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54 Cards in this Set
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Liver anatomy |
Largest single organ 1200-1600 g (3-4 lbs). RUQ |
Glisson's capsule, thick connective tissue contracting blood vessels and lymph covers the entire surface. A layer of serosa covers the capsule. |
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Falciform ligament- divides the lives into R & L. |
Right is 6x larger than left. |
Right is subdivided into right, caudate, & quadrate love. |
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Hepatocytes |
Hexagonal row of hepatic cells |
Secrete bike into the bike canaliculi |
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Portal triad |
Lobule, portal vein, & bile duct |
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Sinusoids |
Interlobular cavities between each row of cells |
Each is lined with Kupffer cells- remove amino acid, nutrients, sugars, old erythrocytes, bacteria, debris |
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1500 ml blood enters each minute. |
Portal vein 75% of blood 50% of O2 supply |
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Vagus nerve and thoracolumbar supply liver. |
Sympathetic innervation |
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Liver functions: |
*Bile formation and secretion *Metabolism of carbs, proteins, fats, steroids *Vitamins storage *Manufx clotting and anti coag substances *Detox foreign and toxic substance |
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Right and left hepatic ducts combine and form |
Common hepatic duct |
The cystic duct combines with hepatic duct to form common bile duct |
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Metabolism |
Converting glucose, fructose, galactose to glycogen for storage in the liver |
Glycogenesis |
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Metabolism |
Breaks down glycogen to glucose to maintain blood glucose levels |
Glycogenesis |
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Synthesizing glucose ( from proteins and fats) |
From non-carbohydrate to maintain blood glucose levels |
Gluconeogenesis |
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The liver deaminates anime acid to produce |
Ketoacids & ammonia |
Urea is formed and excreted in urine |
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Daily protein synthesis |
Plasma proteins: albumin, fibrinogen, transferrin, ceruloplasmin, haptoglobin, lipoproteins. |
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Liver metabolism |
Adrenocortical steroids Glucocorticoids Estrogens Testosterone Progesterones Aldosterone |
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Coagulation |
Prothrombin & fibrinogen Produced in liver |
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Anticoagulant heparin |
Production in liver and releases vasopressor substances after hemorrhage |
Std. Meas. Incl. PT, PTT. Thrombocytopenia is common and DIC disseminated intravascular coagulation. High risk*** |
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Detoxification |
Hepatocytes attempt to make substances water-soluble to be excreted in urine or bile. |
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Mechanisms of detox |
Reduction hydrolysis Conjugation Oxidation Excretion/bile Degradation Storage for later |
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Reticuloendothelial system |
Protects body by phagocytosis of viruses, bacteria, dyes, foreign proteins |
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Vitamin storage |
Vit B2 -riboflavin Nicotinic acid Pyridoxine Vit c Vit d Vit e- excret in bile Vit a 95% |
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Cirrhosis |
Cell death Fibrosis Regeneration alters vasculature
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Impaired blood flow results in herpetic insufficiency |
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Etiological types of cirrhosis |
+Alcoholic: Micronodular Portal Laennec's 50% |
Enlarged and altered lipids metabolism leads to fatty infiltrates. Tx abstinence, high calorie, nutrient dense diet |
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Etiological types of cirrhosis |
Immune related bile duct injuries: - Biliary cirrhosis - Sclerosing cholangitis Assoc w/ inflammatory bowel disease |
Jaundice, pruritus, steatorrhea, death. Fibrosis, ductal cell destruction & inflammation = liver enlargement, firm & green |
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Post necrotic cirrhosis |
R/t: Hepatitis Infection Metabolic liver disease Hepatotoxin exposure Chemical exposure |
Liver becomes small and distorted |
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S/s cirrhosis |
Weight loss Anorexia Abd pain Spider veins Hand & foot itching Bruising Jaundice Mental confusion Difficulty concentrating |
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Complication of cirrhosis |
Portal Htn Varicies GI bleeding Ascites Hepatorenal syndrome Hepatic encephalopathy |
Increased risk of PHCC primary hepatocellular carcinoma |
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Portal Htn |
Liver blockage leads to increased portal vein resistance and backflow, portal vein pressure increases. |
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S/s portal hypertension |
Melena Hematoemesis Bleeding tendencies Fetor hepatitis Splenomegaly Varicies Dilated umbilical cutaneous veins Jaundice Peripheral edema |
Altered hair distribution Gynecomastia Testicular atrophy Menstrual disorders |
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TIPS Transjugular intrahepatic portosystemic shunt |
Places expandable wire tube in a created tract between the hepatic veins and portal veins. |
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Varicies |
Created by back pressure, forcing blood into the collateral vessels. |
Esophagus, umbilicus, Duodenum, abd., Rectum |
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Acities |
Fibrotic tissue prevents from leaving the liver. Expansion beyond capacity. Vasoconstrictor and anti natriuretic factors to compensate. Sodium retention, renal fx abnl. Fluid shifts into abd cavity. |
Paracentesis to relieve resp & abd distress |
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Hepatorenal syndrome |
Progressive, functional form of renal failure. Comorbid cirrhosis, tense acities, encephalopathy. |
90% fatality. Death r/t hemorrhage, infection, hypotension, or hepatic failure |
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Hepatic encephalopathy |
Accumulation of lg amts of ammonia within the brain tissue. |
Breakdown of protein in the bowel cannot be metabolized by the liver to form urea. The blood cannot pass into liver and the snobbish flies to the brain. |
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Hepatitis |
Inflammation of the liver may be accompanied by parenchymal liver damage. |
Viral most common, Epstein Barr EBV, Cytomegalovirus CMV, rubella, herpes simplex, varicella |
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Types of hepatitis |
A infectious B serum C parentally-transmitted. Non a/b D Delta E epidemic or enterically- non a/b G elevated liver enzymes |
Other: alcoholic, drug induced, autoimmune, NASH |
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Hep A virus (RNA) |
Most common. 45% fecal/oral milder. 15-45 days incubation |
Low grade fever, fatigue, nausea, anorexia, myalgia, malaise. |
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Hep B virus HBV (DNA) |
Trans. Blood, semen, saliva, perinatal. 95% recovery |
Immunization prevention. Risk: HCW, hemodialysis, sex, IV drugs, |
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Hep C. HCV (RNA) |
Trans: IV drug use, transfusion, sex, natal, |
Interferon tx |
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Hep D. HDV (RNA) |
Parasite single strand. Tx: alpha-interferon |
Trans: serum, sex, polytransfusion, IV drugs |
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Hep E epidemic/enteric |
Fecal oral or contaminated food. 6-8 weeks incubation |
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Budd-Chiari syndrome BCS |
Hepatic venous outflow obstruction. Malignancy, thrombus, inflammatory, hormonal. |
Tx: anticoagulant tx, angioplasty, TIPS, transplant |
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Non-alcoholic fatty liver.(NAFLD) Non-alcoholic steatohepatitis (NASH) |
Any liver condition arising without association to alcohol. Risks: obesity, DM, HDL |
Fat accumulates in the liver when it cannot degrade or export the lipids. S/s fatigue, RUQ pain, wt loss, weakness |
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NASH s/s |
Anorexia, nausea, varices, low sex drive, acities, itching, edema, encephalopathy. |
Can lead to cirrhosis |
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Tumors Dx: US, CT, arteriography. Mets to regional lymph nodes |
Tx: excision of vessels Ca usu origin in hepatocytes or bile duct epithelium or mesenchymal tissue. |
Risks: cirrhosis, hep B, hep C, alcohol, androgen tx, hepatotoxic chemicals, |
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Hepatocellular ca (HCC) most common primary malignant tumor of the liver. |
5th most common neoplasm, 3rd most common cause of CA related death. Risk: hepatitis, cirrhosis, cholangitis, BCP, smoking, |
S/s: and pain, wt loss, weakness, n/v, hepatomegaly, bruit, acities, splenomegaly, wasting, fever. |
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Wilson's disease S/s develops < age 15 |
Defective excretion of copper into bile, excessive amts of copper in brain, liver, kidneys, cornea |
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Porphyria Aquired enzyme defect |
Overproduction of proteins or precursors |
Hereditary coproporphyria (HCP) Variegate porphyria (VP) Porphyria cutanea tarda (PCT) |
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Hemochromatosis -gene recessive disorder of iron metabolism. |
S/s weakness, malaise, libido loss, wt loss, abd pain, joint pain, skin changes. |
CHF, TX: phlebotomy |
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Intrahepatic biliary dysplasia (IHBD) |
Combo of anomalies with cholestasis. |
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Biliary atresia |
Bile duct disorder, obst. of the flow of bile through the extra hepatic system. |
Sx: Kasai procedure, liver transplant |
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Neonatal hepatitis 1-2 months age |
Causes: viruses- CMV, rubella, hep A,B, or C. |
May lead to mental retardation, cirrhosis, chronic liver diseases |
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Gilbert syndrome Congenital, males |
Fluctuating increase of serum bilirubin. Liver tests WNL. |
No tx required |
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Orthotopic liver transplant |
Cadaver or living donors. |
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