Hepatic Quiz 2, Hepatic Biliary Dysfunction

Front 1

Most common complications of hepatic dysfunction are?
Manifested as?
Based on?

Back 1

continued bleeding , sepsis, and hepatic decompensation
Manifested as jaundice, categorized as prehepatic, intrahepatic, post hepatic
Based on repeated measures of bilirubin, transaminase enzmes and alk phos

Front 2

Caused by hemolysis, hematoma reabsorpition, bilirubin overload from whole blood
Characterized by what?

Back 2

prehepatic dysfunction
characterized by
increased unconjugated bilirubin
normal plasma transaminase
normal alk phos

Front 3

Caused by viral hepatitis, drug toxicity, sepsis, arterial hypoxemia, cirrhosis
characterized by what?

Back 3

Intrahepatic dysfunction
Characterized by
Increased conjugated bilirubin
Markedly increased plasma transaminase
Normal to slightly elevated alkaline phosphatase
Also known as hepatocellular dysfunction

Front 4

Caused by retained common bile duct stone, can also be caused by sepsis.
characterized by?

Back 4

Post hepatic dysfunction
characterized by
increased conjugated bilirubin
normal to slightly slevated transaminase
markedly increased alk phos
urine contain large amounts conjugated bilirubin

Front 5

causes difficult to confirm, liver function often returns to normal without specific treatment

Back 5

Extrahepatic dysfunction

Front 6

Inflammatory disease of hepatocytes, most often due to viral infections or ingestion of toxic drugs

Back 6

Acute hepatitis

Front 7

Causes of Viral hepatitis

Back 7

Type A, B, C, epstein Barr, cytomegalovirus

Front 8

Early symptoms of viral Hepatitis

Back 8

Dark urine, fatique, anorexia, nausea, fever, abdominal discomfort

Front 9

Lab values Viral hepatitis

Back 9

Plasma transaminases elevated 7-14 days before onset of jaundice and decline after jaundice is noticable
Bilirubin not greater 20mg/dl unless liver disease is severe or hemolysis is also present

Front 10

Severe and potentially fatal hepatitis is suggested by what?

Back 10

plasma albumin 2.5 or markedly long prothrombin time

Front 11

Infectious hepatitis or short incubation hepatitis
highl infectious and cross contamination within families is very common
Transmission by fecal-oral route
What reduces severity?
Does chronic carries state exist?

Back 11

Hepatitis A
Pooled gamma globulin greatly reduces severity of type A hepatitis
chronic liver disease or carrier state does not develop

Front 12

Most common form viral hepatitis
transmission via blood transfusion, percutaneous ionculation, oral to oral and sexual activity
Chronic carrier?
Cancer?

Back 12

Hepatitis B virus
Persistence of HBsAg longer than six months in the absence of antibodies indicates that the patient is a chronic arrier and can potentialy infect others
Primary hepatocellular carcinoma is 220 times more likely to develop in chronic carriers

Front 13

Route of transmission inoculation, liver disease often develops and chronic state is common

Back 13

Hepatitis C

Front 14

What drugs can cause hepatitis and when do clinical signs occur?

Back 14

antibiotics, antihypertensives, anticonvulsants, analgesics, tranquilizers, and anesthetics
Signs occur 2-6 weeks after starting drug therapy

Front 15

Unresolving disease caused by a virus, drugs, inborn errors of metabolism or unkown factors.
Moslty associated with what?
Divided into what?

Back 15

chronic hepatitis
Mostly associated with hepatitis B
Divided into chronic active or chronic persistent hepatitis

Front 16

Most serious form chronic hepatitis
Ultimately resulting in cirrhosis and hepatic failure
widespread inflammation and destruction of hepatocytes
What treated with

Back 16

chronic Active hepatitis
Treated with corticosteroids with or without azathioprine

Front 17

Benign non progressive inflammatory disease mainly confined to portal area-type chronic hepatitis
How treat?

Back 17

chronic persistent hepatits
nutrition, avoidance of potential hepatotoxins and frequent observation is treatment

Front 18

S/S include hepatic encephalopathy, hyperventilation, high ammonia levels, hypoglycemia, metabolic acidosis, increased CO, renal failure, thromobocytopenia, DIC, anemia

Back 18

Acute Hepatic failure
regardless of etiology, is associated with a poor prognosis
plasma transaminase levels are high and parallet the extent of hepatic injury
Treatment supportive, N-acetylcyseine is a antioxidant that improves oxygen content

Front 19

the only curative therapy for patients in hepatic failure is?

Back 19

liver transplant

Front 20

Chronic disease process which destroys the hepatic parenchyma and replaces it with collagen.
Most frequent cause is?

Back 20

cirrhosis
alcohol most frequent cause

Front 21

alcoholic cirrhois occurs in what percent of those who consume how much alcohol?

Back 21

10% of those who consume 80g of alcohol daily for ten years

Front 22

Characterized by jaundice in assocaition with elevations of the plasma transaminase enzymes,
Ascites occurs in 50% of patients
Plasma albumin may be reduced below 3g/dL
Prothrombin prolonged

Back 22

Acute Alcoholic Hepatitis

Front 23

Develops several years after first attack of alcoholic hepatitis

Back 23

Portal vein hypertension

Front 24

Why does ascites occur with portal vein hypertension?

Back 24

ascites is due to decreased oncotic pressure secondary to low plasma albumin, elevated resistance to blood flow through the portal vein system and increased secretion of ADH

Front 25

What are lab values with portal vein hypertension?
Hematocrit
Na
Bun
liver

Back 25

hematocrit 30-35
hyponatremia
Bun<10
bilirubin, transaminases, alk phos mildly to moderatley elevated

Front 26

Alcoholic cirrhosis complications are?

Back 26

hyperdynamic circulation
arterial hypoxemia
hypoglycemia
gallstones
duodenal ulcer
gastroesophageal varices
hepatic encephalopathy
impaired immune defense

Front 27

compensensatory neuronal excitablility and catecholamine release following abrupt d/c of alcohol
6-8 hrs after abstinence
Autonomic nervous system imbalance may be reflected by HTN, tachycardia, and dysrhythmias

Back 27

minor alcohol withdrawal syndrome

Front 28

Occurs in 5% of alcoholic pts
Medical emergency
onset 48-72 hrs after stop drinking
Increased SNS with catecholamine release leading to diaphoresis, hyperpyrexia, htn, and tachycardia
grand mal seizures can be first sign

Back 28

Severe alcohol withdrawal

Front 29

Chronic , progressive and often fatal cholestatic liver disease
Characterized by destruction of intrahepatic bile ducts, portal inflammation and scarring
development of cirrhosis and liver failure

Back 29

primary biliary cirrhosis

Front 30

Excess amounts of iron are deposited in hepatocytes, leading to scarring and cirrhosis
treated by repeated phlebotomy

Back 30

hemochromatosis

Front 31

manifested by the presence of gallstones, may present as acute cholecystitis or chronic chollithiasis

Back 31

Diseases of biliary tract

Front 32

Almost always due to obstruction of the cystic duct by gallstones
Rapid onset of severe pain in the mid epigastrium which extends into the right upper abdomen, have Murphs sign

Back 32

Acute cholecytitis

Front 33

The development of fibrotic gallbladders, which are not capable of contracting to expel bile.

Back 33

Chronic cholelithiasis

Front 34

inflammation of the hepatic biliary tree which develops in response to obstruction of the biliary tract

Back 34

Chronic cholangitis