liver and gall blader Flashcards

Question

VIRAL HEPATITIS C RNA virus

Answer 1

``` Spread: Blood, venereal Often asymptomatic 15-150 days incubation Clinical course similar to Hep B (less severe usually) Fluctuating liver chemistry Tendency to chronicity (cirrhosis) ``` the worst to get - can never get rid of

Answer 2

Normally, liver takes up fats and incorporates these into lipoproteins for export. Steatosis: Accumulation of fats (triglycerides) in liver (5kg instead of 1.2kg- can happen in 24hours- gets white) Usually asymptomatic or vague discomfort of pain in the right upper abdominal quadrant

Answer 3

Fat can accumulate in cells as: Macrovesicular (single large droplet) Alcohol, Toxins -CCl4, Steroids, Drugs Microvesicular (multiple small droplets) if stop drinking can go back withiin 24 hours but if do it too often then the cells can burst- causes inflammation- acute can come and go in 24hours

Answer 4

``` Test results Bilirubin – Mildly High Transaminases- high Alkaline phosphatase – normal Albumin – slightly low PT (INR) – mildly reduced What we know so far: Chronic hepatocellular injury ``` ``` Next step Identify the underlying cause Given the history GGT high Liver biopsy ```

Answer 5

Common cause of acute / chronic liver disease Spectrum: Fatty change Hepatitis with Mallory hyaline Fibrosis / Cirrhosis Multifactorial Diversion of metabolic resources Direct hepatotoxicity Stimulation of collagen synthesis Similar changes outside of alcohol: Non-alcoholic steatohepatitis (NASH) Obesity, rapid weight loss, diabetes, drugs abnormal accuamulation of neutrofils, alcohol

Answer 6

liver cell damage

Answer 7

Generalized hepatic fibrosis & regenerative nodules. Not a specific disease (end-stage organ damage) Relatively inefficient organ: relationship between vessels and cells is less than optimal Causes are the same as those of chronic liver injury Following liver cell necrosis, there is replacement fibrosis Regenerative nodules form Active cirrhosis: fibrosis + continuing inflammation repeated apesodes of cell injury- bumps are liver cells trying to regenerate chronic inflammation- scarring - hardening of the liver fibrous tissues contract- smaller bile cant go through ducts structuraly abnormal and functionally abnormal active cirrhosis- continuous damage and inflammation

Answer 8

PORTAL VENOUS OBSTRUCTION leading to PORTAL HYPERTENSION HEPATIC FAILURE LIVER CELL CARCINOMA (~ 10%)- due to all the regeneration veins: hemorrhoids, varices (eosophagus)- rupture when eating

Answer 9

``` Ascites Splenomegaly Enlarged porta-systemic shunts Esophageal varices Hemorrhoids Caput!!!! medusae Splenic vein thrombosis Contributes to hepatic encephalopathy ```

Answer 10

Two basic problems Synthesis of clotting factors Failure to eliminate endogenous waste products Manifests as jaundice, encephalopathy and metabolic derangements Two types: acute and chronic Rapid onset- massive necrosis Slow onset- cirrhosis

Answer 11

Alcohol induced liver cirrhosis (Current age: 40) Active with ongoing inflammation Prognosis In the absence of social supports unlikely to have full recovery. Considerations: Bio-psycho-social model of disease Societal norms and existing laws… Most likely cause for death will be one or a combination of the following: Liver failure due to progressive cirrhosis Fatal Head injury Hepatocellular carcinoma Death facilitated by the social environment he is in.

Answer 12

Benign tumors are rarely of clinical significance Metastatic!! (where did it come from) carcinoma is the commonest liver tumor ALSO, LIVER IS THE COMMONEST METASTATIC SITE Primary malignant tumors: Hepatocellular carcinoma,