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55 Cards in this Set

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which organ holds 13% of the body's blood supply at any time, is visible on plain film and has the ability to regenerate?
the liver
what makes up the blood supply for the liver?
The splenic vein, joining with the superior mesenteric vein to form the portal vein, brings venous blood from the spleen, pancreas, small intestine, and large intestine, so that the liver can process the nutrients and byproducts of food digestion.
The hepatic veins drain directly into the inferior vena cava.
The hepatic artery is generally a branch from the celiac trunk, although occasionally some or all of the blood can be from other branches such as the superior mesenteric artery.
Approximately ⅔ of the blood flow to the liver is from the portal venous system, and ⅓ is from the hepatic artery
what are the primary functional units of the portal tract which contains the portal triadwhere the hepatocytes lie?
the acinus
this network of tubes carries bile from the liver to the intestine?
the biliary tree
this duct network allows bile to drain out of the liver?
HEPATIC DUCT
a substance that helps carry away wastes and is needed for the breakdown and absorption of dietary fats?
bile
what are some of the functions of the liver?
Bile acid synthesis and secretion
synthesis of prothrombin, factors VII, IX,X
Kills germs
Filters toxic chem from body
biotransformation, detox, excret of various endog/exog compounds
disposes of bilirubin
an orange-yellow breakdown product of RBC-when in excess causes jaundice?
bilirubin
which globulinprotein molecule is synthesized exclusively in the liver, is essential for carrying molecules and drugs in the body, and for keeping fluid in blood vessels
albumin
where are bilirubin and ammonia metabolized?
in the liver
how is uncongugated bilirubin transported?
in the plasma bound to albumin
what is fetor hepaticus?
foul sulfur smelling breath
a rare autosomal recessive disease that is characterized by excessive deposition of copper in the liver and brain,
Wilson's Disease
what are some general findings on the PE of a patient with liver disease?
fever, weight loss
spider angiomas, palmar erythema, jaundice, xanthelasma
what are some endocrine findings for liver disease?
gynecomastia, testicular atrophy, hypoglycemia
what manifestations in the GI tract are caused from liver failure?
RUQ pain, abdominal swelling/ascites, heptosplenomegaly, G.I. bleed
what hematological manifestation can result from liver disease?
pale skin/mucous membranes, ecchymoses
what neuro manifestations can result from liver disease?
NH4 build up could lead to hepatic encephalitis, ataxia, somnolence, confusion, asterixis & obtundation
the triad of confusion, ataxia and ophthalmoplegia that develops due to thiamin deficiency is what syndrome common in alcoholics
Wernicke-Korsakoff
if your patient has a combo of dark urine and light stool what explains this?
in liver disease: there is an excess of uncongugated bilirubin
what are some physical features of chronic liver disease?
icteric mucous membranes, ascites, caput medusa, telangiectatic lesions, xanthelasma, splinter hemorrhages, spider angiomas
what are some tests for liver function?
Serum albumin
PT: tests capacity for protein synthesis
measures function of the livers clotting ability
LFT's/Transaminases: ALT, AST
ALK PHOS
serum bilirubin
which protein is of the highest concentration in plasma?
albumin
what are some of the causes of decreased albumin?
liver disease (it is synthesized in the liver)
kidney disease (it escapes through urine)
malnutrition or a low protein diet
what test result is the most sensitive indicators of severe liver disease?
prolonged Prothrombin time (PT)
a deficiency in what factors prolongs the PT time?
factors I (fibrinogen)
factor II (prothrombin)
factor V
Factor VII
factor X
what should the INR be for a person on full anticoagulant therapy?
2-3 times the normal value= 2-3
what should the INR be for a patient on anticoagulation with a mechanical heart valve?
INR 2.5-3.5
which LFT/transaminases is more specific indicator for liver damage?
ALT (SGPT)
these transaminases are released into the circulation post hepatocyte injury or death?
ALT and AST
what is the ratio of AST : ALT that indicates alcoholic liver disease?
> 2:1
this enzyme is derived from liver, intestines, bones and placenta and is released during liver damage, necrosis, cholestasis, ...?
alkaline phosphatase
conjugated bilirubin: elevated in intra or extra hepatic obstruction?
direct bilirubin
this enzyme is derived from liver, intestines, bones and placenta and is released during liver damage, necrosis, cholestasis, ...?
alkaline phosphatase
unconjugated or insoluble bilirubin, elevated when hemolysis releases it from RBC's or in rare genetic deficiencies in conjugating enzymes??
indirect bilirubin
a yellow/green appearance to the skin & eyes (icterus) produced by increased serum bilirubin
jaundice
what makes your feces brown?
stercobilin
conjugated bilirubin: elevated in intra or extra hepatic obstruction?
direct bilirubin
what is the most common cause of jaundice?
neonatal jaundice
a yellow/green appearance to the skin & eyes (icterus) produced by increased serum bilirubin
jaundice
a type of brain damage that causes athetoid cerebral palsy and hearing loss. it also causes problems with vision and teeth and sometimes can cause mental retardation?
kernicterus
dark brown or green urine implies?
conjugated hyperbilirubinemia
a type of brain damage that causes athetoid cerebral palsy and hearing loss. it also causes problems with vision and teeth and sometimes can cause mental retardation?
kernicterus
patient has a hx of pale stools & pruritus is indicitive of???
cholestasis
what findings are indicitive of hyperbilirubin?
a HOT Liver!
Hemolysis
Obstruction
Tumor
Liver disease
what are some causes of jaundice of PREHEPATIC origin?
hemolytic blood transfusion
sickle cell
thalassemia
spherocytosis
autoimmune hemolytic anemias
what are some causes of intrahepatic jaundice?
decreased bilirubin uptake by liver
Gilbert's dz
decreased conjugation of bilirubin
hepatitis
cirrhosis
cancer of the liver
what are some causes of posthepatic jaundice?
cholelithiasis
bile duct obstrucion: tumors
cogenital atresia of extrahepatic bile ducts
what is the name of the location on the gall bladder where all the pathology takes place on the "neck"
Hartmann's pouch
what makes up the common bile duct?
common hepatic ducts and the cystic duct
what makes up bile?
an isotonic mixture:
electrolytes
protein
bile salts
cholesterol
phospholipids
bile pigment
what is the name of the location on the gall bladder where all the pathology takes place on the "neck"
Hartmann's pouch
what makes up the common bile duct?
common hepatic ducts and the cystic duct
this pancreatic enzyme is released from the small bowel after a fatty meal, simulates the GB to contract and sphincter of oddi to relax?
CCK
if there is a bile acid insufficiency, why is there a malabsorption of fat?
because bile acids facilitate the absorption of dietary fat by the formation of intraluminal micelles