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Pathophysiology > Liver cont. > Flashcards

Liver cont. Flashcards

1
Q

This is a progressive, patterned fibrosis of the entire liver

A

Cirrhosis

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2
Q

What is the most common cirrhosis

A

Portal cirrhosis

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3
Q

What causes cirrhosis

A

Repeated episodes of liver necrosis with regeneration and repair and SCARRING

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4
Q

What are the most common causes of cirrhosis

A
  • Alcoholism

- Chronic hepatitis

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5
Q

This results from chronic inflammation of the bile ducts

A

Biliary cirrhosis

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6
Q

Describe biliary cirrhosis

A
  • Autoimmune

- Usually due to secondary things like gallstones

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7
Q

What is Sclerosing cholangitis

A

A cause of bile duct inflammation associated with ulcerative colitis

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8
Q

Describe a cirrhotic liver

A

-Small, scarred, and retracted

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9
Q

In early stages of cirrhosis the liver can be ______

A

fatty

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10
Q

T/F- Iron deposits (hemochromatosis) and accelerated emphysema are common in cirrhosis

A

True

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11
Q

What is equilalent to portal hypertension

A

over 30 cm H2O

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12
Q

What causes portal hypertension

A

Obstruction of portal flow

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13
Q

What are S&S of cirrhosis

A
  • Ascites
  • Congestive splenomegaly
  • Varicosities
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14
Q

What are hemodynamic consequences of portal hypertension

A
  • Ascites
  • Congestive splenomegaly
  • Esophageal varicies
  • Hemorrhoids
  • Prominent periumbilical veins (caput medusa)
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15
Q

What does portal hypertension cause?

A
  • hemorrhoids
  • esophageal varices
  • splenomegaly
  • caput medusa veins radiating from the umbilicus, and contributes to the formation of ascites.
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16
Q

The failing of hepatic metabolism of estrogen results in…

A

High blood estrogen

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17
Q

S&S of high blood estrogen

A
  • Gynecomastia
  • Thickening of scalp and genital hair
  • Palmar erythemia
  • Atrophic testes
  • Spider angiomas
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18
Q

These result from failing hepatic metabolism of ammonia

A
  • Hepatic coma

- Fetor hepaticus (liver breath)

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19
Q

Failure of excretion of bilirubin causes…

A

Jaundice

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20
Q

What does failing hepatic protein sysnthesis cause?

A

-Decrease in plasma albumin–> ascites and edema–> decreased levels of coagulation factors–> bleeding due to increased PT and PTT –> bruising

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21
Q

Common findings in acute alcohol abuse

A

-Steatosis (fatty liver)

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22
Q

Common findings in chronic alcohol abuse

A
  • Cirrhosis
  • Gastric ulcers
  • Accidents
  • Thiamine deficiency
  • Cardiomyopathy
  • Pancreatitis
  • Hypertension
  • Spontaneous abortion
  • Fetal alcohol syndrome
  • Cancers of the mouth, throat, larynx, esophagus, pancreas, and bladder
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23
Q

What does alcohol do to hepatocytes

A

ALCOHOL DAMAGES HEPATOCYTES

24
Q

What are the 3 stages of liver damage?

A
  • Steatosis
  • Hepatitis
  • Cirrhosis
25
Q

How does steatosis manifest?

A

Large clear areas within the hepatocytes

-they are filled with fat

26
Q

What are councilman bodies?

A

Necrotic liver cells that are caused by HEPATITIS

27
Q

What are the 3 things that indicate hepatitis

A
  • Necrotic liver cells (councilmen bodies)
  • Intracellular degenerative inclusions (Mallory bodies)
  • Fibrosis
28
Q

What are ways that hepatitis A-E differ?

A
  • Mode of transmission
  • Length of incubation period
  • if a carrier state can occur
  • if chronic hepatitis can occur
  • if fulminant hepatitis can occur
  • is there increased risk for liver cancer
29
Q

Describe Hep A

A
  • Spread by fecal oral route
  • Mild, self limiting
  • DOES NOT lead to severe consequences like cirrhosis or liver cancer
30
Q

What do Hep B and C have in common?

A
  • Spread by bodily fluids
  • Long viremia
  • Carrier state
  • Chronic hep
  • Increased risk for liver cancer
31
Q

Describe asymptomatic hepatitis

A
  • No symptoms

- Usually discovered on routine labwork with elevated liver enzymes

32
Q

___________ is an asymptomatic chronic infection that you still have the virus and CAN infect others

A

Carrier state

33
Q

What kind of hepatitis has a carrier state?

A

Mainly Hep C

34
Q

What are the phases of acute viral hepatitis?

A
  • Incubation
  • Symptomatic prejaundice
  • Symptomatic jaundice
  • Convalescence
35
Q

In what heps do you see jaundice?

A
  • MOST HEP A
  • half Hep B
  • Very few Hep C
36
Q

How do you diagnose chronic viral hepatitis

A
  • Liver biopsy

- 6 months or more of lab evidence

37
Q

What types of hep lead to chronic

A
  • NO Hep A
  • 10% Hep B
  • 50% Hep C
38
Q

_________ acute disease progressing rapidly to hepatic failure and encephalopathy in a matter of weeks

A

Fulminant Hepatic failure

39
Q

What types of Hep do you see fulminant hepatic failure?

A

Hep A

Hep B

40
Q

What Heps do you have an increased risk of cancer

A

Hep B

Hep C

41
Q

_______ is a benign, self-limited disease with no carrier state or chronic hepatitis

A

Hep A

42
Q

________ is transmitted by personal contact and oral-fecal contamination of food and water

A

Hep A

43
Q

clinical phases and blood markers of infection=

A

Hep A

44
Q

When do IgG and IgM appear in Hep A and what does it mean?

A
  • IgM appears when there are acute phase antibodies in the blood
  • IgG appears when there is immunity against the infection/reinfection
45
Q

_________ is much more serious and may cause symptomatic acute hepatitis, fulminant hepatitis with massive liver necrosis, or chronic hepatitis that may advance to cirrhosis; a small percent of patients becomes carriers.

A

Hep B

46
Q

How is Hep B transmitted?

A
  • Transfusions
  • Blood products
  • Renal dialysis
  • Needle stick accidents
  • IV drug use
  • Sex
47
Q

Describe Hep B acute infection

A
  • Rapid appearance of virus in blood before symptoms
  • Disappearance of virus in the blood
  • Appearance of antibodies for hep B surface antigen (this marks the recovery phase)
48
Q

What are the S&S for chronic hepatitis?

A
  • Continued jaundice
  • Clinical S&S
  • Continued presence of Virus in blood (HBsAG)
49
Q

What signals Hep B carrier state?

A
  • Disappearance of S&S

- Persistance of virus in the blood

50
Q

Is there a vaccine for Hep B?

A

YESSSS- reduced the number of infections by a lot!!

51
Q

Do most people recover completely from Hep B?

A

Yes because they develop antibodies to HBsAg

52
Q

If you have chronic hep B what are you at risk for?

A
  • Cirrhosis

- Liver cancer

53
Q

What indicates an acute infection for Hep C

A

-Permanent disappearance of clinical S&S and virus in blood

54
Q

What indicated chronic hep C?

A
  • Reappearance of jaundice or S&S

- Persistent levels of virus in the blood

55
Q

What indicates the hep C carrier state?

A

Persistent evidence of virus in the blood

56
Q

What percentage of people with Hep C recover?

A

50% recover completely

  • majority develop chronic hepatitis
  • 1/3 of chronic patients develop cirrhosis and have a high chance of getting cancer

Pathophysiology (18 decks)

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