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Pathology > Liver and GI > Flashcards

Liver and GI Flashcards

1
Q

What are the functions of the Liver?
[4]

A

Amino acid synthesis
Carbohydrate metabolism
Fat metabolism
Protein synthesis

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2
Q

Liver function – carbohydrate metabolism

A

Glycogenesis - the formation of glycogen from glucose

Glycogenolysis - the breakdown of glycogen into glucose

Gluconeogenesis - the synthesis of glucose from certain amino acids, lactate or glycerol

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3
Q

Liver function – fat metabolism

A

cholesterol synthesis, the production of triglycerides

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4
Q

Liver function – protein synthesis

A

Liver produces albumin, coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI

The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin).

The liver breaks down toxic substances (e.g., by methylation) and most medicinal products in a process called drug metabolism. Preferably, the toxins are conjugated to avail excretion in bile or urine.

The liver converts ammonia to urea.

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5
Q

Role of albumin

A

retains fluid in vascular compartment

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6
Q

What is bilirubin?

A

Bilirubin is the main bile pigment that is formed from the breakdown of heme in red blood cells.

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7
Q

Why does bilirubin need to be conjugated? How?

A

Bilirubin is in a lipid-insoluble form that must be made water-soluble to be excreted.

The free, or unconjugated, bilirubin is carried by albumin to the liver, where it is converted or conjugated and made water soluble by glucuronyl transferase

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8
Q

What is the difference between direct and indirect bilirubin

A

Direct bilirubin is conjugated with glucuronic acid
Indirect bilirubin is not conjugated to the liver and it attaches to the carrier protein albumin.

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9
Q

What are the clinical manifestations of liver disease?

A

Jaundice
Loss of appetite
Pale stools
Dark urine
Itching
Swelling of the abdomen, ankles and feet
Excessive fatigue
Bruising and easy bleeding
Hepatic coma

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10
Q

Clinical manifestations of liver disease - jaundice

A

Yellow colour comes from bilirubin

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11
Q

Clinical manifestations of liver disease - pale stool

A

occurs when the secretion of bile pigments is blocked due to obstruction in bile duct

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12
Q

Clinical manifestations of liver disease - Itching

A

when bilirubin is deposited in the skin - causes an intense itch

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13
Q

Clinical manifestations of liver disease - swelling

A

due to decreaed osmotic pressure due to decreased albumin hn the blood and therefore accumulation of fluid in tissues

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14
Q

Clinical manifestations of liver disease - dark urine

A

occurs when conjugated bilirubin is excreted in urine

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15
Q

Clinical manifestations of liver disease - bruising and easy bleeding

A

clotting factors are not being produced by liver

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16
Q

Clinical manifestations of liver disease - Hepatic coma

A

failure of liver to remove toxic substances such as ammonia from the blood

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17
Q

Liver function tests

A

Albumin: normal range: 3.9 to 5.0 g/dL
- decreased levels sign of liver failure
Total bilirubin: normal range: 0.1–1.2 mg/dL.
- raised in prehepatic, hepatic, and post hepatic abnormalities

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18
Q

Types of Jaundice

A

pre-hepatic jaundice
intra-hepatic jaundice
post-hepatic jaundice

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19
Q

Pre-hepatic jaundice

A

Occurs when a condition speeds up the breakdown of red blood cells
e.g. malaria, sickle cell anaemia, thalassaemia.

The bilirubin raised in the blood is unconjugated

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20
Q

Intra-hepatic Jaundice

A

causes include: Viral hepatitis, alcoholic hepatitis, paracetamol overdose, leptospiroses and liver cancer.

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21
Q

What is Hepatitis?

A

Inflammation of the liver

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22
Q

How long does acute and chronic hepatitis last?

A

Acute - immune system clears the virus within 6 months

Chronic - infection lasts longer because the immune system is unable to clear the virus

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23
Q

What are the causes of Hepatitis?

A

Drugs
Toxins
Alcohol
Infections (A,B,C,D,E)
Other infections: parasites, bacteria and fungus
Physical damage

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24
Q

What is Hepatitis A?

A

Single stranded RNA virus
Acute infection and provides lifelong immunity.
Incubation period: 30 days average

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25
Q

How is Hepatitis A transmitted?

A

Fecal contamination in food or water
Contaminated shellfish

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26
Q

Is Hepatitis A spread through salvia, kissing and sneezing?

A

no

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27
Q

When is a person with hepatitis most contagious?

A

2 weeks before the person feels unwell

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28
Q

What are the clinical features of Hepatitis A?

A

Fever, malaise and anorexia - 3-6 weeks post incubation

Most infections with HAV are anicteric (w/o jaundice) and remain undetected.

HAV never peruses a chronic course. There is no carrier state and infection provides lifelong immunity

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29
Q

How is Hepatitis A diagnosed?

A

Anti-HAV IgM suggests acute infection

Anti-HAV IgG suggests past infection and is common over the age of 50

Liver enzyme levels may be raised

Stool test for the presence of virus

30
Q

What isthe presense of HBeAg in a hosts serum associated with?

A

High rate of viral replication and infectivity

31
Q

How is Hepatitis A treated?

A

Rest, fluid intake, and symptom management
Most people recover completely and become immune to reinfection

32
Q

How are vaccines for HAV developed?

A

Developed from formalin-inactivated , cell culture-derived virus.
2 doses, administered 1 month apart

33
Q

Who are Hepatitis A vaccinations recommended to?

A

travellers to third world countries

34
Q

What is Hepatitis B?

A

DNA virus - partial double stranded
Incubation period: 60-90 days on average
Can cause serious diseases

35
Q

How is Hepatitis B transmitted?

A

Direct contact with blood or bodily fluids

36
Q

Can Hepatitis B be transmitted though food water or casual contact?

A

No

37
Q

What are the possible outcomes of infection with the Hepatitis B virus (HBV)?

A
38
Q

What are the types of Hepatitis B?

A
  1. Acute Hepatitis B
  2. Fulminant Hepatitis B
  3. Chronic Hepatitis
  4. Hepatitis B carriers
39
Q

What are the clinical features of Acute Hepatitis B?

A

Most patients have acute HVB - similar to that produced by HAV - complete recovery and lifelong immunity

40
Q

What are the clinical features of Fulminant Hepatitis B?

A

Rare.
Characterised by massive liver cell necrosis, hepatic failure and high mortality rate.

41
Q

What are the clinical features of chronic hepatitis?

A

In 5-10% of patients
HBs antigenemia does not resolve > infections persists > disease progresses to chronic hepatitis B.

42
Q

What are the clinical features of Hepatitis B carriers?

A

Elevated serum alanine aminotransferase levels.

43
Q

Who is considered a Hepatitis B carrier?

A

Individuals who remain HBsAg positive for at least 6 months.
Carriers may have chronic hepatitis B.

44
Q

Hepatitis B and pregnancy?

A

A woman with Hepatitis B can transfer infection to her baby at birth

Babies with Hep B can get very sick, can develop chronic infection, cirrhosis or liver cancer

Pregnant women should be tested for Hep B

All Babies should get Hep B vaccine at birth

45
Q

How is Hepatitis B diagnosed?

A

Hepatitis surface antigen (HBsAg) screening – blood test

PCR test to detect and measure the amount of HBV DNA

ALT and bilirubin levels raised in blood

46
Q

What is the treatment for HBV?

A

Lamivudine (Epivir), Adefovir (Hepsera), Tenofovir (Viread), Telbivudine

47
Q

Who is vaccination of Hepatitis B given to?

A

High risk groups

48
Q

What is the dosage of the vaccination for hepatitis B?

A

Three doses given
1st and 2nd one month apart and 3rd dose 5 months later

95% protective

49
Q

What is the HBV vaccine? How protective is it?

A

Recombinant HBsAg vaccine
95%

50
Q

Describe the pathogenesis of Hepatitis A & B?

A
51
Q

What is Hepatitis C?

A

Positive Single Stranded RNA virus
Incubation period: 6-7 weeks on average

52
Q

How is Hepatitis C transmitted?

A

Shared injection equipment (60%)
Blood transfusion
Sexual intercourse
Mother to baby
10-20% - no identifiable risk factors

53
Q

Is there a vaccine available for Hepatitis C?

A

No effective vaccine

54
Q

What percentage of patients develop chronic Hepatitis C?

A

80

55
Q

What is the lifecycle of Hepatitis C Virus?

A
  1. Viral entry
  2. viral replication and assembly - HCV genome does not enter through the nucleus
    RNA replication occurs in the cytoplasm of hepatocytes.
  3. release of virus through budding
56
Q

What is the Pathogenesis of the Hepatitis C Virus?

A
57
Q

How is Hepatitis C diagnosed?

A

Detection of anti-HCV antibodies
Positive antibody test followed by additional testing for the presence of hepatis C virus (PCR)
To check for liver function: live enzyme tests or a liver biopsy

58
Q

How is Hepatitis C treated?

A

combination of Pegylated interferon-alpha-2a OR
Pegylated interferon-alpha-2b and ribavirin (aniviral) for a period of 24 or 48 weeks, depending on hepatitis C virus genotype

59
Q

What are the types of alcohol hepatitis?

A
  1. Fatty liver (steatosis) - accumulation of fat within hepatocytes - is irreversible
  2. Hepatitis (steatohepatitis) - fatty liver with inflammation
    can range from mild hepatitis, to severe liver dysfunction with complications
  3. Cirrhosis
60
Q

What is cirrhosis?

A

Characterised by fibrosis (scarring) and structurally abnormal nodules with loss of function

61
Q

What is the cause of cirrhosis?

A

Caused by many forms of liver diseases and conditions
such as hepatitis and chronic alcoholism

62
Q

What can cirrhosis lead to?

A

Portal hypertension

63
Q

What are the complications of cirrhosis?

A

Ascites - abnormal build up of fluid in the abdomen
Hepatocellular carcinoma

64
Q

What is appendicitis?

A

Inflammation of the appendix

65
Q

What are the signs and symptoms of appendicitis?

A

Abdominal pain
Anorexia, nausea and vomiting
Low grad fever
leukocytosis - increased level of leukocytes

66
Q

What are the causes of appendicitis?

A

Obstruction of the appendix lumen
- most commonly faecaliths
- less commonly by tumors, mass of works, foreign body

67
Q

Describe the pathogenesis of appendicitis.

A
  1. Luminal obstruction
  2. Bacterial stasis and inflammation
  3. Distension
  4. Ischemia
  5. Focal necrosis
  6. Perforation
68
Q

How is Appendicitis diagnosed?

A

High WBC count: 12,000 – 18,000

HCG Negative

Signs & symptoms

69
Q

What are the complications of Appendicitis?

A

Perforation (75% risk at 48h)
Abscess
Peritonitis
Septicaemia

70
Q

What treatments are available for appendicitis?

A

Antibiotics before surgery
Appendectomy in uncomplicated cases
Laparotomy – open abdominal surgery
Laparoscopic surgery

71
Q

What is the daily production of bilirubin?

A

250-350mg

Pathology (11 decks)

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