Week 4 Flashcards
hepatic =
pertaining to liver
2 surfaces of liver
superior/ diaphragmatic
inferior/ visceral
units of liver
hepatocytes
oxygenated blood supply into liver
proper hepatic artery
deoxygenated blood out
portal vein, hepatic vein
what does liver do?
removes glucose from bloodstream and stores it as glycogen
what is glycogen?
forms of glucose that is stored in liver and muscles
what is bilirubin?
pigment excreted into the digestive fluid called BILE
excessive amounts of bilirubin =
jaundice/icteric
major ligament that divides left and right lobes
falciform
abc produces what inside the macrophage?
unconjugated bilirubin (type 1)
is unconjugated bilirubin lipid soluble?
yes
where is unconjugated bilirubin found?
blood stream, never in urine!
what does liver do with unconjugated bilirubin?
combines it with albumin to make conjugate it in the hepatocyte
is conjugated bilirubin water soluble?
yes, therefore it goes into urine
how do you make primary bile salts?
primary bile acids colic acid and chenodeoxycholic acid, conjugated with glycine and taurine.
what do primary bile salts form?
micelles
what is Jaundice?
Excessive amounts of bilirubin
if skin seems yellowish, can you assume it is?
no, look at eyes.
If sclera of eyes are yellow, is it likely jaundice?
yes, but still need to order lab tests
what confirms jaundice in lab tests?
Conjugated Bilirubin percentage (CB% = CB:Total Bilirubin (TB)) Ratio
3 levels of jaundice?
what is prehepatic jaundice?
it means pathology is going on before liver, in the blood
what is hepatic jaundice?
pathology happening in the liver (in the process of accepting bilirubin, impairment of intake, or in converting or conjugating bilirubin)
post hepatic jaundice?
pathology is after liver, maybe obstructed before or inside of the gall bladder
CB < 20% is what kind of jaundice?
unconjugated hyperbilirubin (UCB), pre-hepatic jaundice
who gets CB < 20%
newborns, Gilbert syndrom
what is porphyrin?
Porphyrin is a group of organic heterocyclic compounds that are comprised of four modified pyrrole subunits connected via methine bridges and form an aromatic macrocyclic structure, which has one or more side chains attached. Many porphyrins are naturally occurring pigments.
CB 20% - 50% jaundice is called?
Hepatic Jaundice: Mixed jaundice of UCB and CB
Diagnoses of Hepatic Jaundice?
Hepatitis
Hepatocellular carcinoma
what is CB > 50% called?
Post-hepatic jaundice, conjugated hyperbilirubinemia
Post-hepatic jaundice diagnoses
bile duct obstruction (intra/extrahepatic)
what is viral hepatitis?
disease manifestations due to viral infection of hepatocytes
what do infection of hepatocytes lead to?
apoptosis of hepatocytes
what does apoptosis of hepatocytes lead to?
necrosis
causes of loss of functional hepatocytes?
-Elevation of liver enzymes (ALT, AST)
-Hyperbilirubinemia (jaundice)
Sx of viral hepatitis?
It can be asymptomatic or present with malaise, weakness, nausea, anorexia, jaundice, dark urine
Acute Viral Hepatitis defined as?
viral hepatitis with signs and symptoms < 6 mo
Chronic Viral Hepatitis defined as?
viral hepatitis with signs and symptoms > 6 mo
How is Hepatitis A transmitted?
Fecal-Oral (contaminated food, water, close body contact, rarely blood thru drug use or transfusion)
Immune response to HAV
ALT spikes in the first two months, immunoglobulin (IgM) anti-HAV mounts after a month and comes down at 5.5 months, and total anti-HAV continues to go up for over a year
Cases in US going up or down?
Acute or recent HAV infection serology
Anti-HAV IgM
Prior infection or immunization serology
Anti-HAV IgG
HAV Treatment
- Bed rest
- If nausea and vomit are pronounced à oral intake substantially decreased à IV 10% Glucose is indicated
- Diet à palatable meals as tolerated, no overfeeding
- No strenuous physical exercise, alcohol, hepatotoxic agents
- Corticosteroids have no benefit in viral hepatitis, including acute liver failure
Incubation period of HAV
15-50 days
Average: 28 days
Abrupt onset
HBV incubation period
45-160 days
(old: 50—180)
Insidious onset
severity of HAV?
Mild
Severity of HBV
Occasionally severe
incubation period of HCV
14-180 days
(Old: 20-90)
Insidious onset
Severity of HCV
Usually subclinical
what is Ag
Antigen
what is Ab
Antibody
what is Ig?
Immunoglobulin
What does Hb Ag mean?
Hepatitis B antigen
what is HBV
Hepatitis B virus (enveloped, partially doublestranded DNA virus)
what is Hbs Ag?
Antigen found on SURFACE of HBV, incubation period, continued presence indicates carrier state (still can transmit to others)
What is Anti-Hbs Ag?
Antibody to Hbs Ag, incubation, chronic or cured/convalescent stage, or post HBV
vaccination, or history of HBV
HbC Ag?
Antigen associated with CORE of HBV, rather than the surface
Anti-Hbc Ag
Antibody to Hbc Ag, positive during window phase, IgM Hbc Ab is an indicator of recent disease, first to appear – initial 1-2 weeks of infection (early stage of infection)
Hbe Ag?
A second, different antigenic determinant on HBV core, important indicator of transmissibility, EARLY stage presence of HBV
Anti-Hbe Ag?
Antibody to Hbe Ag, indicates low transmissibility, indicates patient that about to recover from infection (not last long)
Delta Agent?
Small RNA virus with Hbs Ag envelope, defective virus that replicates only in HBV- infected cells Linda Morse TCM Review – Hepatitis and CNT section. Rarely ordered as a lab test.
Most important HBV test?
The surface tests. Hbs Ag, anti-Hbc Ab IgM
Tx of HBV?
anti-viral agents
Most popular are TAF and TDF, similar to anti-HIV drugs
HCV is shifting to what age demographic?
from older to younger, namely through injection-drug use
efficacy of all-oral, well-tolerated, highly effective Direct Acting Antivirals (DAA’s)
95-99%
New tools, what does Liver Stiffness by transient elastography do?
measure amount of fibrosis
why is it important to know fibrosis?
Level of severity of disease
3 stages of Alcohol Liver Disease
Hepatic Steatosis (fatty change)
Alcohol Hepatitis
Alcohol Cirrhosis
Hepatic Steatosis early on
- Alcohol is metabolized to
triacylglycerol - Reversible with alcohol abstinence, eating less fat
- Liver is enlarged and may be tender
During fasting for liver cleanup
promotes breakdown of stored fats in liver
Alcoholic hepatitis 2nd stage
- Acute illness caused by acetaldehyde following binge drinking
- Some may have no symptoms and others may have RUQ abdominal pain, hepatomegaly, jaundice, malaise, anorexia, or even fulminant liver failure
What’s a mallory body?
a necrotic hepatocyte with no nucleus and keratin buildup
Alcoholic cirrhosis (3rd stage of Alcohol Liver Disease)
- Develops in 15% of alcoholics
- Typically micronodullar or Laennec cirrhosis
Non-alcoholic Fatty Liver Disease
NASH (non-alcoholic steatohepatitis -> Cirrhosis from fat buildup.
causes of NASH
Obesity, hyperinsulinemia, insulin resistance, Type 2 Diabetes
Morbidity for NASH?
33.2% died or underwent liver transplant
Gold Standard for determining severity of NASH
Liver biopsy
