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70 Cards in this Set

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Liver failure, >PT, GI bleed; how do you treat?
1. Vitamin K- treats coumadin OD (in fresh frozen plasma)

2. Beta Blocker
Children with liver disease, especially if accompanied by pulmonary manisfestations (emphysema/COPD); what may be the cause?
Alpha 1 anti-trypsin
This vein is formed by the junction of the splenic & superior mesenteric veins
The portal vein
what is the Acini
The acinus make up the primary functional unit of the portal tract; contains the portal triad (hepatic artery, portal vein, bile ducts)
where are hepatocytes found and what do they contain?
Found in the ascini
They contain glycogen
Which clotting factors does the liver produce?
Prothrombin

factors:
VII
IX
X

from vitamin K absorption
what is the main functions of albumin?
Carries molecules (drugs)
Osmotically active (prevents edema)
T/F The liver produces fat-soluble vitamins, ADEK.
False, the liver does not produce them, only stores them
_______ bilirubin is transported in the plasma bound to albumin
Unconjugated
what are some cutaneous physical findings of liver disease
spider angiomas
telangiectasias
palmar erythema
jaundice
xanthomas & xanthelasma
GI bleed with liver problems are most likely due to?
ruptured esophageal varices from portal HTN
Name 3 causes of decreased albumin in the blood
Liver disease- < production
Renal disease - albumin escapes into urine
Malnutrition
Wernecke's encephalopathy symptoms
Confusion
Ataxia
ophthalmoplegia
what causes Wernecke's encephalopathy?
Thiamine deficiency
S/sx of Korsakoff encephalopathy
confabulation
recent memory loss
what test would you do to test for fluid in the abdomen?
shifting dullness
what is asterixis
flapping of the hands when extended forward

caused by cerebellar or liver problems
what is the most sensitive prognosticators of severe liver disease
Prolongation of the PT
what does the PT (prothrombin Time) test do?
It measures clotting ability of factors I (fibrinogen), II (prothrombin), V, VII, and X
name 2 things that can prolong the PT
Vit K deficiency
Coumadin
What is the normal PT range?
11-15 seconds
what is the normal value of INR?
The normal value for the INR is 1.0
what substance helps with the absoption of Vit K?
Bile
which liver enzyme would be elevated with tissue injuries like MI or muscle disorders?
AST: found in liver, muscle, kidney, heart, and brain; released into serum if these organs are damaged
This enzyme is mostly concentrated in the liver and is released in response to liver damage
ALT; therefore it is a more specific test for liver injury
what does a ratio of AST:ALT > 2:1 suggest?
Alcoholic liver disease
what does a ratio of AST:ALT < 1:1 suggest?
viral hepatitis
what conditions can give you very high levels of AST/ALT?
disorders that cause extensive hepatic necrosis:

Viral Hep
Acetaminophen OD
Circulatory shock
Since AST/ALT ratios and ALK Phos tests are not specific, what other test should you do?
Isoenzymes
where does Alk Phosphatase come from?
liver
intestines
bones
Placenta
when will Direct (conjugated) bilirubin be elevated?
with Intra or Extra Hepatic obstruction

Ex: Choledocolithiasis
when will Indirect bilirubin (Unconjugated, insoluble)be elevated?
when hemolysis releases it from red blood cells

Ex: hemolytic anemia
what is the normal bilirubin level?
Normal Bilirubin ranges 0.5 to 1.0 mg/dl.
at what levels is it considered to be clinically jaundiced?
Levels >3.0 mg/dl
which cells conjugate bilirubin?
Kupffer cells of the liver; they make the bilirubin water-soluble (shows up in urine)
what happens to bilirubin in the terminal ileum?
it is converted to sterobilinogen and urobilinogen by natural bacteria
what makes feces brown?
stercobilin
what can prevent production of urobiligen & stercobilinogen
Obstruction of biliary system

Stool will be light and urine dark
what causes dark urine?
if excretion of conjugated bilirubin into the bile is hindered, it is excreted by the kidneys givin urine a dark color
Name 3 causes of Unconjugated hyperbilirubinemia
overproduction
decreased hepatic uptake
decreased conjugation of bilirubin
MCC of jaundice?
Neonatal jaundice
what substance makes bilirubin water-soluble?
UDPglucuronate
what is Dubin-Johnson Syndrome?
an autosomal recessive disease which presents shortly after birth with an increase of conjugated bilirubin without elevation of liver enzymes (ALT, AST).
name some causes that impair conjugation of bilirubin
Hepatocellular disease

drug inhibition: chloramphenicol
anabolic steroids

genetic disorders:
Gilbert’s syndrome
Crigler- Najjar syndrome (decreased UDP-glucuronyl transferases)
what would lab results show with cholestatic jaundice?
Increased alk phos to 3-4 times normal
Hx of pale stools and pruritis
Cholestasis
10-15 fold increase in transaminases (AST/AlT)suggest?
Liver disease
Increased alk phos to 3-4 times normal suggest?
biliary obstruction
How do you Dx Cholestatic Jaundice?
Ultrasound -stones
Bile duct dilation - ERCP
Liver Biopsy
MC hereditary cause of increased bilirubin
Gilbert's Syndrome
MC manifestation of cholestatic jaundice
Hypercholesterolemia
Which Heps are fEcAl/orally transmitted?
E & A
name some symptoms of hepatitis
DAMN VARF

Diarrhea
Anorexia
Malaise
Nausea

Vomiting
Arthralgia
Rash
Fatigue
when is the PT,PTT elevated in liver disease?
when destruction reaches ~55%
what test is done for Mono?
Monospot
what do you NEVER give to treat a patient with Mono?
Ampicillin or Omoxicillin, causes rash
what are the key symptoms of Mono?
Fever
Exudative Pharyngitis
Lymphadenopathy
Splenomegaly
Name some complications of Mono
Bacterial pharyngitis
Upper airway obstruction
Rupture Spleen
Bells palsy
When lab testing, if the Mono test is negative, which test should you do next?
CMV test
which is the least dangerous of the viral hepatitis?
Hep A

shortest incubation(2-6 wks)
h/o of eating clams, travel
what's the incubation time for Hep B?
1-6 months
this serum marker is positive in acute HBV
HBeAg: envelop antigen
which serum marker is the first to show up in HBV infection?
HBsAg surface antigen
which serum marker will show up in late acute HBV and immunized people?
Anti-HBs: anti surface
this serum marker appears when antigen decreased
HBeAb: envelop antibody
what are the 2 HBcAb (core antibodies)
IgM marker: for acute infection
IgG marker: chronic HBV & carrier
what anti-serum marker would be dectectable 2 weeks after the appearance of HBsAG?
Anti-HBc: IgM

It is indicative of an acute infection
which Anti-HBc predominates after 6 months and generally persists indefinitely
IgG
This serum marker is considered to be a marker of active virus replication and infectivity
HBeAG: envelope antigen
Primary biliary cirrhosisis is manifested by?
cholestasis