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124 Cards in this Set
- Front
- Back
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What is the end product of heme degradation?
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Unconjugated bilirubin
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Unconjugated bilirubin is _____ soluble
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Lipid
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UCB combines with what in the blood?
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albumin
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Conjugated Bilirubin is ____ soluble.
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Water
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What converts CB to urobilinogen?
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Intestinal bacteria
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Color of urine is due to?
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urobilin
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Jaundice is first noticed in the ______?
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Sclera
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Second most common cause of jaundice?
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Gilbert's Syndrome
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Most common cause of jaundice?
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Viral hepatitis
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Name the disease associated with CB <20%
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Hemolytic anemias (hereditary spherocytosis, ABO mismatches), Crigler-Najjar syndrome, Physiologic Jaundice of a newborn
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Name the diseases associated with CB 20-50%
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Viral Hepatitis
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Name the diseases associated with CB > 50%
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Obstructed: Primary Biliary Cirrhosis, Dubin-Johnson syndrome, Gallstones in common bile duct, Carcinoma of head of Pancreas
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ALT
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Specific enzyme for liver cell necrosis
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AST
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Present in the mitochondria thus ETOH damages mitochondrea
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AST>ALT
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Indicates alcoholic hepatitis
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GGT
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gamma glutamyl transferase: Intr a or extrahepatic obstruction to bile flow
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ALP
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Alkaline Phosphatase:Obstruction to bile flow
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Hepatocyte Function Markers
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Serum Albumin
Prothrombin time Blood Urea Nitrogen Serum Ammonia |
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Antimitochondrial Antibody is seen in?
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Primary biliary cirrhosis
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Antinuclear antibody is seen in?
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Autoimmune hepatitis
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What is the tumor marker for hepatocellular carcinoma?
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Alpha-Fetoprotein (AFP)
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What makes one have chronic HBV?
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Persistence of HBsAg for longer than 6months
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What makes one a "Healthy" chronic carrier of HBV?
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Presence of HBsAG, HBcIgG and absence of DNA and e antigen
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What makes one a "Infective" chronic carrier?
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Presence of HBV-DNA and HBVe antigen
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Autoimmune hepatitis occurs most often in?
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Young woman
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What antibody would you find in a person with autoimmune hepatitis?
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Anti-nuclear and anti-smooth muscle
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Prehepatic obstruction to blood flow includes what arteries or veins?
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Hepatic artery and Portal vein
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Hepatic artery thrombosis is uncommon bc?
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the dual blood suppy
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Hepatic artery and portal vein tributaires normally empty blood into the ____.
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sinusoids
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What would cause an obstruction of the hepatic artery?
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Liver transplant rejection or Vasculitis due to polyarteritis ndosa
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What would cause an obstruction to the portal vein?
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Pylephlebitis (inflammation of the portal vein) due to appendicitis
Polychythemia Vera (too many RBC) Hepatocellular Carcinoma |
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What would the clinical finding of an obstruction of portal vein or hepatic artery blood present like?
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Portal HT (ascites, varicies, hemorrhoids, splenomegaly)
NO NUTMEG LIVER |
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Intrahepatic obstruction to blood flow is caused by what?
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Blocked sinusoidal Blood flow
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What are the top 3 reasons for Intrahepatic obstruction?
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Cirrhosis, Centrilobular hemorrhagic Necrosis (LHF or RHF), Sickle cell disease, peliosis(anabolic steriods)
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How does LHF cause centrilobular hemorrhagic necrosis?
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LHF decreases CO causing hypoperfusion of the liver(via hepatic artery) thus causing an ischemic necrosis
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How does LHF cause centrilobular hemorrhagic necrosis?
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RHF causes a back up of systemic venous blood into the central vein and sinusoids
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What is the most common reason for Intrahepatic liver obstruction?
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Cirrhosis
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What is Peliosis hepatis?
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Sinusoidal dilation due to anabolic steriods
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What are ppl. with Peliosis hepatis at risk for?
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Intraperitoneal hemorrhage
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What is the main reasons for Posthepatic obstruction of blood flow from the liver?
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Hepatic Vein Thrombosis or Veno-occlusive disease
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What is hepatic vein thrombosis called?
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Budd-Chiari syndrome?
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What is the 2 main reasons for Budd-Chiari syndrome?
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Oral contraceptive and Polycythemia vera
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What would the clinical finding be for someone who has Post hepatic Obstruction of blood flow from the liver?
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Portal HT (Ascites,Spleenomegaly, varices, hemorrhoids, Caput Madusae), Nut meg liver(hepatomegaly)
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What is the main reason for veno-occlusive disease of the hepatic vein?
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Collagen develops around the central vein
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What is hematobilia?
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Blood in the bile in patients with trauma to the liver
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Most common cause of hepatic vein thrombosis?
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Polycythemia Vera
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Alcoholic hepatitis is due to?
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Acetaldehyde damage to hepatocytes
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What four microscopic finding are indicative of alcoholic cirrhosis?
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Fatty infiltrate, Fibrosis, and neurtophilic leukocytosis and mallory bodies
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What are the clinical findings of someone with Alcoholic hepatitis?
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Painful hepatomegaly, Fever, Neutrophilic leukocytosis, Ascites, hepatic encephalopathy,
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What are the 2 types of obstructive (cholestatic) liver disease?
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Intrahepatic or extrahepatic
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Intrahepatic is most commonly caused by what?
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Drugs: Oral contraceptive pills and anabolic steriods
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Extrahepatic cholestasis is most commonly caused by what?
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Blockage of the CBD by a stone, biliary atresia, carinoma in the head of the pancreas
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Macroscopically what would a cholestatic liver problem look like?
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Enlarged, green gallbladder with the bile ducts distended
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What are some clinical findings of someone suffering from a cholestatic liver disease?
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light colored stool (no sterobilin), Puritis (bile salts being deposited under the skin), malabsorption (bile salts are not present in the small int. to help with absorption of fats, and jaundice (back up of CB)
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CB>50%
Bilirubinuria Absent UBG in urine Increase ASP and GGT |
Obstructive Bile
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What is Primary sclerosing pericholangitis?
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Fibrosis of inttrahepatic and extrahepatic bile ducts
Male Dominant Associated with ulcerative colitis |
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What is primary sclerosing pericholangitis associated with?
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Ulcerative Colitis
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What is cirrhosis?
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Irreversible diffuse fibrosis of the liver with formation of regenerative nodules
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Regenerative nodules of someone with cirrhosis lacks what important anatomical features?
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Portal triads and sinusoids
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The bands of fibrosis in someone with cirrhosis cause what?
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Compression of sinusiods and central veins leading to intrasinusoidal HT
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Name the most common reasons for one to get cirrhosis?
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Alcohol, Hepatitis Virus B or C, Autoimmune (PBC), Metabolic (hemochromatosis or wilson's disease
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Name the complications of Cirrhosis?
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Ascites, Pitting edema, Female hair growth pattern, Gynecomastia, Decreased immune funtction, spider angioma, hepatic encephaolopathy, muscle wasting, hypoalbuminemia, hyperammonium, increased Prothrombin time, esophageal varices, hemorroids, Icterus, jaundice, peptic ulcers
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What is primary biliary cirrhosis?
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An autoimmune disorder that destroys the bile ducts in portal triads. Occurs most often in woman 40-50years of age
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What antibodies are found in primary biliary cirrhosis?
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Antimitochondria
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When does the jaundice present in someone with primary biliary cirrhosis?
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late in the disease
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Hereditary hemochromatosis is?
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Autosomal recessive; male dominant
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When do woman get hemochromatosis?
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After menopause bc menses causes a loss of iron
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What is hemochromatosis?
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unrestricted reabsorption of iron in the small intestines
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Iron stimulates the production of ?
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Free radicals that damage tissue and cause fibrosis
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What are the 3 main places that Iron deposits in?
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Liver, pancreas and skin
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How does iron cause hyperpigmentation?
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Iron increases melanin production
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How does Iron cause diabetes?
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Destruction of the Beta-Islet cells
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A liver biopsy must be stained with _______ for the iron to show up blue?
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Prussian blue
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Hemochromatosis will have an increase or decreased total iron binding capacity?
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decrease
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Wilson's Disease?
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Autosomal recessive that causes a defect in hepatocytes ability to transport copper into bile for excretion and decrease the synthesis of ceruloplasmin by the liver
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What binds Copper in the blood?
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Ceruloplasmin
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Copper deposits in the cornea is called what?
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Kayser-Fleisher ring
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Will the total serum copper be increased or decreased in Wilson's disease?
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Decreased bc of the decrease production of ceruloplasmin
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Where in the brain does copper like to deposit?
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In the putamen, subthalamic nuclues and cerebral cortex
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Lesion of the putamen causes?
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Parkinsonism movement disorders
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Lesion of the subthalamic nucleus causes?
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Hemiballismus (wild flinging of arms)
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Lesion of the cerebral cortex causes?
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Dementia
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laboratory test Abnormalities in cirrhosis?
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Decrease BUN
Increase Ammonia Lactic acidosis Hyponatremia Hypokalemia Increased PT Hypocalcemia Vitamin D Deficiency |
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Name 2 Benign Liver tumors?
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Cavernous hemangioma'
Hepatic cell adenoma |
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What is the most common benign tumor of the liver?
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Cavernous hemangioma
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Which benign tumor is highly vascular and tend to rupture during pregnancy?
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Hepatic cell adenoma
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Most common cancer of the liver is?
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Metastasis from the lung
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How can you tell if a cancer is from metastasis?
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It's has multiple nodular masses
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What is the most common primary liver cancer?
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Hepatocellular carcinoma
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What is the most common cause of heptocellular carcinoma?
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Hep B and C
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Hepatocellular carcinoma always comes from a prexisiting ?
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Cirrhosis
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Hepatocelluar carcinoma peaks around?
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Males 60y/o
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What is characteristic of HC carcinoma?
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Presence of bile in neoplastic cells
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Will you find blood in the ascites of someone with hepatocellular carcinoma
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Yes
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What is the most common metastatic site for hepatocellular carcinoma?
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Lung
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What protein will be increased in hepatocellular carcinoma?
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Alpha fetoprotein
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The most common malignancy of the bile ducts is
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cholangiocarcinoma
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What disease predisposes a person to cholangiocarcinoma?
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Primary Sclerosing pericholangitis
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What is Courvoisier's Sign
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Palpable gallbladder
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What color are cholesterol stones?
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yellow and radiolucent
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What color are pigment stones?
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Black and radiopaque
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What are the risk factors for gallstones?
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Forty, Female, Fat, Fair skin, oral contraceptive pills
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How do cholesterol stones form?
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Supersaturation of Cholesterol or decreases bile salts
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Black pigment gallstones are a sign of?
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Extravascular hemolysis (calcium bilirubinate)
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What are 3 common complications of gallbladder stones?
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Cholecystitis, CBD obstruction, gallbladder concer, acute pancreatitis
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What is the most common pathogenesis for acute cholecystitis?
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Obstruction of cystic duct by a stone leading to the congestion of bile. This leads to increase in intraluminal pressure and then to ischemia of the gallbladder wall then to ulceration.
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Pain that starts in the midepigastric and is colicky then moves to the RUQ radiating to the right scapula
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Gallbladder disease
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What is the gold standard for identifying a stone in the common bile duct?
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Ultrasound
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What is an annular Pancreas?
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Dorsal and ventral buds form a ring around the duodenum that causes an obstruction of the small bowel
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What are the 2 major causes of acute pancreatitis?
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ETOH and gallstone
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What is the pathogenesis of a gallstone causing acute pancreatitis?
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The gallstone obstructs the Common bile duct, the bile then backs up into the pancreas. The Enzymes then activate the proenzymes in the pancreas leading to it's destruction
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What is the pathogenesis of a ETOH causing acute pancreatitis?
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ETOH thickens the secretions thus back flow of pancreatic enzymes back into the pancreas and activation of trypsinogen and others
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Epigastric pain that radiates to the back?
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Pancreatitis
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What is the most common cause of pancreatitis in children?
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Seat belt trauma
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What is the most common cause of acute pancreatitis in adults?
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Alcohol
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What 2 enzymes are elevated in acute pancreatitis?
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Amylase and Lipase
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What is the gold standard for diagnosing Pancreatitis
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CT-bc pancreas is behind the stomach
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What would a plain radiograph show of a person with acute pancreatitis?
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Sentinel loop(air in the duodenum) because of localized ileus. Inflammation around duodenum stops peristalsis
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What is a complication of pancreatitis that presents with an abdominal mass with persistence of serum amylase longer than 10 days.
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Pseudocyst
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What is a pancreatic pseudocyst?
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collection of digested around pancreas
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What is the most common cause of chronic pancreatitis?
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Idiopathic
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What is the most common cause of known chronic pancreatitis?
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Alcohol then cystic fibrosis
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What is a radiographic hint that someone has chronic pancreatitis?
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Calcium deposits inside the pancreas
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What are some clinical finding of someone with chronic pancreatitis?
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Severe pain radiating into the back, Malabsorption, Type 1 diabetes
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