Liver diseases Flashcards
hepatitis
- Inflammation+ fxn change
- 2 types: acute, chronic
- destruction of hepatocytes
acute hepatitis lasts how long?
< 6 months
chronic hepatitis lasts how long?
> 6 months
HAV- +ssRNA (infectious hepatitis)
– spreads through fecal
contamination of food and water, causes an acute and self-limiting infection, does not cause chronic hepatitis
HBV - +dsDNA (serum hepatitis)
– spreads through blood,
body fluids, sexual contacts, tattoos, mother to child
by breast feeding
causes chronic hepatitis, can cause cirrhosis and cancer
HCV - +ssRNA (serum non-A, non-B hepatitis )
– spreads
through sexual contacts and hemotransfusions, cross the placenta
most common causes chronic hepatitis, cirrhosis, liver cancer
HDV–ssRNA (serum delta hepatitis)
– 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
HEV- +ssRNA (infectious hepatitis)
– 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
HFV (serum, mutated B-virus)
– spreads through blood
transfusion, or oral fecal route ,
causes chronic hepatitis
-DNA virus
HGV –(GB virus C)
-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
virus’s that cause hepatitis
- Cytomagalovirus (Herpes 5)
- Epstein-Barr virus (herpes type 4)
- Yellow fever virus (jaundice)
- Ebola virus and Marburg virus
toxic hepatitis could be caused by:
- medications (e.g. Tylenol, birth control pills, Lipitor
etc) - mushroom poison
- alcohol (the most common
cause of toxic hepatitis)
what bacteria causes hepatitis?
- Staphylococci aureus and Streptococci pyogenes,
causes Toxic Shock Syndromes - Leptospira (Gram-negative spirochaete) liver, brain, heart
- Listeria (Gram- positive, non spore-forming, rods bascilla)
Protozoa causes of hep
- toxoplasma
- leishmania
parasite that causes hep
- echinococcus
- toxocara
- schistosoma
fungi that causes hep
- aspergillus (liver cancer)
- histoplasma capsulatum
- candida
autoimmune disease that cause hep
sjogren’s syndrome
The incubation period
- 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)
Genetic causes of hep
- alpha-1-antitrypsin def (abnormal accumulation of the protein within liver cells)
- hemocromatosis (iron accumulates in liver)
- wilson disease (copper)
- glycogen storage disorders
ischemic hep
- aka shock liver
- ACUTE NEVER CHRONIC
- associated with:
- heart failure, shock, sepsis
viral, bacterial, fungal, and toxic etiological agents
usually result in:
acute hepatitis
autoimmune, parasites, protozoa, obesity
etiological agents usually result in
chronic hepatitis
initial manifestations of acute hepatitis
for first 2 –4 days are non-specific, and characterized by flu-like signs and symptoms: - fever - malaise - joint aches - headache - nausea, vomiting - diarrhea
typical for acute hepatitis in
overt stage:
- hepatomegaly
- abdominal discomfort and pain
- jaundice
- yellowing of the skin and eyes
(icterus)
normal size of liver
6 in (f) - 12 in (m)
Chronic hepatitis usually results from acute form of hepatitis but sometimes develops insidiously, with non-specific initial clinical manifestations:
- weakness
- fatigue
Signs and Symptoms typical for all forms and
etiologies of hepatitis in overt stage (cont.):
- weight loss
- easy bruising
- encephalopathy
- hepatosplenomegaly
- lymphadenopathy
- dark colored urine
- white stool (dec bilirubin)
tests for bilirubin
-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
what are the three types of blood tests for hepatitis?
1) Aminotransferases (liver enzymes)
2) Anti-viral antibodyies/
viral genetic materials
3) serum proteins
what types of aminotransferases
- AST aspartate aminotransferase
- ALT alanine aminotransferase
- GGT gamma glutamyltransferase
aspartate aminotransferase (AST),
a.k.a serum glutamic oxaloacetic transaminase (SGOT)
- 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
alanine aminotransferase (ALT)
a.k.a. serum
glutamic pyruvic transaminase (SGPT)
- 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
gamma-glutamyltransferase (GGT)
- 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
anti-viral antibodies and viral genetic materials
- diagnose acute and chronic
- anti-HAV (for hepatitis A)
- anti-HBV (for hepatitis B)
- anti-HCV (for hepatitis C)
serum proteins
-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
serum protein most specific tests for liver destruction
Hypoalbuminemia and increased prothrombin time are the most specific tests for liver destruction
complications of hep
- liver cirrhosis (hep B,C,D,F, toxic, autoimmune)
- hepatic failure
- hepatocellular carcinoma (hepatoma)
hepatitis recommendations by chiropractor?
- rest to minimize energy demands
- avoid alcohol and other hepatotoxic drugs (tylenol)
- small amount, high-calorie meal
Cirrhosis
is a consequence of chronic liver diseases characterized by replacement
of liver tissue by scarring tissue leading to loss of liver function.
Mallory bodies
-an eosinophilic cytoplasmic inclusion, alcoholic hyaline, found
in the liver cells
-indicative of cirrhosis
cirrhosis causes
- alcoholism
- chronic hepatitis B, C, D, F
- autoimmune hepatitis
- some medicines (e.g. corticosteroids)
- genetic diseases
(e. g. genetic hemochromatosis, Wilson’s disease)
Early symptoms of Cirrhosis include:
- 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 )
telangiectasia, spider angioma
small, red, spider-like blood vessels on
the skin
Cirrhosis Signs and Symptoms
- 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
-
“Caput medusae”
- fucked up belly button, looks like worms or something
- represents the dilation of periumbilical collateral veins, and is an important sign of portal hypertension
what is the major cause of esophageal varicies
liver cirrhosis
palmar erythema
-itchy redness over thenar and hypothenar
Cirrhosis diagnosis
- 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
Cirrhosis recommendations by
chiropractor?
- avoiding alcohol consumption
- eating healthy diet that is low in salt
- vitamin and nutritional supplements
Liver Cancer Forms:
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
Liver cancer is ranked what number in the highest annual mortality rate list
3rd
hepatocellular carcinoma
a.k.a.
hepatoma - is the most frequent liver
cancer, which originates from hepatocytes
cholangiocarcinoma
– this tumor originates from the bile duct cells
angiosarcoma, a.k.a.
hemangioendothelioma
– originates from
the blood vessel cells in the liver
liver cancer etiology
-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
Signs and Symptoms of liver cancer
- 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
METS from liver
- to local veins the LUNGS
- advanced cases can metastasize to bone (including spine) and brain
Liver cancer diagnosis
- 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
increased alfa-fetoprotein is found not only in
primary liver cancer but also in?
- cancer of testicles and ovaries
- metastatic cancer to the liver
liver cancer treatment
- cryotherapy in early stage
- chemoembolisation
- radiotherapy
- liver transplantation
primary liver cancers
- hepatoma
- angiosarcoma
- cholangiocarcinoma
increased alfa-fetoprotein is found in what cancers?
- hepatoma
- cancer of testicles
- metastatic cancer of the liver
what is a predisposing factor for development of liver cancer?
rice with aflatoxin
ankle swelling in liver cirrhosis is called _____.
non-pitting edema
what is an early manifestation of liver cirrhosis?
telangiectasia
when does the lipase break down fat to fatty acids and glycerol?
after emulsification of fat
what is associated with hepatocyte destruction?
decreased production of clotting factors
what enzyme is increased in the case of hepatocyte necrosis?
GGT
ALT is present in
normally in liver cells can be in heart, kidneys, and pancreas
what is a sign of PORTAL HYPERTENSION in liver cirrhosis
caput medusae
increased serum IgG in hepatitis indicates what?
chronic hepatitis
early manifestations of acute hepatitis?
- malise
- fever
- nausea
- vomitting
what is the most common etiological factor of toxic hepatitis?
alcohol abuse
Hepatitis E virus causes _______
acute hepatitis with cholangitis
what is the most common cause of mallory-weiss syndrome?
alcoholism
