Liver- Cirrhosis & Neoplasms Flashcards
what mediates (what cytokine) fibrosis in cirhosis
TGF-B from stellate cells which lie beneath the endothelial cells that line the sinusoids
what are 4 things that portal HTN leads to?
- ascitis
- congestive splenomegaly/hypersplenism
- portosystemic shunts
- hepatorenal syndrome
what are the 3 classical portosystemic shunts
esophageal varices, hemorrhoids and caput medusae
what is hepatorenal syndrome
rapidly developing renal failure secondary to cirrhosis
what causes the eventual coma in cirrhosis
increased serum ammonia levels
what are some SE that can be seen because the loss of the liver’s ability to metabolize estrogen
gynecomastia
spider angiomata
palmar erythema
how do you follow the degree of coagulation factor deficiency caused by hepatic cirrhosis?
follow the PT
what is the most common cause of liver disease in the west?
alcohol related liver disease
what is the appearance of the liver in alcohol related liver disease
heavy, greasy liver (resolves with abstinence)
what metabolite of alcohol mediates the cell damage?
acetaldehyde
what are mallory bodies and when are they seen?
they are damaged cytokeratin filaments and they are seen in alcohol related liver disease
what liver enzyme is more elevated in alcoholic related liver disease?
both AST and ALT are elevated but AST it more markedly elevated
so some one has fatty liver disease and they sayyyy they dont drink but you know that sometimes people hide that shitttt so how do you tell if his fatty liver is due to alcohol or not
NONalcoholic fatty liver disease is a diagnosis of exclusion.. so you gotta have some faith in da patient
but also their ALT will be “more elevated” than their AST (and its opposite in alcoholic related fatty liver)
what word..
“ excess body iron leading to deposition in tissues”
hemosiderosis
what word..
“ excess body iron leading to deposition in tissues and organ damage”
hemachromatosis
what is technically causing the damage in hemachromatosis
formation of free radicals
what causes primary hemachromatosis?
due to mutation in HFE gene (usually C282Y)
what causes secondary hemachromatosis?
chronic transfusions
what is the classic triad of symptoms seen in hemachromatosis
cirrhosis, secondary DM and bronze skin
what are some other signs/symptoms that can be see in hemachromatosis (besides the triad)
dilated cardiomyopathy
cardiac arrhythmias
gonadal dysfunction (due to testicular atrophy)
what do the labs show in hemachromatosis ferritin TIBC serum iron % saturation
ferritin- increase
TIBC- decrease
serum iron- increase
% saturation- increase
soooo normal aging of the liver will show brown spots (lipofuscin), but you’re telling me that in hemachromatosis there is also brown spots in the liver, so when i get a tricky question how am i suppose to know what the cause is
prussian blue stain distinguishes iron (blue) from lipofuscin
you have a recessive defect in ATP7B, what disease do you have? what does this gene encode for?
wilsons disease
gene encodes for an ATP mediated hepatocyte copper transport
how does wilsons disease present
presents in childhood with cirrhosis, neurologic manifestations and kayser fleisher rings in cornea
