Liver Function (Part 2) Flashcards
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Pre-Hepatic jaundice
-Four specific causes
Hemolysis, ineffective erythropoiesis, increased turnover of non hemoglobin heme compounds, hematoma
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Pre-hepatic jaundice
-general cause
any process that causes premature RBC destruction and increased production of unconjugated bilirubin
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Pre-hepatic jaundice
-explanation of typical serum total, unconjugated and conjugated bilirubin levels, urine bilirubin level, fecal and urine urobilinogen levels (increased or decreased)
unconjugated: increased; conjugated: Normal; urine bilirubin: Neg/normal; fecal and urine urobilinogen: increased
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Post-hepatic jaundice
-General cause
caused by any process that prevents excretion of conjugated bilirubin (biliary obstructive disease)
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Post-hepatic jaundice
-Three specific causes
Ductal occlusion by stones, spasms or strictures, compression by neoplastic diseases (tumors)
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Post-hepatic jaundice
-Explanation of typical serum total, unconjugated and conjugated bilirubin, urine bilirubin level, fecal and urine urobilinogen levels (increased or decreased)
Serum total: increased; unconjugated: Normal; conjugated: increased; urine bili: positive; fecal and urine urobili: decreased to absent
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Post-Hepatic jaundice
-four enzymes that are elevated to a significant degree
ALP, GGT, LAP, 5’-NT
In hepatic (hepatocellular) jaundice the hepatocyte itself is sick; which functions are impaired?
Normal functions of uptake, conjugation, and/or excretion of bilirubin are impaired
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Hepatocellular Disease
-Causes
all 3 processes (uptake, conjugation, and exretion of bilirubin) are impaired
Most common cause is HEPATITIS
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Hepatocellular Disease
-1 Expected serum total, 2 unconjugated, and 3 conjugated bilirubin levels
1 increased 2 increased 3 increased
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Hepatocellular Disease
-Urine bilirubin level
positive
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Hepatocellular Disease
-fecal and urine urobilinogen levels
normal to decreased
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Hepatocellular Disease
-Elevated enzymes in hepatitis
AST, ALT (ALT>AST), ALP, LD4/LD5, ammonia
Remember cannot detoxify ammonia to urea so the BUN will be low!
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Gilbert’s Disease
-Causes
Pre-conjugation transport failure
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Gilbert’s Disease
-1 serum total, 2 unconjugated, and 3 conjugated bilirubin
1 increased 2 increased 3 decreased
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Gilbert’s Disease
-urine bilirubin
Negative
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Gilbert’s Disease
-fecal and urine urobili
decreased (normal)
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Crigler-Najjar syndrome
-causes
conjugation failure
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Crigler-Najjar syndrome
-expected 1 serum total, 2 unconj, and 3 conj
1 increased 2 increased 3 decreased
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Crigler-Najjar syndrome
-urine bili
NEgative
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Crigler-Najjar syndrome
-fecal and urine urobili
decreased
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Physiologic jaundice of the newborn
-Causes
Conjugation failure (common/normal), liver not yet producing UDP-glucuronyl transferase yet b/c immature
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Physiologic jaundice of the newborn
-1 serum total, 2 unconjugated, 3 conjugated
1* 2 increased 3 NONE
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Physiologic jaundice of the newborn
-Urine bili levels
*
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Physiologic jaundice of the newborn
-fecal and urine urobilinogen levels
*
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Dubin-Johnson Syndrome
-Causes
Post-Conjugation transport failure
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Dubin-Johnson Syndrome
-1 serum total, 2 unconjugated, and 3 conjugated
1 increased 2 normal 3 increased
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Dubin-Johnson Syndrome
-urine bili level
positive
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Dubin-Johnson Syndrome
-fecal and urine urobilin levels
decreased/normal
Specific range of total bilirubin levels in the blood at which jaundice is observed
> 2.0-3.0 mg/dL
7 clinical manifestations of liver disease
jaundice, portal hypertension, hepatic failure/encephalopathy, altered drug metabolism, disordered hemostasis, endocrine abnormalities, and immunoglobulin abnormalities
Causes of toxic hepatitis
acetamenophen, heavy metals, drugs, poison causing liver necrosis
Fecal-oral transmission; infection is often transmitted in restaurants or households
Hepatitis A
Routes of transmission of this disease include heterosexual sex, homosexual sex, mother to child, sharing needles, receipt of blood products, and needlestick injury
Hepatitis B
Routes of transmission of this disease include blood transfusions, sharing of needles, mother to baby, body piercing, tattooing, and unprotected sex with multiple partners
Hepatitis C
This disease coexists with Hep B and shares similar routes of transmission
Hepatitis D
This disease is transmitted by fecal-oral route; raw sewage can spread this disease to contaminate food and drinking water
Hepatitis E
This virus can live in humans without causing infection; can act as a co-infection with Hep C in order to show symptoms
Hepatitis G
a two-phase illness associated with a previous viral illness (flu, cold, chicken pox, etc) for which aspirin or salicylate-containing medications were given
Reye’s Syndrome
In Reye’s Syndrome, abnormal accumulations of fat develop in the _____, along with a severe increase of pressure in the brain
Liver
Symptoms of Reye’s Syndrome as it progresses
viral illness, repetitive vomiting, lethargy, delirium, decorticate coma, decerebrate coma, flaccid coma; unless diagnosed and treated successfully, death is common within a few days or a few hours
4 lab results that are increased in Reye’s Syndrome
ALT/AST, PLASMA AMMONIA, hypoglycemia in infants, and fatty deposits in liver
Seven causes of cirrhosis
Viral Hep B or Hep C, toxic alcohol or methotrexate administration, Wilson’s Disease, Alpha-1-antitrypsin deficiency, and hemochomatosis
Metal involved in Wilson’s Disease
Copper
Results in deposits of copper in brain, liver, kidney, and cornea; neurological degeneration; cirrhosis; and Kayser-Fleischer Rings
Wilson’s Disease
Expected 1 plasma cerulopasmin, 2 serum copper levels, and 3 urine copper levels in Wilson’s Disease
1 decreased 2 increased 3 increased
Metal involved in primary hemochomatosis
Iron
Expected 1 iron, 2 ferritin, 3 and total iron binding capacity in primary hemochomatosis
1 increased 2 increased 3 decreased
Treatment of primary hemochromatosis
Therapeutic phlebotomy
autoimmune etiology; many patients have AMA’s (anti-mitochondrial antibodies), damage in bile duct causing scarring and altered immunity; itching, weight loss, fatigue; primarily in women 40-60
Primary Biliary Cirrhosis
Inflammation and scarring of the bile ducts; primarily in males 20-30; associated with ulcerative colitis
Primary Sclerosing Cholangitis
Neonatal (physiologic) jaundice is a transient, ________ occurence
NORMAL
Significance of Neonatal jaundice
reaction of mother’s milk due to immature liver; can cause kernicterus, infiltrating the brain and causing severe damage
Treatment for neonatal jaundice
discontinue breast feeding, treat with UV light source (phototherapy), exchange transfusion in extreme cases
