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53 Cards in this Set

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4 main functions of the liver:
1. digestion
2. endocrine
3. hematologic
4. excretory
2 digestive functions of the liver:
1. bile salt secretion via bile
2. processing and storing of fats, CHO, proteins, vitamins and minerals
2 endocrine functions of the liver:
1. metabolism of glucosteroids, mineralosteriods, sex hormones
2. replication of CHO, fat and protein metabolism
4 hematologic functions of the liver:
1. temporary storage of blood
2. synthesis of bilirubin from blood breaks down products
3. hematopoiesis in certain disease states
4. synthesis of blood clotting factors
4 excretory functions of the liver:
1. excretion of bile pigment
2. excretion of cholesterol via bile
3. urea synthesis
4. detoxification of drugs and other foreign substances
Hepatitis A:
"infectious"
-usually spread by fecal/oral route
-generalized symptoms (flu-like)
-jaundice later if severe (common in A)
Tx for Hepatitis A:
-support
-immune globin (prophylaxis)
-steroids
-vaccine currently under development
Hepatitis B:
"serum"
-parenteral contact with infected blood or its products and oral and sexual contact
-symptoms are worse
-higher incidence of complications
-Tx similar to A, but vaccine prophylaxis is available
What kind of complications are associated with Hep B?
aplastic anemia
pancreatitis
cardiomyopathy
neuropathy
skeletal myopathy
Hepatitis C:
-non A and non B
-transmission similar to B
-usually asymptomatic or mild
-Tx is support and blood transfusions, prophylaxis not warranted
Delta Hepatitis:
aka Hepatitis D
-co-infects with Hep B
-parenteral routes are blood and blood products
-prevention by Hep B vaccine
Chronic Hepatitis:
> 6 months
-usually asymptomatic
-prognosis excellent
-no drug tx needed
Chronic active hepatitis:
-progressive, destructive, inflammatory disease
-leads to cirrhosis or arrest with some degree of fibrosis
-symptoms as acute hepatitis or nonspecific
-can result in jaundice or significant liver disease
-Dx by liver biopsy
Tx of chronic active hepatitis:
-corticosteroids and immunosuppressive drugs
Hepatic disease is usually secondary to what 4 conditions?
1. CHF
2. Cancer
3. Alcoholism
4. Infections
4 results of hepatocellular failure:
1. Jaundice
2. decreased serum albumin causing edema
3. Hyper or Hypoglycemia
4. impairment absorption ADEK
aka Hepatocellular Failure
"liver cell failure"
2 results of portal hypertension:
1. esophageal varices, hemorrhoids
2. ascites
2 results of portal systemic encephalopathy:
1. mild confusion, stupor, coma
2. correlation with blood ammonia levels
4 general manifestations of liver disease:
1. Hepatocellular failure
2. Portal hypertension
3. Portal systemic encephalopathy
4. Ascites
Tx for Portal systemic encephalopathy:
1. elimination of dietary proteins
2. oral neomycin (suppress flora and decrease ammonia production)
3. lactulose (reduce ammonia)
4. IV glucose and vitamins
Causes of Ascites:
1. accumulation of sodium, water and protein
2. malignancy
3. infections
4. nephrosis
5. cardiac failure
6. portal vein thrombosis
Tx for ascites:
1. large volume paracentesis
2. Na restriction
3. diuretics
4. aldosterone antagonis (spironolactone)
5. salt-poor albumin (low salt protein)
6. shunts into venous system
How is ascites diagnosed?
paracentesis
Chronic viral hepatitis:
-5% of acute patients are HBV or HBC
-variable course from mild to cirrhosis and hepatic failure
-Tx: interferons with a 40-50% response rate
Biliary cirrhosis:
-damage to bile ducts
-obstruction, sclerosing cholangitis, tumors
-diffuse fibrosis
Consequences of biliary cirrhosis:
portal hypertension and liver failure
3 Causes of alcohol liver disease:
1. fatty liver
2. alcoholic hepatitis
3. cirrhosis
Tx of Alcohol liver disease:
1. stop alcohol intake
2. nutrition
3. possible corticosteriods when critical
lipofuscin:
-pigments in liver
-a dark brown lipochrome found especially in the tissue (as of the heart) of the aged
hemosiderin:
-hemorrhage or congestion
-hemoglobin derived with iron
-severe liver and pancreatic damage
-insoluble protein that contains iron and that is produced by phagocytic digestion of hematin and found as granules in most tissues, especially in the liver
hemochromatosis:
-inherited disorder
-excessive and uncontrollable iron absorption from GI tract
-Dx: by an increased serum iron or ferritin and biopsy
Name 2 Metal storage diseases:
1. Hemochromatosis
2. Hepatolenticular degeneration (Wilson's disease)
Wilson's disease:
aka hepatolenticular degeneration
-excess copper accumulation in liver and other organs
-an autosomal recessive hereditary disease
Tx for Wilson's disease:
1. D-penicillamine
2. cross-reaction with penicillin allergy
(side effects are common with tx)
2 types of toxic liver disorders:
1. metal storage disorder
2. acetaminophen poisoning
Dx for Wilson's disease:
1. slit-lamp exam of cornea for Kayser-Fleischer (brown) rings
2. Liver biopsy for hepatic copper
Dx of Liver abscess:
1. right upper abdominal or lower thoracic pain with fever
2. leukocytosis
3. increase in enzymes
4. ultrasound and CT scan
5. needle aspiration
4 Causes of Liver abscess:
1. infection ascending from biliary tree
2. direct extension
3. secondary to cysts (benign or parasitic) and necrotic cancers
4. abdominal infections via portal vein (ex: appendicitis)
Tx for liver abscess:
antibiotics and drainage
What condition would cause a decrease in body function?
any condition that is severe enough; depends on severity.
Liver damage from Trauma:
-most common injury from penetrating wounds
-2nd most common from blunt
-hemorrhage is most significant feature
-Tx fluid and blood replacement or surgery
Liver cancer:
-usually metastatic
-primarily hepatic carcinoma
is most common
symptoms of liver cancer:
-hepatosplenomegaly
-jaundice
-ascites
-general cancerous symptoms
What is the most common type of liver cancer?
Primary hepatic carcinoma
Primary hepatic carcinoma:
-rare in USA, common in Africa
-reflects incidence of chronic HBV and HCV
-cirrhosis increases risk of this
Tx for liver cancer:
-partial hepatic resection
-chemotherapy
-hepatic artery ligation (supply to tumors)
Liver Transplantation:
-conditions such as end-stage cirrhosis from hepatitis, wilson's disease
-not for malignancies
-immunosuppression increases risk of cancer (esp lymphoma)
3 categories of jaundice:
1. Newborn jaundice(takes care of itself)
2. Hepatocellular (disease in liver like cirrhosis)
3. Obstructive (tumor, etc)
Liver:
-largest organ
-large, reddish-brown, glandular vertebrate organ
-located in the upper right portion of the abdominal cavity
-secretes bile
-formation of certain blood proteins and in the metabolism of CHO, fats, and proteins
-frequently injured organ
-contains 2 lobes
-covered by visceral peritoneum except for "bare area"
blood supply of liver:
-25% fed by hepatic artery and remainder from portal vein
-rich lymphatic system
sinusoid:
-any of the venous cavities through which blood passes in various glands and organs, such as the adrenal gland and the liver
What is a common condition that pts get in to liver disease?
Portal hypertension