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Pathophysiology > module 13 hepatitis > Flashcards

module 13 hepatitis Flashcards

1
Q

hepatitis s/s

A

sequence

  • incubation
  • prodromal (preicteric) phase
    • variety of s/s ending with jaundice
  • icteric phase: hepatocellular destruction and bile stasis, phase of illness
  • recovery phase
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2
Q

Hepatitis A

A

RNA
fecal-oral transmission (enteric)
2-7 week incubation
immunity via IgG

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3
Q

Hep A risk factors

A

crowded, unsanitary conditions

food and water contamination

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4
Q

Hep A s/s

A 
anicteric: no s/s or mild without jaundice
Majority
- jaundice
- malaise
- anorexia
- nausea
- low fever
- RUQ pain
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5
Q

Hep B

A

Double stranded DNA
incubation 2-6 months
parental transmission: infected blood, body fluids, or contaminated needles
3 types of viral particles
prodromal period longer with immune-complex related s/s

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6
Q

Hep B s/s

A 
urticaria
rashes
arthralgia
arthritis 
angioedema
serum sickness
glomerulonephritis
jaundice
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7
Q

Hep B infection to recovery/death

A

acute infection

  • 60-65% sublinical disease -> 100% recovery
  • 20-25% acute hepatitis -> 99% recovery, 1% fulminant hepatitis -> death
  • 4% chronic hepatitis -> 20-30% cirrhosis -> hepatocellular carcinoma/death
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8
Q

fulminant hepatitis

A

liver coma

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9
Q

Hep C

A

RNA
Parental transmission, though less through sex or perinatal
- drug use, blood transfusion, needle stick

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10
Q

Hep C infection to recovery/death

A

acute infection

  • 85% chronic hepatitis -> 80% stable disease, 20% cirrhosis -> 50% stable, 50% death
  • 15% resolution
  • rare: fulminant hepatitis
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11
Q

Hep D

A

co-infection
- depends on Hep B for replication
Parental transmission

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12
Q

Hep A and Hep E similar

A

typically self-limiting
2-8 wk incubation
does not cause chronic hepatitis or cancer
oral transmission

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13
Q

Hep B, Hep C, and Hep D similar

A

cause carrier state
cause chronic hepatitis and cancer
parenteral transmission

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14
Q

Hep E

A

RNA
transmission: fecal- oral
parental may occur
incubation: 2-9wks

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15
Q

chronic hepatitis

A

inflammation of liver > 6mo.
chronic persistant
chronic active
autoimmune

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16
Q

chronic persistant

A

triaditis, transaminitis

  • chronic, low-grade inflammation
    • portal triads w/out destruction of liver structures
    • inc. serum transaminase
  • not progressive
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17
Q

chronic acute

A

progressive, destructive
extends beyond portal triad to hepatic lobule
could spontaneously arrest or progress to cirrhosis

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18
Q

chronic acute s/s

A 
fatigue
malaise
nause
anorexia
ascites
hepatomegaly
abdominal pain
jaundice
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19
Q

autoimmune hepatitis

A

progressive inflammation characterized by autoantibodies and polyclonal hypergamaglobulinemia

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20
Q

cirrhosis

A

irreversible end stage of many different hepatic injuries
- acute hepatitis
- chronic hepatits
- toxic hepatitis
- metal storage diseases
- alcoholism
nodule regeneration and fibrosis -> dec. hepatic function
Biliary channels obstructed -> portal HTN
-> blood shunting away from liver, hypoxic necrosis

21
Q

alcoholic cirrhosis

A 
more fat delivered to hepatocyte than it can metabolize; defect in fat metabolism 
fatty infiltration (hepatic steatosis)
- inc. lipogenesis and dec. fatty acid oxidation 
Alcohol -> acetaldehyde -> lipid peroxidation -> disruption of cellular function, damage, and inflammation
22
Q

alcoholic cirrhosis s/s

A 
usually mild and asymptomatic
enlarged liver
abdominal discomfort 
portal HTN 
multisystem disease r/t alcohol intake
23
Q

Biliary cirrhosis

A

end result of continuous inflammation of bile ducts r/t biliary obstruction and backup of bile in the liver
-> inflammation and scarring of liver with obliteration of bile ductules, diffuse, widespread fibrosis, and nodule formation
Portal HTN

24
Q

Biliary autoimmue (1st degree)

A

unknown etiology
destruction of intrahepatic ducts
portal inflammation
fibrosis

25
Q

Biliary cirrhosis s/s

A

mitochondrial IgG antibodies
inc. serum alkaline phosphotase
hyperbilirubinemia

26
Q

biliary obstruction (2nd degree)

A

prolonged complete or partial block
gallstones, tumors, fibrotic stricture
- inc. pressure in hepatic bile duct -> accumulation in centrilobular spaces and fibrosis

27
Q

liver fibrosis and scarring ->

A 
portal HTN ->
ascites
edema 
splenomegaly 
- anemia
- thrombocytopenia
- leukopenia 
varices
- esophageal
- hemorrhoids
- superficial abd. veins
28
Q

liver inflammation ->

A 
pain
fever
N/V
anorexia
fatigue
necrosis
29
Q

Liver necrosis -> Gi/GU

A

dec. bilirubiin metabolism
- > hyperbilirubinemia, jaundice
dec. bile in gastrointestinal tract
- > light colored stolls
dec. vit. K absorption
- > bleeding
inc. urobilinogen
- > dark urine

30
Q

liver necrosis -> dec. metabolism

A

dec. metabolism of proteins, carbs, and fats
- > hypoglycemia
dec. plasma proteins
- > ascites and edema

31
Q

liver necrosis -> biochemical alterations

A

inc. AST and ALT
inc. bilirubin
dec. albumin
inc. PT time
inc alkaline phosphatase

32
Q

liver necrosis -> dec. hormone metabolism

A

inc. androgens and estrogens
- gynecomastia
- loss of body hair
- menstrual dysfunction
- spider angiomas
- palmar erythema
inc. ADH and aldosterone
- edema

33
Q

portal HTN

A

impaired blood flow through liver r/t inc. resistance from fibrosis and degeneration
- venous congestion in GI tract

34
Q

portal HTN s/s

A

few early on, until abnormal vascular patterns

- anorexia

35
Q

portal HTN complications

A

varices
-> uncontrolled bleeding form esophageal ruptures
ascites

36
Q

ascites

A

accumulation of fluid in peritoneal cavity
typical with advanced liver disease r/t
- portal HTN
- dec. albumin
-> inappropriate pressure gradient, intraabd. accumulation of Na, H2O, protein

37
Q

hepatic encephalopathy

A

complex neuropsychiatric syndrome characterized by s/s ranging from mild confusion to stupor and coma
- dementia
- psychotic symptoms
- spastic myelopathy
- cerebella or extraprymidal sings
Classic findings
- asterixis (liver flap): spastic jerking of hands held in force extension
assoc. with fulminant hepatic failure and severe chronic liver disease
arterial ammonia level directly correlates with level of encephalopathy

38
Q

hepatic encephalopathy s/s

A

dec. K
dec. Na
alkalosis
hypoxia
hypercarbia
infection
GI hemorrhage
protein meal gorging
renal failure
constipation

39
Q

Hepatic encephalopathy grade 1

A

confusion
subtle behavior change
no flap

40
Q

hepatic encephalopathy grade 2

A

drowsy
clear behavior change
+ flap

41
Q

hepatic encephalopathy grade 3

A 
stupor
can follow commands
marked confusion 
slurred speech 
\+ flap
42
Q

hepatic encephalopathy grade 4

A

coma

no flap

43
Q

Jaundice

A

yellow-green staining of tissue r/t impaired bilirubin metabolism
may occur from dysfunction anywhere along pathway: 3 divisions
- prehepatic
- hepatic
- posthepatic

44
Q

normal bilirubin metabolism

A

RBC broken down and release Hgb

  • broken down to unconjugated bilirubin: transferred to liver bound to albumin
  • liver makes conjugated (water-soluble) bilirubin and excretes in bile -> small intestine, not absorbed
  • colon: bacterial B-glucuronidase converts it to uribilinogen
  • > small amount resorbed and excreted by kidneys and liver
45
Q

prehepatic jaundice

A

hemolysis and ineffective erythropoiesis reabsorption of large hematoma

46
Q

hepatic jaundice

A

dysfunction of hepatic steps

- many disorders that affect liver function

47
Q

posthepatic jaundice

A 
level of canalicular transport
inherited: dubin-johnson syndrome, Rotor syndrome
-> inc. conjugated bilirubenemia 
drugs
sex hormones
mechanical obstruction of bile ducts
48
Q

hepato-renal syndrome

A

complication of liver failure
intrarenal blood flow disturbed
- imbalance between vasoconstriction/dilation mechanisms r/t liver disease
- may follow vigorous diuretic therapy or paracentesis
– diarrhea, nonsteroidal anti=inflammatory drugs, variceal bleeding, sepsis

49
Q

hepato-renal syndrome s/s

A

inc. creatine
AKF
oliguria

Pathophysiology (80 decks)

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