Diseases Of The Liver And Biliary Tract

Front 1

How is the liver's circulatory system unique to the human body?

Back 1

Blood from one capillary system, the intestinal system, flows through it on to another capillary system, the hepatic system, before returning to the heart

Front 2

What is the most important consequence of cirrhosis?

Back 2

Portal HTN
-It can result in liver failure & severe hemorrhage

Front 3

What are the anatomic patterns of liver injury?

Back 3

-Inflammation (Hepatitis)
-Degeneration (Hydropic change & fatty degeneration)
-Necrosis (Councilman bodies)
-Fibrosis (Cirrhosis)

Front 4

What are the direct metabolic consequences of hepatic injury?

Back 4

-Jaundice (excess bilirubin)
-Cholestasis
-Hepatic failure

Front 5

Jaundice can be caused by what three things?

Back 5

1. The presence of excessive amounts of bilirubin
2. Defective liver fnx
3. Biliary obstruction

Front 6

What is the most common cause of unconjugated bilirubin in the blood?

Back 6

Gilbert syndrome: it is a genetic enzyme deficiency

Front 7

Jaundice resulting from bile duct obstruction is characterized by....

Back 7

-Increased conjugated bilirubin in the blood

Front 8

What is the jaundice of Cholestasis usually accompanied by?

Back 8

-Pruritis: b/c of the deposition of bile acids in the skin
-Xanthomas: b/c bile is the means by which the body rids itself of excess cholesterol

Front 9

What are the eight clinical features of hepatic failure?

Back 9

1. Jaundice
2. Ascities
3. Fetor hepaticus (liver breath...NH3
4. Hypoalbuminemia
5. Hypoglycemia
6. Hyperammonia
7. Palmar erythema, spider angiomas, balding, & gynecomastia (high blood estrogen)
8. Bleeding disorders

Front 10

What is hepatorenal syndrome?

Back 10

Renal failure owing to hepatic failure
-The mechanism is not understood

Front 11

What are the signs of hepatic encephalopathy?

Back 11

-Rigidity
-Hyperreflexia
-Seizures (rare)

Front 12

What are the two anatomical types of cirrhosis?

Back 12

1. Portal cirrhosis
2. Biliary cirrhosis

Front 13

Which is more common: portal or biliary cirrhosis?

Back 13

Portal

Front 14

What are the main causes of portal cirrhosis?

Back 14

-Alcoholic liver
-Chronic viral hepatitis

Front 15

What is the main cause of primary biliary cirrhosis?

Back 15

Chronic inflammation of the bile ducts

Front 16

What is always associated with portal HTN?

Back 16

Cirrhosis

Front 17

What are the four clinical features of cirrhosis?

Back 17

1. Failure to metabolize estrogen & ammonia
2. Protein synthesis failure
3. Excretory failure
4. Portal HTN

Front 18

What are the characteristics of HAV?

Back 18

-Fecal-oral route
-No carrier state
-No chronic hepatitis
-No increased risk for hepatocellular carcinoma
-Vaccine available
-No cirrhosis
-Can cause fulminant hepatitis

Front 19

What are the characteristics of HBV?

Back 19

-Sex or needles
-Carrier state (uncommon)
-Chronic hepatitis in 5-10%
-Increased risk for hepatocellular carcinoma
-Vaccine available
-Cirrhosis
-Can cause fulminant hepatitis

Front 20

What are the characteristics of HCV?

Back 20

-Sex or needles
-Carrier state (common)
-Chronic hepatitis in >50%
-Increased risk for hepatocellular carcinoma
-No vaccine available
-Cirrhosis
-Cannot cause fulminant hepatitis
-Highly associated with IVDU

Front 21

What are the four clinical phases of acute viral hepatitis?

Back 21

1. Incubation
2. Symptomatic prejaundice phase (ass'd w/ malaise, fatigue, nausea, etc.)
3. Symptomatic jaundice phase
4. Convalescence

Front 22

When does peak infectivity occur with viral hepatitis?

Back 22

About the time symptoms appear

Front 23

When does infectivity disappear with viral hepatitis?

Back 23

At the time antibodies appear in the blood; convalescence

Front 24

What is fulminant hepatitis?

Back 24

-Acute liver dz that progresses to failure & encephalopathy is a few wks
-Ass'd w/ HAV & HBV

Front 25

What is the cause of epidemic hepatitis?

Back 25

Hep A

Front 26

What is the detection of hepatitis B surface antigen indicative of?

Back 26

Acute infection

Front 27

Which appears first in hepatitis B infection: hepatitis core antibody or hepatitis surface antibody?

Back 27

Core!

Front 28

What can HDV not exist without?

Back 28

HBV

Front 29

What are the two types of toxic liver reactions & which is more common?

Back 29

1. Dose related
2. Idiosynchratic; damage is out of proportion with the dose. This is more common

Front 30

What is the first sign of alcohol injury?

Back 30

Fatty degeneration

Front 31

What is alcoholic hepatitis characterized by?

Back 31

-Inflammation
-Hepatocyte necrosis
-Early fibrosis

Front 32

What is secondary hemochromatosis usually caused by?

Back 32

Repeated blood transfusions usually associated with SCA, thalassemia, or aplastic anemia

Front 33

When does hemochromatosis become symptomatic?

Back 33

In adulthood; it takes years to accumulate enough iron to cause damage

Front 34

What is another name for fatty degeneration?

Back 34

Steatosis

Front 35

What is on your DDx for silent jaundice?

Back 35

Pancreatic cancer

Front 36

Is splenomegaly often seen with liver disease?

Back 36

Yes

Front 37

What is the most common type of post-transfusion hepatitis?

Back 37

HCV

Front 38

Which type of hepatitis is Bx proven?

Back 38

Chronic

Front 39

Which type of viral hepatitis is the most serious?

Back 39

HCV
-50% develop chronic hepatitis

Front 40

What ethnicities experience a higher incidence of gallstones?

Back 40

-Hispanics
-Native Americans
-

Front 41

When is hepatic vein occlusion most commonly seen?

Back 41

With BCP's or in pregnancy

Front 42

What is the most common tumor of the liver?

Back 42

Benign hemangioma

Front 43

What is the most common liver cell carcinoma?

Back 43

Hepatocellular carcinoma

Front 44

What sized gallstones cause the most problems?

Back 44

Middle-sized

Front 45

What are gallstones associated with?

Back 45

Pancreatitis; therefore gall bladder removal is advisable

Front 46

Path of blood through the liver....

Back 46

Venous: Intestinal veins-portal V-liver capillaries-hepatic V-IVC
Arterial: hepatic A-capillaries-mixes with portal blood-IVC

Front 47

Where does most cholesterol absorbed from the liver come from?

Back 47

From reabsorbed bile acids, not dietary

Front 48

What are the major functional reactions of the liver to injury?

Back 48

-Jaundice
-Cholestasis
-Hepatic failure

Front 49

What is unconjugated bilirubin attached to?

Back 49

Albumin

Front 50

What are the two main causes of cirrhosis?

Back 50

Alcoholism
Chronic hepatitis