Unit 1 Finals PPP/Clin Med Flashcards
What impact do cytokines have on appetite in response to chronic LPS elevation?
Negative impact on appetite
What effect does increased leptin levels have on appetite?
Decreased appetite
What leads to fibrosis of the liver?
Chronic inflammation along with stellate cell collagen and scar tissue
What does fibrosis lead to?
Which is reversable?
Fibrosis leads to cirrhosis.
Fibrosis can be reversed while cirrhosis cannot.
High NADH levels inhibit breakdown of fatty acid to acetyl-CoA and TG break down to fatty acids. What is the result?
Hypertriglyceridemia and Steatosis
Chronic liver disease leads to functional loss of gluconeogenesis and glycogenolysis. What is the result?
Increased production of triglycerides and suppressed glucose regulation
What are the consequences of prolonged chronic alcohol use? (6)
- prolonged satiety
- poor appetite
- hypoglycemia
- weight loss
- nutritional deficiencies
- cachexia, muscle wasting
How much ethanol is processed by CYP (%) and what are the products?
25%
Reactive O2 species and DNA adducts (cancerous)
Thiamine deficiency can lead to what 3 diseases?
- Wernicke Encephalopathy
- Beriberi
- Korsakoff syndrome
What is cirrhosis?
Fibrosis and conversion of normal liver architecture into abnormal nodules. – late stage fibrosis
What happens to the liver in cirrhosis size wise?
It shrinks
What are the top 2 causes of cirrhosis in the USA?
HepC (26%)
Alcoholic liver disease (21%)
What ratio of AST to ALT is suggestive of alcoholic liver disease? What other lab value would be elevated?
AST:ALT 2:1
GGT would also be high
Gold standard for confirmation of cirrhosis?
Liver biopsy
–NOT FIRST LINE
All blood from the pancreas, stomach, spleen, gallbladder, small and large intestine is sent to where?
to the liver via portal vein
Fibrosis/Cirrhosis can lead to what in the portal vein?
Portal hypertension
What are the 5 varices sites?
- esophageal
- paraumbilical
- superior mesenteric veins
- inferior mesenteric veins
- Rectal veins
Varices can lead to what signs? (4)
- coffee ground emesis
- melena
- anemia
- positive hemoccult blood test
What 3 effects does accumulation of blood in the liver/portal system/splenomegaly have on the CBC?
- thrombocytopenia due to less thrombopoietin
- Anemia (blood loss, malnutrition)
- Leukopenia (more prone to infection)
What is ammonia converted to normally?
Urea
What is a common sign of hepatic encephalopathy?
Asterixis
What is asterixis?
flapping of wrist and fingers due to rapid relaxation of wrist dorsiflexion
What is a classic EEG finding for a patient with encephalopathy?
triphasic waves over the frontal lobes at oscillate at 5Hz and in stage 4 show slow delta waves
Hepatorenal syndrome can be diagnosed by what 3 signs?
- renal failure
- degreased GFR
- increased BUN/CRE
What is itching caused by in liver damage?
High levels of uric acid in the skin - hyperuricemia
What 4 vitamin levels are low in liver disease?
Vitamin A, D, K and Zinc
What is the result of zinc deficiency?
Altered taste
What is the first line test for cirrhosis?
Sonography
What is the purpose of lactulose?
It traps ammonia and reduces the concentration.
-Helps prevent hepatic encephalopathy
