Liver cont. Flashcards
This is a progressive, patterned fibrosis of the entire liver
Cirrhosis
What is the most common cirrhosis
Portal cirrhosis
What causes cirrhosis
Repeated episodes of liver necrosis with regeneration and repair and SCARRING
What are the most common causes of cirrhosis
- Alcoholism
- Chronic hepatitis
This results from chronic inflammation of the bile ducts
Biliary cirrhosis
Describe biliary cirrhosis
- Autoimmune
- Usually due to secondary things like gallstones
What is Sclerosing cholangitis
A cause of bile duct inflammation associated with ulcerative colitis
Describe a cirrhotic liver
-Small, scarred, and retracted
In early stages of cirrhosis the liver can be ______
fatty
T/F- Iron deposits (hemochromatosis) and accelerated emphysema are common in cirrhosis
True
What is equilalent to portal hypertension
over 30 cm H2O
What causes portal hypertension
Obstruction of portal flow
What are S&S of cirrhosis
- Ascites
- Congestive splenomegaly
- Varicosities
What are hemodynamic consequences of portal hypertension
- Ascites
- Congestive splenomegaly
- Esophageal varicies
- Hemorrhoids
- Prominent periumbilical veins (caput medusa)
What does portal hypertension cause?
- hemorrhoids
- esophageal varices
- splenomegaly
- caput medusa veins radiating from the umbilicus, and contributes to the formation of ascites.
The failing of hepatic metabolism of estrogen results in…
High blood estrogen
S&S of high blood estrogen
- Gynecomastia
- Thickening of scalp and genital hair
- Palmar erythemia
- Atrophic testes
- Spider angiomas
These result from failing hepatic metabolism of ammonia
- Hepatic coma
- Fetor hepaticus (liver breath)
Failure of excretion of bilirubin causes…
Jaundice
What does failing hepatic protein sysnthesis cause?
-Decrease in plasma albumin–> ascites and edema–> decreased levels of coagulation factors–> bleeding due to increased PT and PTT –> bruising
Common findings in acute alcohol abuse
-Steatosis (fatty liver)
Common findings in chronic alcohol abuse
- Cirrhosis
- Gastric ulcers
- Accidents
- Thiamine deficiency
- Cardiomyopathy
- Pancreatitis
- Hypertension
- Spontaneous abortion
- Fetal alcohol syndrome
- Cancers of the mouth, throat, larynx, esophagus, pancreas, and bladder
What does alcohol do to hepatocytes
ALCOHOL DAMAGES HEPATOCYTES
What are the 3 stages of liver damage?
- Steatosis
- Hepatitis
- Cirrhosis
How does steatosis manifest?
Large clear areas within the hepatocytes
-they are filled with fat
What are councilman bodies?
Necrotic liver cells that are caused by HEPATITIS
What are the 3 things that indicate hepatitis
- Necrotic liver cells (councilmen bodies)
- Intracellular degenerative inclusions (Mallory bodies)
- Fibrosis
What are ways that hepatitis A-E differ?
- 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
Describe Hep A
- Spread by fecal oral route
- Mild, self limiting
- DOES NOT lead to severe consequences like cirrhosis or liver cancer
What do Hep B and C have in common?
- Spread by bodily fluids
- Long viremia
- Carrier state
- Chronic hep
- Increased risk for liver cancer
Describe asymptomatic hepatitis
- No symptoms
- Usually discovered on routine labwork with elevated liver enzymes
___________ is an asymptomatic chronic infection that you still have the virus and CAN infect others
Carrier state
What kind of hepatitis has a carrier state?
Mainly Hep C
What are the phases of acute viral hepatitis?
- Incubation
- Symptomatic prejaundice
- Symptomatic jaundice
- Convalescence
In what heps do you see jaundice?
- MOST HEP A
- half Hep B
- Very few Hep C
How do you diagnose chronic viral hepatitis
- Liver biopsy
- 6 months or more of lab evidence
What types of hep lead to chronic
- NO Hep A
- 10% Hep B
- 50% Hep C
_________ acute disease progressing rapidly to hepatic failure and encephalopathy in a matter of weeks
Fulminant Hepatic failure
What types of Hep do you see fulminant hepatic failure?
Hep A
Hep B
What Heps do you have an increased risk of cancer
Hep B
Hep C
_______ is a benign, self-limited disease with no carrier state or chronic hepatitis
Hep A
________ is transmitted by personal contact and oral-fecal contamination of food and water
Hep A
clinical phases and blood markers of infection=
Hep A
When do IgG and IgM appear in Hep A and what does it mean?
- IgM appears when there are acute phase antibodies in the blood
- IgG appears when there is immunity against the infection/reinfection
_________ 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.
Hep B
How is Hep B transmitted?
- Transfusions
- Blood products
- Renal dialysis
- Needle stick accidents
- IV drug use
- Sex
Describe Hep B acute infection
- 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)
What are the S&S for chronic hepatitis?
- Continued jaundice
- Clinical S&S
- Continued presence of Virus in blood (HBsAG)
What signals Hep B carrier state?
- Disappearance of S&S
- Persistance of virus in the blood
Is there a vaccine for Hep B?
YESSSS- reduced the number of infections by a lot!!
Do most people recover completely from Hep B?
Yes because they develop antibodies to HBsAg
If you have chronic hep B what are you at risk for?
- Cirrhosis
- Liver cancer
What indicates an acute infection for Hep C
-Permanent disappearance of clinical S&S and virus in blood
What indicated chronic hep C?
- Reappearance of jaundice or S&S
- Persistent levels of virus in the blood
What indicates the hep C carrier state?
Persistent evidence of virus in the blood
What percentage of people with Hep C recover?
50% recover completely
- majority develop chronic hepatitis
- 1/3 of chronic patients develop cirrhosis and have a high chance of getting cancer
