liver disease Flashcards
where is AST vs ALT found originally ?
AST - located in the mitochondria
ALT located in the cytoplasm
which liver enzyme is mostly elevated in alcoholic hepatitis ?
AST
which liver enzyme is associated with hepatocellular damage ?
ALT
what are the different sources of ALP ?
liver
bones
GIt
when is ALP increased ( lover associated)?
in cholestasis - any obstruction of bile flow
what are the non liver conditions where ALP is elevated ?
pregnancy
thyroid disease
bone disease
how can we determine the source of rised ALP ?
by measuring the GGT
elevated in cholestatic pattern but not elevated in bone disease
what are the conditions associated with increased GGT levels ?
cholestatic disease
heavy alcohol consumption
what other enzyme can be used to determine the source of elevated ALP ?
5 nucleotidase
what are the liver function tests ?
albumin ( decrease in dysfunction)
PT /PTT ( increase)
glucose ( decrease )
what are the different problems that alcohol can cause in the liver ?
alcoholic fatty liver disease
acute hepatitis
cirrhosis
what is the cause of alcoholic fatty disease ?
accumulation of fatty acids
asymptomatic conditions
may be enlarged in an alcholic
what kind of toxin is alcohol ?
mitochondrial toxin
which zone of the liver lobule is highly affected by alcohol ?
zone 3
where fatty infiltration is first affected
what is NAFLD ?
non alcoholic fatty liver disease
often asymptomatic
associated with obesity
may progress to cirrohsis
when does alcoholic hepatitis classically happen ?
classically occurs after heavy binge drinking on top of long history of alcohol consumption
present with jaundice and RUQ pain
what is alcoholic hepatitis a toxic effect from ?
due to the formation of acetaldehyde
what is found on biopsy of people with alcoholic hepatitis ?
mallory bodies
caused due to the damaged intermediate filaments in hepatocytes
what is budd chiari syndrome ?
thrombosis of hepatic veins
what is the presentation of budd chiari syndrome ?
ascites
abdominal pain
hepatomegaly
which zone of the liver lobule is first affected by budd chiari ?
zone 3
what are the common causes of budd chiari syndrome ?
myeloproliferative disorders
hepatocellular carcinoma
OCP/pregnancy
hypercoaguable state
how does right heart failure cause cirrhosis ?
also called cardiac cirrohsis
rare cause of liver failure
chronic liver edema causes cirrhosis
what is distinctively seen in cardiac cirrohsis ?
nutmeg liver
mottled like a nutmeg
what is reyes syndrome ?
rare cause of liver failure with encephalopathy
associated with children who have a virus infection and are then treated with aspirin
classically chicken pox and influenza B
how does aspirin cause the liver failure in reyes syndrome ?
aspirin inhibits beta oxidation
what is the only condition where aspirin should not be avoided in children ?
kawasaki disease
what is the mode of inheritance of alpha 1 anti trypsin deficiency ?
autosomal co-dominant
what is the presentation of children with alpha 1 anti trypsin deficiency ?
has emphysema - no smoke exposure
liver cirrhosis - pathologic polymerization of AAT, occurs in endoplasmic reticulum
what are the histological findings associated with alpha 1 anti trypsin deficiency in the liver ?
AAT polymers stain purple with PAS
resist digestion by diastase ( unlike glycogen)
what are the causes of liver abscess in the US vs developing countries ?
US - bacteremia , cholangitis (GN rods, klebsiella )
entamoeba histolytica and echinococcus in developing countries
what is the most common vs most specific antibody abnotrmality with autoimmune hepatitis ?
ANA - most common
Ansti smooth muscle antibody - more specific
what is the maximum dose for tylenol ?
4 grams every 24 hours
what is the danger of tylenol overdose ?
acute liver failure
what is the treatment for acetomeniphone overdose ?
activated charcoal
n-acetylcysteine
which of the metabolites of acetaminophen is toxic to the liver ?
NAPQI
what is shock liver ?
also called ischemic hepatitis
due to hypo perfusion - hypotension or shock
which zone is associated with shock liver ?
zone 3 near the central vein
