin 2x

55
Q

Primary bile duct blockage

A

Very high bilirubin/ALP/GGT 8x

56
Q

Secondary bile duct blockage

A

If uncorrected hepatocytes incur Minor damage, and mildly increased AST and ALT

57
Q

What hepatitis has a vaccine we can give?

A

HAV and HBV(and D)

58
Q

Recent infection immunoglobulin

A

IGM

59
Q

Old infection immunoglobulin

A

IgG

60
Q

What is the exception to IgG for infections

A

If there is a 4x change in IgG titer, treat like IgM

61
Q

What is the hepatitis that is most likely to cause chronic infection

A

HCV

62
Q

Recall which hepatitis viruses can be vaccinated against and interpret a case to determine if the patient has been vaccinated, recovered or is a carrier of HBV

A

HAV

HBV (and D)

63
Q

Portal hypertension

A

Ascites

64
Q

How does cirrhosis cause ascites

A

The blood flow coming into the liver through the portal system is scarred and there will be increased back up of blood

65
Q

Predict the impact of a bile duct blockage on bilirubin and urine and fecal urobilinogen

A

The liver dumps bile and conjugated bilirubin into gut to be recycled normally, some bacteria convert the bilirubin to urobilinogen which gives urine and feces their color
-if there is a blockage and it does not get dumped into the gut, there will not be urobilinogen, no color to their stool, liver is not dumping bilirubin into the gut like it should (clay colored stool)

66
Q

What’s the difference between hemochromatosis and polycythemia Vera

A

Hemochromatosis: iron overload

Polycythemia Vera: RBC overproduction

67
Q

Skin color in someone with hematochromotiss

A

Bronzed skin

68
Q

How do you treat PCV and hemotochromisi

A

Phlebotomy

69
Q

What levels are high in hematochromotiss

A

Serum iron and ferritin

70
Q

Offending agent in Wilson’s disease

A

Mutation in ATP7P gene (copper transport protein)

71
Q

Ceruloplasmin and Wilson’s disease

A

Copper transport protein, low levels but could be elevated in acute phase

72
Q

Spectrum of presentation of Wilson’s

A
  • asymptomatic state to fulminating hepatitis, choleric liver disease +/- cirrhosis, neuropsychiatric manifestation
  • psychiatric abnormalities may be Preston before hepatic or neurological signs
  • ocular: kayser-fleisher ring (copper in the descemet’s membrane), sunflower cataracts
73
Q

Kaiser fleischer rings

A

Present in 50% of patients with hepatic rings but are Preston invariably in neurological WD

74
Q

Ceruloplasmin in Wilson’s

A

Low, but can be high

75
Q

Copper in Wilson’s disease

A

High free copper (unbound)

76
Q

Goal treatment for Wilson’s disease

A

Copper removal with ultimate goal of normalizing free copper levels in plasma

77
Q

What kind of drugs used for treating Wilson’s disease

A
  • chelating agents: penicillamine, trientine, tetrathiomlybdate
  • blocking intestinal copping absorption: zinc sulfate
78
Q

Difference between penicillamine and zinc acetate

A
  • pencillimaine is a leading drug, it chelates it

- zinc acetate blocks the absorption of copper in the GI

79
Q

Endocrine pancreas’s

A

Insulin

Glucagon

80
Q

Exocrine pancreas

A

Proteases, amylase, lipases

81
Q

Two primary causes of pancreatitis

A

Alcohol abuse and gallstones

82
Q

What blood enzymes are elevated in pancreatitis

A

Increased serum amylase and lipase

83
Q

The most likely complication of pancreatitis

A

Pancreatic cancer

84
Q

If this is made, it will destroy the HBV virus

A

Surface antigen is the part that is Ab are made to it

-with vaccination (only with the surface antigen, cant get to the core)

85
Q

Which Hepatitist resolve easily

A

A and E

86
Q

Why order a PT/INR when investigating liver disease

A

See if liver is functioning

87
Q

End of chronic liver disease where the liver is replaced with fibrous tissue

A

Cirrhosis

88
Q

Signs of cirrhosis

A

Weight loss, fluid retention, ascites, edema, jaundice, confusion, variceal bleeding

89
Q

Causes of cirrhosis

A

Virus hepatitis, alcohol, acetaminophen, drugs, biliary obstruction

90
Q

Complication in cirrhosis

A

Portal HTN, GI bleeding, liver failure

91
Q

First place you see jaundice

A

Sclera of eye

92
Q

Gallstones

A

Choleslithiasis

93
Q

Inflammation to the gallbladder

A

Cholescystitis

94
Q

Who is cholecystitis most common in

A

Overweight females of childbearing age

95
Q

Signs of cholescystitis

A 
RUQ pain
ASP and GGT elevated 
Pain and belching after fatty meal 
Murphys sign 
Leukocytosis with left shift

Pathology Block 12 (7 decks)

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