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Med Path Fall 2020 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

4 main liver functions

A

Digestive
Endocrine
Hematologic
Excretory

Also: Detox, drains bile, glucose regulation, synthesizes and stores AA/proteins/vitamins.

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2
Q

Gall bladder function

A

Storage of bile

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3
Q

Pancreas functions (2)

A

Digestive, endocrine.

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4
Q

5 types of liver injury

A
  1. Toxic - ETOH, meds like acetaminophen
  2. Infectious
  3. Neoplastic- secondary is more common
  4. Metabolic- non alcoholic fatty liver disease
  5. Circulatory
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5
Q

4 stages of progressive liver disease

A

Normal liver can lead to hepatitis or steatosis by severe exposure.

Hepatitis- cell necrosis, inflammation
Steatosis- Accumulative adaptation. Fatty change.

Repeated attacks or continued exposure can lead to:
Cirrhosis- fibrosis, nodules

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6
Q

Two forms of liver degeneration

A

Hydrophobic (watery) due to toxins

Fatty due to alcohol, obesity, type 2 DM

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7
Q

Liver injury can result in:

A

Inflammation, degeneration (watery or fatty), necrosis, fibrosis.

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8
Q

How does fibrosis affect liver?

A

Scarring causes architectural change and reduces function.

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9
Q

Prehepatic jaundice vs hepatic jaundice vs posthepatic jaundice

A

Pre: Liver is fine. Excess production of bilirubin. Maybe hemolytic event.

Hepatic: Defective liver function due to hepatitis, drugs or cirrhosis.

post: Biliary obstruction, gallstones, pancreatic cancer.

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10
Q

Steatosis

  • Reversible?
  • Accumulation of what
  • Risk factors?
  • Increase risk of what
A

Reversible
Accumulation of triglycerides in liver cells
Risk factors: Alcohol, diabetes, obesity, high fat.
increase risk of hepatocellular carcinoma.

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11
Q

Fulminant hepatic failure

  • What is it
  • 2 main causes
A 
Rapidly progresses to hepatic failure and encephalopathy in weeks. 
due to acetaminophen overdose (46%) 
or hepatitis (10%)
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12
Q

Cirrhosis

A

Endpoint of liver disease.
Fibrosis of entire liver
Irreversible
Side effects: portal hypertension

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13
Q

Main causes of cirrhosis

A

Hepatitis C virus
Alcohol
Cryptogenic cirrhosis- at least 1 risk factor for NAFLD.

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14
Q

Portal HTN

  • causes
  • symptoms
A

Due to slow hepatic blood flow or enlarged spleen.

Anorexia, varices, ascites.

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15
Q

Most common complication of cirrhosis

A

Ascites
Increased hydrostatic pressure.
50% 2 year survival rate.

Kidney will activate RAAS when fluid in veins decrease because all the fluid is in the abdomen. This causes BP to increase = more HTN. Bad cycle.

results in widespread bleeding since coagulation cascade proteins are made in liver.

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16
Q

Main cause of acute liver failure

A

Acetaminophen

17
Q

How does hepatic failure affect men and women

A

Due to failure to metabolize estrogen and ammonia.

Men: Excess estrogen leading to gynecomastia, impotence, testicular atrophy, female hair distribution.

Women: Irregular periods, reddening of plasma, spider telangiectasia.

18
Q

How can hepatic failure cause multiple organ failure?

A

Due to portal hypertension.

19
Q

Liver function tests look at

A

enzymes, bilirubin, proteins, coagulation tests, hepatitis antigens, autoimmune antibodies

20
Q

Main 4 things to look for in blood panel if kidney failure

A 
Calcium 
Glucose
Creatinine
Albumin 
Blood urea nitrogen (BUN)
21
Q

What occurs during each of these stages and is recovery possible?

Fatty liver
Liver fibrosis
Cirrhosis

A

Fatty liver- deposits of fat causes liver enlargement. Strict abstinence= full recovery

Liver fibrosis- Scar tissue forms. Recovery possible, but scar tissue will remain.

Cirrhosis- Growth of connective tissue destroys liver cells and this is irreversible.

22
Q 
#1 cause of acute hepatitis 
#1 cause of chronic hepatitis 
#2 cause of chronic hepatitis
A

Viral
Viral
Alcohol

23
Q

After having viral hepatitis, you could become a carrier. Which type is most common for this to occur

A

Hep C > Hep B

Can usually clear A

24
Q

How to catch hep A, B, and C

A

A: oral fecal

B and C: needle, sexually

25
Q

Reyes syndrome

  • What is it
  • Due to what
  • Findings/main cause of death
  • __% mortality rate
A

Fatty liver + encephalopathy
Due to viral infection + aspirin. Which is why you never give someone under 15 aspirin. !!!!!!

Hypoglycemia is main cause of death

Prognosis poor 50% death

26
Q

Hepatocellular carcinoma

  • Risk factors
  • What protein is elevated in 70% of cases?
A

Risk- hepatitis B and C, aflatoxins from mods.

Elevated alpha fetoprotein that correlates with tumor.

27
Q

Hepatolenticular degeneration.

  • another name
  • What is it?
  • May see what in eye
A

Wilsons

  • Impaired excretion of copper= accumulation = toxic
  • Kayser Fleischer rings in K
28
Q

Gallbladder is stimulated by

A

Fat in the duodenum

29
Q

How are gallstones produced

-Risk factors

A

Supersaturated bile prob due to excess cholesterol.

Risk factors- elevated estrogen, obesity, age, cirrhosis.

30
Q

Exocrine and endocrine pancreas functions

A

Exocrine: Empties into duodenum. Produces zymogens (proteases) that are not activated until in intestine. Lipases, amylase, and protease inhibitors that prevent premature activation so they can’t act inside pancreas.

Endocrine: Produce insulin and glucagon

31
Q

Pancreatic diseases are usually related to what functions

A

Exocrine function- emptying into duodenum.

Ex: Premature activation of protease enzymes, obstruction of common bile duct, pancreatic malignancies- 80% mortality.

32
Q

Pancreatic cancers cause __% of cancer deaths

A

7%. Hard to treat.

33
Q

Acute pancreatitis. 50% are related to

A

Gallstones.
Short lived, usually resolves.

May cause organ failure due to shock or duodenal obstruction.

34
Q

Chronic pancreatitis. 60% related to

A

Alcoholism.
Does not resolve by self, progressive destruction.

May cause jaundice or intestinal malabsorption.

35
Q

Metabolic liver disease #1 example

A

NAFLD non alcoholic fatty liver disease.

Progressively gets worse.

36
Q

1 cause of drug induced liver damage

A

acetaminophen, ibuprofen

37
Q

Most common manifestations of NAFLD

A

Diabetes, obesity, high triglycerides.

First presents as steatosis- accumulation of fat. Reversible.

38
Q

How can NAFLD progress to cirrhosis

A

1/3 of adults have NAFLD (fat in liver. Reversible)

2% progress to NASH- non alcoholic steatosis hepatitis. (fat + inflammation)

10% convert to cirrhosis. Chronic inflammation and scarring.
**NAFLD is a big contributor to Cirrhosis.

39
Q

1 and #2 causes of cirrhosis

A 
Hep C (26%) 
Alcoholic liver disease (21%)

Med Path Fall 2020 (20 decks)

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