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GE > Liver diseases > Flashcards

Liver diseases Flashcards

1
Q

hepatitis

A
  • Inflammation+ fxn change
  • 2 types: acute, chronic
  • destruction of hepatocytes
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2
Q

acute hepatitis lasts how long?

A

< 6 months

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3
Q

chronic hepatitis lasts how long?

A

> 6 months

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4
Q

HAV- +ssRNA (infectious hepatitis)

A

– spreads through fecal

contamination of food and water, causes an acute and self-limiting infection, does not cause chronic hepatitis

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5
Q

HBV - +dsDNA (serum hepatitis)

A

– spreads through blood,
body fluids, sexual contacts, tattoos, mother to child
by breast feeding
causes chronic hepatitis, can cause cirrhosis and cancer

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6
Q

HCV - +ssRNA (serum non-A, non-B hepatitis )

A

– spreads
through sexual contacts and hemotransfusions, cross the placenta
most common causes chronic hepatitis, cirrhosis, liver cancer

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7
Q

HDV–ssRNA (serum delta hepatitis)

A

– the most aggressive
form, with high mortality rate, cannot exist without
B virus, spreads through the blood, typical for I.V. drugs
users and hemophilia patients,
causes chronic hepatitis, cirrhosis, liver cancer.
- coexists w/ HBV-dsDNA

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8
Q

HEV- +ssRNA (infectious hepatitis)

A

– spreads through
contaminated food and water,
often causes an acute and self-limiting infection,
but (unlike to hepatitis A) causes severe:
intralobular necrosis acute cholangitis,
does not cause chronic hepatitis

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9
Q

HFV (serum, mutated B-virus)

A

– spreads through blood
transfusion, or oral fecal route ,
causes chronic hepatitis
-DNA virus

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10
Q

HGV –(GB virus C)

A

-this is a new discovered hepatitis
virus, spreads by blood and sexual contact.
It does not appear to replicate primarily in the liver,
its characteristics are in the process of study.

  • RNA mutation of Hep C
  • spreads to lymph nodes
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11
Q

virus’s that cause hepatitis

A
  • Cytomagalovirus (Herpes 5)
  • Epstein-Barr virus (herpes type 4)
  • Yellow fever virus (jaundice)
  • Ebola virus and Marburg virus
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12
Q

toxic hepatitis could be caused by:

A
  • medications (e.g. Tylenol, birth control pills, Lipitor
    etc)
  • mushroom poison
  • alcohol (the most common
    cause of toxic hepatitis)
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13
Q

what bacteria causes hepatitis?

A
  • Staphylococci aureus and Streptococci pyogenes,
    causes Toxic Shock Syndromes
  • Leptospira (Gram-negative spirochaete) liver, brain, heart
  • Listeria (Gram- positive, non spore-forming, rods bascilla)
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14
Q

Protozoa causes of hep

A
  • toxoplasma

- leishmania

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15
Q

parasite that causes hep

A
  • echinococcus
  • toxocara
  • schistosoma
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16
Q

fungi that causes hep

A
  • aspergillus (liver cancer)
  • histoplasma capsulatum
  • candida
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17
Q

autoimmune disease that cause hep

A

sjogren’s syndrome

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18
Q

The incubation period

A
  • A: 28 days (range: 15-50 days)
  • B: 90 days (range: 30-150 days)
  • C: 50 days (range: 15-160 days)
  • D: 60-90 days (range: 30-180 days)
  • E: 40 days (range: 14-60 days)
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19
Q

Genetic causes of hep

A
  • alpha-1-antitrypsin def (abnormal accumulation of the protein within liver cells)
  • hemocromatosis (iron accumulates in liver)
  • wilson disease (copper)
  • glycogen storage disorders
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20
Q

ischemic hep

A
  • aka shock liver
  • ACUTE NEVER CHRONIC
  • associated with:
    • heart failure, shock, sepsis
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21
Q

viral, bacterial, fungal, and toxic etiological agents

usually result in:

A

acute hepatitis

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22
Q

autoimmune, parasites, protozoa, obesity

etiological agents usually result in

A

chronic hepatitis

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23
Q

initial manifestations of acute hepatitis

A 
for first 2 –4
days are non-specific, and characterized by
flu-like signs and symptoms:
- fever 
- malaise 
- joint aches 
- headache 
- nausea, vomiting 
- diarrhea
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24
Q

typical for acute hepatitis in

overt stage:

A
  • hepatomegaly
  • abdominal discomfort and pain
  • jaundice
  • yellowing of the skin and eyes
    (icterus)
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25
Q

normal size of liver

A

6 in (f) - 12 in (m)

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26
Q

Chronic hepatitis usually results from acute form of hepatitis but sometimes develops insidiously, with non-specific initial clinical manifestations:

A
  • weakness

- fatigue

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27
Q

Signs and Symptoms typical for all forms and

etiologies of hepatitis in overt stage (cont.):

A
  • weight loss
  • easy bruising
  • encephalopathy
  • hepatosplenomegaly
  • lymphadenopathy
  • dark colored urine
  • white stool (dec bilirubin)
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28
Q

tests for bilirubin

A

-considerable increase of blood total and
conjugated (direct) bilirubin
- finding of bilirubin in the urine (which results in dark brown color of the urine, like dark beer)
- increased concentration of urobilirubinogen in
the urine

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29
Q

what are the three types of blood tests for hepatitis?

A

1) Aminotransferases (liver enzymes)
2) Anti-viral antibodyies/
viral genetic materials
3) serum proteins

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30
Q

what types of aminotransferases

A
  • AST aspartate aminotransferase
  • ALT alanine aminotransferase
  • GGT gamma glutamyltransferase
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31
Q

aspartate aminotransferase (AST),

a.k.a serum glutamic oxaloacetic transaminase (SGOT)

A
  • intracellular enzymes
  • acute toxic hepatitis,
  • AST blood concentration is significantly increased in acute viral hepatitis, alcoholic liver disease
  • MI causes AST/SGOT release for 6 hours
  • can be found in skeletal, and heart muscle, brain, lungs, pancreas
32
Q

alanine aminotransferase (ALT)

a.k.a. serum
glutamic pyruvic transaminase (SGPT)

A
  • intracellular enzymes
  • normally in liver cells can be in heart, kidneys, and pancreas
  • increased levels due to acute hepatocyte , severe heart, kidneys, and pancreas damage
33
Q

gamma-glutamyltransferase (GGT)

A
  • usually in hepatobilary cell membranes, also in kidney, heart, and brain cell membranes
  • increased levels in liver diseases associated with
    • hepatocyte necrosis
    • cirrhosis
    • alcoholic liver disease
34
Q

anti-viral antibodies and viral genetic materials

A
  • diagnose acute and chronic
    • anti-HAV (for hepatitis A)
  • anti-HBV (for hepatitis B)
  • anti-HCV (for hepatitis C)
35
Q

serum proteins

A

-IgM indicates acute case
-IgG indicates chronic case passes through placenta
-hypoalbuminemia indicates a decreased
function of hepatocytes
-increased prothrombin time – indicates the decreased production of clotting factors 11-13 seconds is normal

36
Q

serum protein most specific tests for liver destruction

A

Hypoalbuminemia and increased prothrombin time are the most specific tests for liver destruction

37
Q

complications of hep

A
  • liver cirrhosis (hep B,C,D,F, toxic, autoimmune)
  • hepatic failure
  • hepatocellular carcinoma (hepatoma)
38
Q

hepatitis recommendations by chiropractor?

A
  • rest to minimize energy demands
  • avoid alcohol and other hepatotoxic drugs (tylenol)
  • small amount, high-calorie meal
39
Q

Cirrhosis

A

is a consequence of chronic liver diseases characterized by replacement
of liver tissue by scarring tissue leading to loss of liver function.

40
Q

Mallory bodies

A

-an eosinophilic cytoplasmic inclusion, alcoholic hyaline, found
in the liver cells
-indicative of cirrhosis

41
Q

cirrhosis causes

A
  • alcoholism
  • chronic hepatitis B, C, D, F
  • autoimmune hepatitis
  • some medicines (e.g. corticosteroids)
  • genetic diseases
    (e. g. genetic hemochromatosis, Wilson’s disease)
42
Q

Early symptoms of Cirrhosis include:

A
  • fatigue and loss of energy
  • poor appetite and weight loss (no more than 2 lbs)
  • nausea and upper abdominal discomfort
  • small, red, spider-like blood vessels on
    the skin (telangiectasia, spider angioma )
43
Q

telangiectasia, spider angioma

A

small, red, spider-like blood vessels on

the skin

44
Q

Cirrhosis Signs and Symptoms

A
  • ascites
  • ascites with “caput medusae”
    -esophageal varicies
    -ankle swelling, non pitting edema due to hypoalbuminemia
    -jaundice
    -palmar erythema
    -nail clubbing
    -easy bruising
    -abnormal bleeding
    -confusion or problems thinking
    -hepatic encephalopathy
    -male specific
    -impotence
    -hypogonadism
    -gynecomastia
    -splenomegaly
    -
45
Q

“Caput medusae”

A
  • fucked up belly button, looks like worms or something

- represents the dilation of periumbilical collateral veins, and is an important sign of portal hypertension

46
Q

what is the major cause of esophageal varicies

A

liver cirrhosis

47
Q

palmar erythema

A

-itchy redness over thenar and hypothenar

48
Q

Cirrhosis diagnosis

A
  • increased prothrombin time
  • hypoalbuminemia
  • CBC:
    - thrombocytopenia
    - leukopenia
    - neutropenia
  • aminotransferases: AST, ALT, GGT are elevated
    - AST usually > ALT
    - GGT typically much higher in alcoholic cirrhosis
  • ALP is elevated
  • bilirubin is elevated as cirrhosis progresses
  • liver biopsy
  • CT
  • MRI
  • Endoscopy
  • ultrasound
49
Q

Cirrhosis recommendations by

chiropractor?

A
  • avoiding alcohol consumption
  • eating healthy diet that is low in salt
  • vitamin and nutritional supplements
50
Q

Liver Cancer Forms:

A

1) primary – when the tumor originates from the
liver cells
2) secondary (metastatic) – this is cancer that
begins in another area of the body (colon,
breast, stomach) and then spreads to the liver

51
Q

Liver cancer is ranked what number in the highest annual mortality rate list

A

3rd

52
Q

hepatocellular carcinoma

A

a.k.a.
hepatoma - is the most frequent liver
cancer, which originates from hepatocytes

53
Q

cholangiocarcinoma

A

– this tumor originates from the bile duct cells

54
Q

angiosarcoma, a.k.a.

hemangioendothelioma

A

– originates from

the blood vessel cells in the liver

55
Q

liver cancer etiology

A

-chronic infectios hepatitis B, C, D
-liver cirrhosis
-aflatoxins-poisons produced by the plant
mold Aspegillus, that grows on wheat, rice,
corn, peanuts
- Wilson’s disease
- hemochromatosis
- non-alcoholic fatty liver diseases
- estrogen and anabolic steroids

56
Q

Signs and Symptoms of liver cancer

A
  • appear only in late stages
  • weight loss
  • loss of appetite
  • upper abdominal discomfort and pain
  • nausea, vomiting
  • general weakness, fatigue
  • jaundice with skin itching - hepatosplenomegaly
  • sudden ascites
  • back pain
  • hepatic bruit
  • abdominal venous hum
57
Q

METS from liver

A
  • to local veins the LUNGS

- advanced cases can metastasize to bone (including spine) and brain

58
Q

Liver cancer diagnosis

A
  • Blood test (liver panel AST, ALT, GGT)
  • tumor markers (alfa-fetoprotein
  • carbohydrate antigen 19-9 (CA 19-9)
  • carcinoembryonic antigen (CEA)
  • cancer antigen 125 (CA125)
  • ultrasound
  • CT
  • MRI
  • biopsy
  • PET-CT
59
Q

increased alfa-fetoprotein is found not only in

primary liver cancer but also in?

A
  • cancer of testicles and ovaries

- metastatic cancer to the liver

60
Q

liver cancer treatment

A
  • cryotherapy in early stage
  • chemoembolisation
  • radiotherapy
  • liver transplantation
61
Q

primary liver cancers

A
  • hepatoma
  • angiosarcoma
  • cholangiocarcinoma
62
Q

increased alfa-fetoprotein is found in what cancers?

A
  • hepatoma
  • cancer of testicles
  • metastatic cancer of the liver
63
Q

what is a predisposing factor for development of liver cancer?

A

rice with aflatoxin

64
Q

ankle swelling in liver cirrhosis is called _____.

A

non-pitting edema

65
Q

what is an early manifestation of liver cirrhosis?

A

telangiectasia

66
Q

when does the lipase break down fat to fatty acids and glycerol?

A

after emulsification of fat

67
Q

what is associated with hepatocyte destruction?

A

decreased production of clotting factors

68
Q

what enzyme is increased in the case of hepatocyte necrosis?

A

GGT

69
Q

ALT is present in

A

normally in liver cells can be in heart, kidneys, and pancreas

70
Q

what is a sign of PORTAL HYPERTENSION in liver cirrhosis

A

caput medusae

71
Q

increased serum IgG in hepatitis indicates what?

A

chronic hepatitis

72
Q

early manifestations of acute hepatitis?

A
  • malise
  • fever
  • nausea
  • vomitting
73
Q

what is the most common etiological factor of toxic hepatitis?

A

alcohol abuse

74
Q

Hepatitis E virus causes _______

A

acute hepatitis with cholangitis

75
Q

what is the most common cause of mallory-weiss syndrome?

A

alcoholism

GE (6 decks)

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