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120 Cards in this Set
- Front
- Back
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Why do we call it Cirrhosis?
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Because cirrho means tawny yellow and people with it get yellow!
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What is cirrhosis?
-effect -followed by |
Diffuse fibrosis of the liver Effect: destroys its normal architecture
Followed with nodular regeneration |
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What are 2 types of regeneration in cirrhosis?
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-Micronodular
-Macronodular |
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What's the difference?
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Micro nodules are <3 mm and uniform in size
Macro nodules >3 mm; vary in size |
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What CAUSES micronodular cirrhosis usually?
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METABOLIC insult
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3 examples of metabolic insult that can cause micronodular cirrhosis:
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-Alcohol
-Hemochromatosis -Wilson's disease (copper) |
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What causes MACROnodular cirrhosis usually?
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Significant liver injury leading to hepatic necrosis
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2 examples of liver injuries that lead to macronodular cirrhosis:
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-Drug insult
-Infections |
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Which form of cirrhosis is associated with increased risk of hepatocellular carcinoma?
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MACROnodular
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What is the most likely shunt to relieve the portal hypertension in cirrhosis?
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Portacaval shunt between Splenic vein and Left Renal vein
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What are the 8 major effects of portal hypertension in chronic liver cirrhosis?
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HEMPCASH
-Hematemesis -Esophageal varices -Melena -Peptic ulcers -Caput medusae -Ascites -Splenomegaly -Hemorrhoids |
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Elevated AST/ALT indicate:
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-Viral hepatitis
-Alcoholic hepatitis |
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AST elevation
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Myocardial infarct
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GGT
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Various liver diseases
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Alkaline phosphatase (ALP)
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-Obstructive liver disease - hepatocellular carcinoma
-Bone disease |
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Amylase
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Acute pancreatitis
Mumps |
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Lipase
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Acute pancreatitis
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Ceruloplasmin decrease
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Wilson's disease
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Mallory bodies:
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Alcoholic hepatitis
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Where is most prominent sclerosis in alcoholic hepatitis?
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Zone 3
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What's higher in Alcoholic hepatitis vs Viral hepatitis; AST or ALT?
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Alcoholic: AST>ALT (toasted)
Viral: Alt>AST |
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What are mallory bodies?
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Intracytoplasmic eosinophilic inclusions
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Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis:
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Budd-Chiari syndrome
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What does the occlusion of IVC in buddchiari lead to?
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Congestive Liver Disease
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3 associated CAUSES of Budd-Chiari:
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-Hepatocellular carcinoma
-Pregnancy -Polycythemia vera |
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Wilson's disease:
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Inadequete hepatic COPPER excretion; copper fails to enter circulation
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What is decreased as a result of Wilson's disease?
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Ceruloplasmin - the circulatory form of copper
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Inheritance pattern of Wilson's:
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Auto recessive (its a metabolic condition)
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Wilson's disease is aka:
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Hepatolenticular degeneration
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Why hepatolenticular?
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Copper gets deposited in liver and brain
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Corneal deposits of copper:
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Kayser-Fleischer rings
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What are the 4 findings hallmark in Wilson's disease?
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ABCD
-Asterixisis -Basal ganglia degeneration -Ceruloplasmin decrease, corneal deposits, cirrhosis, copper accumulation, cancer of the liver, choreiform movements -Dementia |
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What is the TREATMENT for Wilson's disease?
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Penicillamine
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Hemosiderosis:
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Deposition of hemosiderin (iron)
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Hemochromatosis:
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The disease CAUSED by iron deposition
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Classic TRIAD of Hemochromatosis:
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-Micronodular cirrhosis
-Pancreatic fibrosis -Skin bronzing |
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So Hemochromatosis is aka:
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Bronze diabetes
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2 complications of chronic hemochromatosis:
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-Congestive heart failure
-Increased risk of liver cancer |
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Inheritance of hereditary hemochromatosis:
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Auto recessive (metabolic!)
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How can hemochromatosis be acquired?
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Chronic transfusions
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Iron studies in hemochromatosis:
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-Increased ferritin
-Increased iron -Low TIBC -Increased transferrin saturation |
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Stain for hemochromatosis/iron:
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Prussian blue
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What may happen in patients with hemochromatosis at airports?
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Can set off metal detectors :)
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Treatment for Hemochromatosis:
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-Phlebotomy for life
-Deferoxamine (chelating agent) |
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What marker is associated with Hemochromatosis?
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HLA A3
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3 types of jaundice causes:
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-Hepatocellular dysfunction
-Obstruction of bile flow -Hemolysis increase |
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What type of hyperbilirubinemia will be seen in Hepatocellular type? What will urine bilirubin be? Urine urobilinogen?
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-Both conjugated/unconjugated
-Increased urine bilirubin -Normal/decreased urobilinogen |
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What type of bilirubin will be high in the serum in an obstructive disease?
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CONJUGATED
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What will the urine bilirubin and urobilinogen be in obstructive problems?
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Urine bilirubin - increased
Urine urobilinogen - decreased |
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Why is urine urobilinogen decreased in hepatocellular and obstructive diseases?
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There's a problem in getting bilirubin out of the liver.
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In Hemolytic disease what is the
-Hyperbilirubinemia type -Urine bilirubin -Urine urobilinogen |
-UNCONJUGATED bilirubinemia
-ABSENT urine bilirubin -Increased urine urobilinogen |
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What are the 3 hereditary hyperbilirubinemias?
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-Gilbert's syndrome
-Crigler-Najjar syndrome -Dubin johnson syndrome |
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Which is the worst? Why?
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Crigler-Najjar syndrome type I - patients die within a few years
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What is Crigler najjar type I caused by?
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ABSENT UDP-glucuronyl transferase - completely unable to conjugate bilirubin
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What can the less severe Crigler-Najjar type II be treated with? Why?
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PHENOBARBITAL!!! It elevates liver enzymes! Thus increases UDP-glucuronyltransferase
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What are the 3 hallmark findings in Crigler-Najjar?
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-Kernicterus
-Jaundice -Increased unconjugated bilirubin |
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Treatment for Crigler-Najjar type I:
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-Phototherapy
-Plasmapheresis |
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Which hereditary hyperbilirubinemia will have NO clinical consequences?
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Gilbert's syndrome
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Why is Gilbert's syndrome asymptomatic?
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Because its just a MILD decrease in UDP-glucuronyltransferase
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What are Gilbert's syndrome flare-ups associated with?
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Stress
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What is the cause of Dubin Johnson hyperbilirubinemia? What type of bilirubin builds up?
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Defective LIVER EXCRETION
-Conjugated! |
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What does the inability to excrete the DIRECT bilirubin in Dubin Johnson result in? How bad is this disease?
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The liver turns BLACK - but this is benign.
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What is a similar syndrome to Dubin Johnson?
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Rotor's syndrome - the liver doesn't even turn black tho.
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Jaundice
Fever RUQ pain |
Primary sclerosing cholangitis
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What is the triad of Jaundice fever and RUQ pain called?
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Charcot's triad of cholangitis
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What IS PSC?
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Sclerosis of the intra and extrahepatic biliary ducts
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What is seen on ERCP in primary sclerosing cholangitis?
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Alternating strictures and Dilation with BEADING
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What disease is PSC associated with?
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UC - ulcerative cholitis
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How do you remember that?
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You EXAMINED a patient with this for petes sake
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So when you think PSC, think:
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Fever/RUQ pain/Jaundice
Ulcerative cholitis |
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What can PSC lead to?
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2ndary biliary cirrhosis
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What is Biliary Cirrhosis?
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Injury and fibrosis of the INTRAHEPATIC BILE DUCTS caused by increased pressure from an EXTRAhepatic obstruction. (PSC)
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What are 3 things that COMPLICATE Secondary Biliary Cirrhosis?
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-Ascending cholangitis (infection)
-Bile stasis -Bile lakes |
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What are 2 lab findings that indicate secondary biliary cirrhosis?
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-High ALP
-High direct bilirubin |
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What are the 2 lab findings that indicate PRIMARY biliary cirrhosis?
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-High SERUM MITOCHONDRIAL ANTIBODIES
-High direct bilirubin |
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With what 2 conditions is PRIMARY biliary cirrhosis associated?
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-Scleroderma
-CREST |
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How is Primary biliary cirrhosis different from secondary in terms of etiology?
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Its due to an INTRAHEPATIC, autoimmune disorder - not extrahepatic obstruction.
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What are 4 complications/results of primary biliary cirrhosis?
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-Severe obstructive jaundice
-Steatorrhea -ITCHING (pruritus) -Xanthomas (hypercholestermia) |
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What is the most common primary malignant tumor of the liver in adults?
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Hepatocellular carcinoma - HEPATOMA
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What are 7 things that have a high risk association with Hepatocellular carcinoma?
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-Hepatitis B
-Heptatitis C -a1-antitrypsin deficiency -Aflatoxin B -Alcoholic cirrhosis -Hemochromatosis -Wilson's disease |
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What is the most common mechanism for spread of Hepatocellular carcinoma?
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Hematogenous
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What serum marker is seen in hepatocellular carcinoma?
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AFP
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What can Hepatocellular carcinoma LEAD To?
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Budd-chiari syndrome - obstruction of the veins leading to congestive liver failure.
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What are 4 clinical findings at presentation of Hepatocellular carcinoma?
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-Hypoglycemia
-Polycythemia -Ascites -Hepatomegaly that's TENDER |
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Fatal childhood hepatoencephalopathy:
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Reye's syndrome
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3 findings in Reye's syndrome:
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-Fatty liver - microvesicular
-Hypoglycemia -Coma |
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What is Reye's syndrome thought to be caused by?
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Giving Aspirin for viruses - VZV and influenza B
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So what should you not give kids?
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Salicylates - Aspirin and probly not Acetaminophen either
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4 risk factors for Gallstones:
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-Fat
-Female -Fertile -Forty |
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Why do gallstones form?
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Cholesterol and/or bilirubin overwhelms the ability for bile acids and lecithin to solubilze them.
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So what are the 3 types of gallstones that can form?
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1. Cholesterol stones
2. Mixed stones 3. Pigment stones |
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Which stones are radioopaque and which are radiolucent?
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Cholesterol - radiolucent
Mixed - radiolucent Pigment - radioopaque |
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What is the most common type of gallstones?
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Mixed
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What do mixed gallstones contain?
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Both pigment and cholesterol
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What ethnicity has a higher incidence of cholesterol stones?
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Native americans
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What diseases are associated with Cholesterol stones?
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-Cystic fibrosis
-Crohn's |
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What weight changes can lead to Cholesterol stones?
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-Obesity
-Rapid weightloss |
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What are 4 conditions in which PIGMENTED gallstones are seen?
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-Advanced age
-Alcoholic cirrhosis -Biliary infections -Chronic RBC hemolysis |
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How are gallstones DIAGNOSED and TREATED?
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Dx: Ultrasound
Tx: Cholecystectomy - yank it out |
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What is acute pancreatitis?
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Autodigestion of the pancreas by its own enzymes
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Acronym for causes of Acute Pancreatitis:
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GET SMASHeD
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GET SMASHeD:
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-Gallstones
-Ethanol -Trauma -Steroids -Mumps -Autoimmune disease -Scorpion stings -Hypercalcemia/hyperlipidemia -Drugs |
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What drugs can cause acute pancreatitis?
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Sulfa drugs
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What is the classic triad of findings at presentation of Acute Pancreatitis?
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-Anorexia
-Nausea -Epigastric pain radiating to the back |
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What labs will be elevated in Acute pancreatitis? Which is more specific?
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Amylase
Lipase - most spcf |
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What is Chronic CALCIFYING pancreatitis more than likely caused by in most cases?
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Alcoholism
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What is Chronic OBSTRUCTIVE pancreatitis likely to be caused by?
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Gallstones
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What is the prognosis for pancreatic ADENOCARCINOMA?
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6 mo or less! Very grave - remember lecture?
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What has already happened in most cases at presentation of Pancreatic adenocarcinoma?
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Metastasis
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Where are most pancreatic adenocarcinoma tumors located? What is the result?
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Pancreas HEAD - obstructive JAUNDICE
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What 2 ethnic groups are at increased risk for getting Pancreatic adenocarcinoma?
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-Jews
-African americans |
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What are 2 other slightly weird lifestyle associations with pancreatic adenocarcinoma?
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Alcohol IS NOT a risk factor
Smoking IS! |
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What are the 4 presenting signs of Pancreatic Adenocarcinoma?
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WAMO
-Weightloss -Abdominal pain radiates to back -MIGRATORY THROMBOPHLEBITIS -Obstructive jaundice w/ palpable gallbladder |
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What is the migratory thrombophlebitis called?
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Trousseau's syndrome
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What is the palpable gallbladder called?
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Courvoisier's sign
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What is Carcinoid?
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Tumor of ENDOCRINE CELLS
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Where are carcinoid tumors found?
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Small bowel - 50% of the tumors there
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What is the most common site of a carcinoid tumor?
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Appendix
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What hormone do Carcinoid tumors often produce?
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5-HT
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4 classic symptoms of Carcinoid:
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-Wheezing
-Right sided heart lesions -Diarrhea -Flushing |
