Liver Path III Flashcards

1
Q

consequences of cirrhosis, male

A

hepatic encephalopathy
esophageal varices
splenomegaly

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2
Q

consequences of cirrhosis, females

A

oligomenorrhea, amenorrhea, sterility, hypogonadism

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3
Q

jaundice

A

yellow staining of membranes by bilirubin

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4
Q

cholestasis

A

inability to excrete bile

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5
Q

bile salts

A

can lead to pruritis - itching

also malabsorption of fats - no Vit K dependent clot factors

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6
Q

cholesterol retention

A

eruptive xanthomas - periorbital or tendinous

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7
Q

canal of hering

A

travel of bile - to portal tract

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8
Q

small ductule cholangioncytes

A

canal of hering

imflammation/proliferation

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9
Q

large ductule cholangiocytes

A

volume/alkalinity

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10
Q

cholestasis and parenchyma

A

enlarged hepatocytes, dilated canalicular spaces, apoptotic cells, kupffer cells present

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11
Q

portal tract and cholestasis

A

edema, bile pigment retention, neutro inflammation

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12
Q

UDP

A

uridine diphosphatase - conjugates bilirubin with glucuronic acid

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13
Q

unconjugated bilirubin

A

binds albumin

-not excreted in kidney

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14
Q

conjugated bilirubin

A

does not bind albumin - lost in urine

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15
Q

urobilinogen

A

brown color of stool and yellow color of urine

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16
Q

choluria

A

dark urine

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17
Q

pale stool

A

in cholestasis

-no bilirubin to darken stool - stercobilinogen

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18
Q

unconjugated hyperbilirubinemia

A

hemolysis
gilbert
crigler najjar

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19
Q

mixed hyperbilirubinemia

A

look at AST, ALT, alk phos, and GGT

high AST, ALT - hepatic
high alk phos and GGT - cholestatic

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20
Q

AST < ALT

A

viral serology

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21
Q

AST > ALT

A

alcoholic liver disease

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22
Q

20-30yo with black liver

A

dubin johnson

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23
Q

high conjugated bilirubin

A

dubin johnson

rotor syndrome

24
Q

gilbert

A

shortage of enzyme
-jaundice under stress

unconjugate bilirubin high

25
Q

crigler najjar type 1

A

no enzyme
-kerniceterus - levels >20
bad

unconjugated bilirubin high

26
Q

crigler najjar type 2

A

some enzyme

bilirubin 6-20

unconjugated bilirubin high

27
Q

bilirubin in urine

A

always pathological - detected on dipstick

28
Q

delta-bilirubin

A

in plasma bound to albumin

not measured

longer half life

this is why after hepatitis starts to resolve or obstruction treated - conjugated levels take some time to return to normal

29
Q

neonatal jaundice

A

cannot conjugate 2 weeks old

physiologic jaundice of newborn that goes away
-unconjugated

worse with breast feeding deconjugating enzymes in milk

30
Q

alpha1 antitrypsin deficiency

A

can cause neonatal jaundice

31
Q

neonatal jaundice causes

A

biliary atresia - require surgery

non-biliary disorders - alpha1 antitrypsin deficiency

idiopathic

32
Q

panlobular giant cell transformation of hepatocytes

A

neonatal hepatitis

33
Q

biliary atresia

A

jaundice before 8 weeks old in neonate
-elevated conjugated**

two forms - fetal and perinatal

34
Q

fetal biliary atresia

A

aberrant intrauterine development of biliary tree - situs inversus, congenital heart disease

35
Q

perinatal biliary atresia

A

most common**

bile ducts destroyed after birth - unknown etiology

type 1 - common duct
type 2 - right or left hepatic bile duct
type 3 - common - above porta hepatis - not correctable**

36
Q

cholestasis histo

A

zone 3 bilirubin in hepatocytes and bile canaliculi

zone 1 ductule proliferation and fibrosis

37
Q

large bile duct injury

A

classically obliterative cholangitis

immunohisto stain IgG4 positive plasma cells surrounding bile duct

38
Q

ampulla of vater

A

bile ducts dump into duodenum

39
Q

acute jaundice

A

flu-like, RUQ pain, acholic stool, choluria, pruritis, eruptive jaundice, encephalopathy

40
Q

chronic jaundice

A

cirrhosis

portal HTN, ascites, variceal hemorrhage

41
Q

spider angiomata

A

chronic jaundice - estrogenic

42
Q

ALT/AST measure of hepatocyte integrity

A

viral infection - destroy hepatocyte

cirrhosis - can have normal levels

43
Q

most common cause of elevated AST/ALT

A

NASH

44
Q

AST:ALT greater than 1

A

more likely alcohol

and never >500

greater than 300 - consider infection, toxic insult

45
Q

more specific indicator

A

ALT

46
Q

GGT

A

specific to liver

can isolate liver as source of problem

47
Q

mild increase in GGT

A

more than 3 drinks/day

48
Q

alk phos and GGT

A

induced enzymes

49
Q

albumin

A

measure of hepatocyte function

-half life 20 day - slow changes

50
Q

protime

A

measure of hepatocyte function

must rule absorption of vit K factors**

51
Q

IgA

A

alcoholic liver disease

52
Q

IgM

A

primary biliary cirrhosis

53
Q

IgG

A

autoimmune hepatitis

54
Q

liver biopsy

A

gold standard

cholestasis - ultrasound
hepatitis - lab tests

55
Q

child pugh score

A

used in chronic liver disease - cirrhosis

class determines one and 3 year survival - based on looking at bilirubin, albumin, PT, ascites, and hepatic encephalopathy