pathology 7 - Cirrhosis and portal hypertension-Serum markers of liver and pancreas pathology-Reye syndrome-Alcoholic liver disease-Non-alcoholic fatty liver disease Hepatic encephalopathy Flashcards
During an autopsy, a 52-year-old man from the United States is found to have a shrunken, nodular liver. What is the most likely etiology?
Alcohol (responsible for 60–70% of cirrhosis in the United States)
Esophageal varices and caput medusae are caused by ____ (pathologic state) and are partially alleviated by ____ shunts.
Portal hypertension; portosystemic
A patient with musty-smelling breath presents to the ED with confusion and asterixis. What skin findings do you expect on exam?
Common skin findings in liver failure are jaundice and spider nevi (the musty breath is fetor hepaticus) & may see caput medusae, edema
A patient with melena is found to have esophageal varices. Where else in the GI tract are you concerned for bleeding?
The stomach, due to bleeding peptic ulcers (or may be caused by portal hypertension)
Name at least three direct effects of portal hypertension.
Splenomegaly, caput medusae, ascites, esophageal varices with hematemesis, peptic ulcers, anorectal varices, portal hypertensive gastropathy
An alcoholic has cirrhosis due to liver failure. What do you expect to find on eye exam?
Scleral icterus
While seeing a patient with known cirrhosis, you cannot help but notice his musty breath. What is this called?
Fetor hepaticus
Visible dilated capillary proliferation within the skin secondary to the effects of liver failure and cirrhosis is called what?
Spider nevi
A man with liver failure also complains of gynecomastia and testicular atrophy. How did this likely develop?
Due to an increase in estrogen
A patient with cirrhosis has a coarse, flapping tremor of the hands. What is this called?
Asterixis
A cirrhotic patient should be cautioned about what kind of hematologic abnormality(ies) due to her liver cell failure?
Bleeding tendency (decreased production of clotting factors, increased prothrombin time) and anemia
Why do patients with cirrhosis have an increased tendency to bleed?
Liver cell failure decreases production of prothrombin and clotting factors
Is the bleeding tendency in cirrhosis considered an effect of portal hypertension or an effect of liver cell failure?
Liver cell failure (it is due to the inability to synthesize clotting factors)
Is the ankle edema of cirrhosis considered an effect of portal hypertension or an effect of liver cell failure?
Liver cell failure (it is due to the inability to synthesize albumin resulting in lack of oncotic pressure)
What is cirrhosis?
Cirrhosis is defined as diffuse fibrotic and nodular regeneration that disrupts the normal architecture of the liver
What two gastrointestinal enzymes are markers of injury to hepatocytes?
The aminotransferases, which are alanine aminotransferase and aspartate aminotransferase
A patient has viral hepatitis. What do you expect the ratio of aspartate aminotransferase to alanine aminotransferase to be?
Low (in viral hepatitis, AST
A patient has alcoholic hepatitis. What do you expect the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) to be?
High (in alcoholic hepatitis, AST > ALT)