Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2 - Diseases Of The Human System > Liver Diseases > Flashcards

Liver Diseases Flashcards

1
Q

What is jaundice?

A

Accumulation of bilirubin in the skin
* Pigmentation yellow/orange
* Significant Itch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is jaundice most noticeable?

A

sclera of the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathway for haem breakdown?

A

erythrocytes > heme > biliverdin > bilirubin > conjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What will happen if the bilirubin is not conjugated?

A

it will not be excreted and therefore it will accumulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is bilirubin excreted as in urine?

A

urobilin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is bilirubin excreted as in stool?

A

stercobilin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 classifications of jaundice?

A

pre-hepatic
hepatic
post-hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why would there be excess bilirubin due to pre-hepatic causes?

A

increased haem load (excess breakdown of RBCs)
due to
autoimmune
spleen issues
abnormal RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why would there be excess bilirubin due to hepatic causes?

A

liver cell failure
due to
cirrhosis
hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why would there be excess bilirubin due to post-hepatic causes?

A

biliary, gall bladder and pancreatic disease causing obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the reasons there may be excessive quantities of RBC breakdown products?

A
  • Haemolytic anaemia
  • Post transfusion (bad match)
  • Neonatal (maternal RBC induced)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why does hepatic failure cause jaundice?

A

Prevents metabolism of RBC breakdown products - no conjugation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What colour is the stool/urine in hepatic jaundice?

A

pale stool/urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can cause a obstruction to the intrahepatic biliary system?

A

primary biliary cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can cause a obstruction to the extrahepatic biliary system? (gall bladder and common bile duct)

A

Gall bladder
- Gall stones

Common bile duct
- Pancreatic carcinoma
- Cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can gall stones do?

A
  • Can block biliary tree - obstructive jaundice
  • Can cause inflammation
  • Can move out to biliary tree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is inflammation of the gall bladder called?

A

cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are symptoms of gall bladder diseases?

A
  • Pain in SHOULDER tip - due to relation with diaphragm and C 3,4,5 nerves
  • Abdominal Pain Right side
  • Pain brought on by eating Fatty food
  • Stimulates bile release by contraction of the gall bladder.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is gall bladder disease usually caused by?

A
  • Usually Gall stones
  • Rarely Cholangiocarcinoma (bile duct cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can jaundice be imaged? And what does it show?

A
  • Ultrasound - Detects dilated bile channels WITHIN the
    liver, also dilated biliary tree
  • Plain Radiographs - Show RADIOPAQUE gall stones
  • ERCP -Endoscopic Retrograde Cholangio Pancreatography - Contrast radiograph of biliary tree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is a ERCP carried out?

A

using an endoscope to put a cannula into the biliary tree from duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where is a cholangiocarcinoma tumour most severe?

A

extra hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two causes of pancreatitis?

A

role of alcohol in chronic pancreatitis
role of mumps virus – usually temporary

24
Q

What common disease is usually a consequence of chronic pancreatic disease?

A

diabetes

25
Q

What do patients with cystic fibrosis require?

A

oral pancreatic enzyme supplements

26
Q

How is jaundice managed at pre-hepatic?

A

identify and treat the cause - spleen, anaemia, autoimmune

27
Q

How is jaundice managed at post-hepatic?

A

Remove obstruction
* Gall stones via ERCP
* Gall Stones via lithotripsy (ultrasound to break stones)
* Force open channel with a stent (biliary tree stent)
* Prevention of Gall stone recurrence - remove gall bladder (cholecystectomy)

28
Q

How can build up of bile acid be prevented?

A
  • Ursodeoxycholic Acid tablets
  • Low calorie & low cholesterol diet
29
Q

How can bile acid resorption form the GIT be prevented?

A

cholestyramine sachets

30
Q

What is neonatal jaundice due to?

A
  • Increased Haem breakdown - Birth trauma
  • ABO & Rhesus incompatibility
  • Poor liver function in neonate
31
Q

What is the risk of neonatal jaundice?

A

kernicterus
brain damage from bilirubin as brain-blood barrier not fully developed

32
Q

What is the treatment for neonatal jaundice?

A

phototherapy
- blue light cause bilirubin to breakdown and get excreted

33
Q

What is acute liver failure and what can it cause?

A

Sudden loss of liver function

Rapid death from:
* Bleeding
* Encephalopathy

34
Q

What is the cause of acute liver failure?

A

paracetamol poisoning
free radical damage to hepatocytes caused by processing paracetamol through alternative pathway due to blockage/overloading of normal pathway

35
Q

What is the treatment for acute liver failure?

A

liver will usually recover given time if patient can be kept alive

transplant often the only option

36
Q

What are the causes of chronic liver failure?

A
  • Cirrhosis
  • Primary liver cancer
  • Secondary liver cancer (metastases from bowel tumours)
37
Q

What is cirrhosis?

A

damage, fibrosis & regeneration of liver structure
standard triad may be damaged

38
Q

What are the causes of cirrhosis?

A
  • Alcohol
  • Primary Biliary Cirrhosis
  • viral disease - chronic active hepatitis
  • autoimmune chronic hepatitis
  • Haemachromatosis (too much iron irratites the liver)
  • Cystic fibrosis
39
Q

What does a small liver mean and what does a large liver mean?

A

small = shrunken and fibrinoid
large = inflammation

40
Q

What are the signs and symptoms of cirrhosis?

A
  • Acute bleed - portal hypertension and oesophageal varices
  • Jaundice
  • Oedema & ascites (abdominal fluid from portal vein to peritoneum)
  • Encephalopathy (toxic materials reach brain as liver can’t remove them)
  • Spider naevi, palmar erythema due to high oestrogen levels from reduced metabolism
41
Q

Why does ascites occur?

A
  • High portal venous pressure
  • Low plasma protein synthesis
  • Lower oncotic pressure

Fluid leaks out

42
Q

How do oseophageal varices occur?

A

Disordered portal triads in liver cirrhosis cause portal hypertension

  • Blood engorges as passes through vessels at the end of the embryological gut – lower oesophagus – getting from left gasric vein to portal vein to the systemic circulation
  • Veins dilated and fragile – thin walled
  • Protrude into oesophageal lumen – easy to rupture and can lead to catastrophic bleed
43
Q

What synthesis functions are lost in liver failure?

A
  • plasma proteins
  • Transporting proteins
  • Gamma globulin
  • clotting factors (rupture of varices can be fatal)
  • hormones
44
Q

What metabolic functions are lost in liver failure?

A
  • drug metabolism (esp. 1st pass)
  • detoxification
  • conjugation of RBC breakdown products
45
Q

What enzymes escape liver cells if they are damaged or inflamed?

A

ALT
GGT

46
Q

What tests are done for liver function?

A

hepatic cell enzyme levels (raised in liver inflammation)

INR

47
Q

What does the INR measure?

A

Measures PROTHROMBIN time against a control (lab worker!)
* Prothrombin > Thrombin

48
Q

Why is the INR measured in liver disease?

A

prothrombin and vitamin K (essential in blood clotting) are produced in the liver

49
Q

What is the normal INR value?

A

1

50
Q

What is the range of INR id on warfarin?

A

2-4

51
Q

What does it mean if the INR is not 1?

A

SIGNIFICANT liver synthetic dysfunction

52
Q

What are the effects of liver failure?

A
  • fluid retention – ascites
  • Portal Hypertension - Oesophageal Varices
  • inability to remove ‘waste’ - urea
  • Encephalopathy
  • build up of haem breakdown products - JAUNDICE
53
Q

What is the INR for liver failure?

A
  • raised INR and prolonged bleeding
  • 1.3 is HIGH for non warfarin patient
    due inadequate liver synthesis of clotting factors
54
Q

What is the treatment of liver failure?

A

transplantation
possibly artificial liver systems similar to dialysis (MARS)

55
Q

How much of the liver can be used?

A

each liver has 3 lobes that can be transplanted for a different patient

56
Q

What are the metabolic considerations for liver failure in dentistry?

A

Prolonged effect of sedatives
- Avoid intravenous sedation!!

Care with antifungals
* avoid miconazole, erythromycin and tetracycline (toxic injury

Suitable analgesics
- Paracetamol probably the safest
- NSAIDS increase bleeding risk

57
Q

What are the synthetic considerations for liver failure in dentistry?

A

Reduced clotting factor synthesis
- Bleeding tendency
- Work with Haematologist - fresh frozen plasma?

  • Reduced plasma transport protein synthesis
  • Drug binding reduced - dose may need reduced
  • Reduced ‘gamma globulin’ synthesis
  • More prone to infections?

NO problem with Local Anaesthetics
-Metabolised in the plasma, not the liver!

2 - Diseases Of The Human System (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions