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pathology > w21 liver & Gastrointestinal pATHOLOGY > Flashcards

w21 liver & Gastrointestinal pATHOLOGY Flashcards

1
Q

What is the structures in the system

A

oesoophagus
liver
stomach
small intestine
large intestine
appendix

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2
Q

What side of the body does the liver sit on

A

right ; over ribs

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3
Q

what organ weighs over 2% of an adults body weight

A

liver

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4
Q

LO

A

Normal liver function​

Viral Hepatitis​

Cirrhosis​

Appendiciti

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5
Q

Name 4 functions of liver

A

Amino acid synthesis
Carb metabolism
Fat metabolism
Protein synthesis

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6
Q

Carbohydrate Metabolism in the liver digests ______ food into _____

A

sugary food - glucose to glycogen

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7
Q

Glycogenesis

A

formation of glycogen FROM glucose

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8
Q

Glycogenolysis

A

bdown of glycogen > glucose

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9
Q

Gluconeogenesis

A

synthesis of glucose from certain aacids, lactase or glycerol

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10
Q

Carbohydrates

A

They are the prime source of energy to do work. They are hydrolyzed to their monomeric units. These are further metabolised and converted to Glucose. Glucose is used by cell so as to form Energy(ATP). They are necessary for cellular respiration in the mitochondria.

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11
Q

lipids

A

second source of energy. If sufficient glucose or carbohydrates are not present then the body will produce Acetyl Co A from the fatty acids by the process of Beta-Oxidation. Acetyl Co A enters the mitochondria and takes part in Krebs Cycle to produce 14 ATP. Fatty acids are a very high source of energy. The fatty acid which is 18 carbon long can produce 8–9 molecules of Acetyl Co-A.​

​

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12
Q

Proteins and amino acids

A

last source of E ; hard to extract E from to form ATP

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13
Q

Fat metabolism by liver involves

A

cholesterol synthesis, production of triglycerides (fats). (used in gluconeogenesis too)

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14
Q

Protein synthesis by liver inv.

A

liver produces, albumin, coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, ​

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15
Q

What metabolites are formed from haemoglobin bdown by liver

A

bilirubin & biliverdin (added to bile as pigment)

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16
Q

What is Hypoalbumina

A

fluid excess ; into interstitial compartmts = excess swelling of liver&raquo_space;> odema

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17
Q

what colour is bilirubin

A

yellow

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18
Q

What is drug metabolism by the liver

A

bdown or modifies toxic substances (e.g., by methylation) and most medicines.
Preferably, the toxins are conjugated to avail excretion in bile or urine. ​

​

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19
Q

Ammonia is converted to _____ by the liver

A

urea

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20
Q

What is the composition of haemoglobin

A

s 2α, 2β polypeptide chains and 4 haem molecules

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21
Q

What is bilirubin

A

yellow pigment of bile from heme bdown in OLD RBCs ; travels to liver and secreted into bile by liver

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22
Q

What is Serum Bilirubin a test of

A

liver function ; shows liver ability to take up, process & secrete BRubin into bile

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23
Q

when reticuloendothelial system bdowns old RBCs in spleen whats the waste product

A
  • lipid and water insoluble form BRubin
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24
Q

what is free/unconjugated bilirubin & why cant it be excreted

A

(indirect) BRubin ; lipid& H20 insoluble needs to be made h20 soluble to be excreted in urine

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25
Q

Albumin

A

carries bilirubin to liver to convert to conjugated (direct) soluble form for excretion in urine

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26
Q

What enzyme is necessary for bilirubin conjugation

A

glucuronyl transferase

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27
Q

What can disturb liers ability to conjugate bilirubin

A

lack of GCronyl transferase or presence of drugs that interfere w glucuronyl transferase

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28
Q

red cell destruction, heme protein catabolism & bone marrow erthyropoiesis lead to heme breakdown which produces…

A

bilirubin

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29
Q

Describe pathway of bilirubin metabolism (using image on ipad)

A

bilirubin ; unconj. BR + albumin to liver ; glucuronyl transferase conjugates BR in liver ; now h20 soluble is secreted through bile duct to small intestine ; some in SI some goes to circulation

need to describe bacterial deconjugation & fecal stercobilinogen

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30
Q

whats the difference between indirect and direct bilirubin

A

bilirubin that is conjugated with glucuronic acid while the indirect bilirubin is not conjugated to the liver and it attaches to the carrier protein albumin.

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31
Q

How can testing show find out if bilirubin is indirect or not

A

Conjugated bilirubin is water-soluble and reacts directly when dyes are added to the blood specimen. The non-water soluble, free bilirubin does not react to the reagents until alcohol is added to the solution. Therefore, the measurement of this type of bilirubin is indirect.

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32
Q

Name a few manifestations of liver disease

A

jaundice ; pale stool ; dark urine ; itching ; swelling of abdomen ; fatigue ; bruising ; hepatic coma

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33
Q

What causes jaundice in liver disease

A

hemolysis ; obstruction to bile duct ;

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34
Q

What is jaundice

A

Jaundice is a yellow coloration of the skin, mucus membranes, or eyes. Other features of Jaundice include, pale or clay coloured stool, dark or borown cloured urine. The yellow coloring comes from bilirubin, a byproduct of heme released from old red blood cells.

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35
Q

How do pale stools occur in LDisease

A

bile pigment secretion blocked from bile duct obstruction ; no Brubin in small intestine so no colour

36
Q

Dark urine occurs cos high levels of ______ bilirubin are excreted in urine

A

conjugated

37
Q

Common symptom of LD is itching which is from bilirubin deposits in the

A

skin

38
Q

Explain why abdominal swelling occurs

A

decreased albumin in blood > decreased osmotic pressure

= fluid accumulation in tissues

39
Q

loss of nutrients, minerals and vitamins causes the general symptom of

A

fatigue

40
Q

Esy brusing and bleeding occur from liver disease as..

A

liver failure means clotting factors usually made to prevent bleeding by liver are not heavy enough

41
Q

Failure to remove toxins by liver can lead to what manifestation of LD

A

hepatic coma

42
Q

Failure to remove toxins by liver can lead to what manifestation of LD

A

hepatic coma

42
Q

Failure to remove toxins by liver can lead to what manifestation of LD

A

hepatic coma

43
Q

Hepatic coma would only occur in late stages of disease (T/F)

A

true

44
Q

Why is ammonia levels affected by liver disease

A

LFailure - ammonia (toxic) cant be converted. to urea - stays in the blood circulation = toxicity symptoms

45
Q

ammonia is turned into what and released by what

A

urea by liver ; urine

46
Q

Elevated bilirubin conc in blood can be from what 4 things

A

either by increased prod.,
decreased conjugation,
decreased secretion by the liver, or
blockage of the bile ducts

47
Q

What can cause lead to elevated levels of unconjugated/indirect bilirubin in the blood

A

accelerated erythrocyte hemolysis in blood, absence of glucuronyl transferase, or hepatocellular diseases such as hepatitis

48
Q

what is Unconjugated hyperbilirubinemia

A

elevated levels of unconjugated/indirect bilirubin in the blood

49
Q

Elevated levels of conjugated/direct bilirubin is caused by

A

obstruction of the biliary ducts, as with gallstones or hepatocellular diseases such as cirrhosis or hepatitis.

50
Q

Conjugated hyperbilirubinemia is

A

elevated levels of conjugated bilirubin in blood

51
Q

When diagnosing LD ; elevated bilirubin levels show only that

A

the liver is not functioning

52
Q

When diagnosing LD , high ALT enzyme levels show that

A

the liver cells are damaged

53
Q

What is the norm range of albumin

A

3.9 to 5.0 g/dL

54
Q

Hypoalbuminea is when the albumin levels fall ___ the normal range

A

under

55
Q

Total bilirubin: normal range: 0.1–1.2 mg/dL. It is raised in prehepatic, hepatic, and post hepatic abnormalities​

​

     ​

​

  • Alanine transaminase (ALT): normal range 9 to 60 IU/L, elevated when liver cells are damaged​
  • Aspartate transaminase (AST): normal range 10 to 40 IU/L, It is raised in acute liver damage but is also present in red blood cells, and cardiac and skeletal muscle and is therefore not specific to the liver.​
  • Alkaline phosphatase (ALP): normal range 30 to 120 IU/L. ALP levels in plasma will rise with large bile duct obstruction, intrahepatic cholestasis or infiltrative diseases of the liver. ALP is also present in bone and placental tissue.​

​

  • Gamma glutamyl transpeptidase (GGT): normal range 0 to 51 IU/L. It is reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP. GGT is raised in alcohol toxicity (acute and chronic).
A

MAKE THIS A PROPER CARD

56
Q

Name the three types of jaundice

A

pre-hepatic
intra-hepatic
post-hepatic

57
Q

Describe pre-hepatic jaundice

A

when a condition speeds up the breakdown of red blood cells, causes include: malaria, sickle cell anaemia, thalassaemia. The bilirubin raised in the blood is unconjugated

58
Q

Describe post-hepatic jaundice

A
59
Q

Describe intra-hepatic jaundice

A
60
Q

Pre hepatic jaundice causes excess hemolysis leads to

A

bdown by phagocytic cells (MpHs) in liver ; will liberate indirect BRubin = high unconj. in circulation ; yellowing cos of liberated BR when already deposited ; (cant move in fluid cos insoluble ?)

61
Q

pre hepatic jaundice is pre cos

A

excess brubin produce before entering liver

62
Q

Intra hepatic jaundice caused by

A

Viral hepatitis, alcoholic hepatitis, paracetamol overdose, leptospiroses and liver cancer.

63
Q

Intra hepatic occurs when

A

liver inflammation compresses bile duct so conj. BR cant pass to intestine – stool colourless and from circulation goes to kidney filters = dark urine

64
Q

Post hepatic jaundice is caused by

A

gallbladder stone obstructing bile duct, pancreatic cancer, bile duct stone or cancer and pancreatitis. The bilirubin raised in the blood is conjugated​

65
Q

Hepatitis is

A

inflamm. of liver

66
Q

acute hepatitis is for______ or less and chronic is more than ___

A

6 months ; IS clears virus or chronic when unable to

67
Q

Name causes of hepatitis

A

Drugs: paracetamol, isoniazid, ibuprofen, halothane, antibiotics(erythromycin, tetracyclines)​

Toxins: poisonous mushrooms, and industrial chemicals such as vinyl chloride​

alcohol​

viral infections (A, B, C, D, E)​

other infections: parasites (amoebic hepatitis, schistosomiasis) bacteria(leptospirosis) and Fungus ​

physical damage​

​

68
Q

Excess paracetamol usage can cause Hepatitis cos it causes

A

severe necrosis of liver

69
Q

Hep A characteristics

A

Non enveloped; + strain RNA virus ; aka Picronavirus w 4 viral polypeptides (VPs)

70
Q

what is a + strain RNA virus

A

non enveloped so RNA can directly bind ribosomes to prod. virus

71
Q

FROM SLIDE CONT. HEP A B c LEFT

A
72
Q

what is the incubation time for Hep A

A

15-50 days range ; average 30 days
acute inf = lifelong immunity

73
Q

How can Hep A be transmitted

A
  • fecal contam. food & h20
  • contam.shellfish
74
Q

Can Hep A be spread via saliva, kissing or sneezing

A

no

75
Q

Is it 2 weeks before or after the manifestations show that a customer become contagious

A

before showing manifestation

76
Q

After incubation HAV develop non-specific symtpoms inc. fever , malaise and anorexia.

A

j

77
Q

What does it mean when it says Hep A infections inc. H epAV are anicteric and remain undetected

A

without jaundicce

78
Q

Does Hep A prod. a chronic course of infection

A

no

79
Q

Describe the general epidemiology of HAV

A

high in china, africa, greenland & south americe (need immuni

80
Q

Hep A course using graph slide 12

A
81
Q

What are the preventative measures against Hepatitis A

A

vaccine
cell-derived virus ; 2 doses administered 1 month apart
travellers get it before 3rd world countries

82
Q

Anti-HAV IgM = acute infection
Anti-HAV IgG - suggest past infection (common for >50s)
liver enzyme levels raised
stool test for virus presence
most recover and become immune

A
83
Q

Ag = viral protein
Anti HBC = Ab prod. by human against virus

DNA virus

A

non-enveloped ; has partial db stranded DNA

84
Q

Hep B

A

42nm DNA virus
non enveloped , has partial db-stranded DNA
HBsAg ; HepS antigen triggers IR , AntiHBs prod.

look at structure img slide 14

85
Q

How is Hep B transmitted

A

direct contact w blood or bodily fluids of an infected person
not spread by food, water or casual contact

pathology (6 decks)

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