Patho - Exam 6 Liver Disease

Front 1

4 main functions of the liver:

Back 1

1. digestion
2. endocrine
3. hematologic
4. excretory

Front 2

2 digestive functions of the liver:

Back 2

1. bile salt secretion via bile
2. processing and storing of fats, CHO, proteins, vitamins and minerals

Front 3

2 endocrine functions of the liver:

Back 3

1. metabolism of glucosteroids, mineralosteriods, sex hormones
2. replication of CHO, fat and protein metabolism

Front 4

4 hematologic functions of the liver:

Back 4

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

Front 5

4 excretory functions of the liver:

Back 5

1. excretion of bile pigment
2. excretion of cholesterol via bile
3. urea synthesis
4. detoxification of drugs and other foreign substances

Front 6

Hepatitis A:

Back 6

"infectious"
-usually spread by fecal/oral route
-generalized symptoms (flu-like)
-jaundice later if severe (common in A)

Front 7

Tx for Hepatitis A:

Back 7

-support
-immune globin (prophylaxis)
-steroids
-vaccine currently under development

Front 8

Hepatitis B:

Back 8

"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

Front 9

What kind of complications are associated with Hep B?

Back 9

aplastic anemia
pancreatitis
cardiomyopathy
neuropathy
skeletal myopathy

Front 10

Hepatitis C:

Back 10

-non A and non B
-transmission similar to B
-usually asymptomatic or mild
-Tx is support and blood transfusions, prophylaxis not warranted

Front 11

Delta Hepatitis:

Back 11

aka Hepatitis D
-co-infects with Hep B
-parenteral routes are blood and blood products
-prevention by Hep B vaccine

Front 12

Chronic Hepatitis:

Back 12

> 6 months
-usually asymptomatic
-prognosis excellent
-no drug tx needed

Front 13

Chronic active hepatitis:

Back 13

-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

Front 14

Tx of chronic active hepatitis:

Back 14

-corticosteroids and immunosuppressive drugs

Front 15

Hepatic disease is usually secondary to what 4 conditions?

Back 15

1. CHF
2. Cancer
3. Alcoholism
4. Infections

Front 16

4 results of hepatocellular failure:

Back 16

1. Jaundice
2. decreased serum albumin causing edema
3. Hyper or Hypoglycemia
4. impairment absorption ADEK

Front 17

aka Hepatocellular Failure

Back 17

"liver cell failure"

Front 18

2 results of portal hypertension:

Back 18

1. esophageal varices, hemorrhoids
2. ascites

Front 19

2 results of portal systemic encephalopathy:

Back 19

1. mild confusion, stupor, coma
2. correlation with blood ammonia levels

Front 20

4 general manifestations of liver disease:

Back 20

1. Hepatocellular failure
2. Portal hypertension
3. Portal systemic encephalopathy
4. Ascites

Front 21

Tx for Portal systemic encephalopathy:

Back 21

1. elimination of dietary proteins
2. oral neomycin (suppress flora and decrease ammonia production)
3. lactulose (reduce ammonia)
4. IV glucose and vitamins

Front 22

Causes of Ascites:

Back 22

1. accumulation of sodium, water and protein
2. malignancy
3. infections
4. nephrosis
5. cardiac failure
6. portal vein thrombosis

Front 23

Tx for ascites:

Back 23

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

Front 24

How is ascites diagnosed?

Back 24

paracentesis

Front 25

Chronic viral hepatitis:

Back 25

-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

Front 26

Biliary cirrhosis:

Back 26

-damage to bile ducts
-obstruction, sclerosing cholangitis, tumors
-diffuse fibrosis

Front 27

Consequences of biliary cirrhosis:

Back 27

portal hypertension and liver failure

Front 28

3 Causes of alcohol liver disease:

Back 28

1. fatty liver
2. alcoholic hepatitis
3. cirrhosis

Front 29

Tx of Alcohol liver disease:

Back 29

1. stop alcohol intake
2. nutrition
3. possible corticosteriods when critical

Front 30

lipofuscin:

Back 30

-pigments in liver
-a dark brown lipochrome found especially in the tissue (as of the heart) of the aged

Front 31

hemosiderin:

Back 31

-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

Front 32

hemochromatosis:

Back 32

-inherited disorder
-excessive and uncontrollable iron absorption from GI tract
-Dx: by an increased serum iron or ferritin and biopsy

Front 33

Name 2 Metal storage diseases:

Back 33

1. Hemochromatosis
2. Hepatolenticular degeneration (Wilson's disease)

Front 34

Wilson's disease:

Back 34

aka hepatolenticular degeneration
-excess copper accumulation in liver and other organs
-an autosomal recessive hereditary disease

Front 35

Tx for Wilson's disease:

Back 35

1. D-penicillamine
2. cross-reaction with penicillin allergy
(side effects are common with tx)

Front 36

2 types of toxic liver disorders:

Back 36

1. metal storage disorder
2. acetaminophen poisoning

Front 37

Dx for Wilson's disease:

Back 37

1. slit-lamp exam of cornea for Kayser-Fleischer (brown) rings
2. Liver biopsy for hepatic copper

Front 38

Dx of Liver abscess:

Back 38

1. right upper abdominal or lower thoracic pain with fever
2. leukocytosis
3. increase in enzymes
4. ultrasound and CT scan
5. needle aspiration

Front 39

4 Causes of Liver abscess:

Back 39

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)

Front 40

Tx for liver abscess:

Back 40

antibiotics and drainage

Front 41

What condition would cause a decrease in body function?

Back 41

any condition that is severe enough; depends on severity.

Front 42

Liver damage from Trauma:

Back 42

-most common injury from penetrating wounds
-2nd most common from blunt
-hemorrhage is most significant feature
-Tx fluid and blood replacement or surgery

Front 43

Liver cancer:

Back 43

-usually metastatic
-primarily hepatic carcinoma
is most common

Front 44

symptoms of liver cancer:

Back 44

-hepatosplenomegaly
-jaundice
-ascites
-general cancerous symptoms

Front 45

What is the most common type of liver cancer?

Back 45

Primary hepatic carcinoma

Front 46

Primary hepatic carcinoma:

Back 46

-rare in USA, common in Africa
-reflects incidence of chronic HBV and HCV
-cirrhosis increases risk of this

Front 47

Tx for liver cancer:

Back 47

-partial hepatic resection
-chemotherapy
-hepatic artery ligation (supply to tumors)

Front 48

Liver Transplantation:

Back 48

-conditions such as end-stage cirrhosis from hepatitis, wilson's disease
-not for malignancies
-immunosuppression increases risk of cancer (esp lymphoma)

Front 49

3 categories of jaundice:

Back 49

1. Newborn jaundice(takes care of itself)
2. Hepatocellular (disease in liver like cirrhosis)
3. Obstructive (tumor, etc)

Front 50

Liver:

Back 50

-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"

Front 51

blood supply of liver:

Back 51

-25% fed by hepatic artery and remainder from portal vein
-rich lymphatic system

Front 52

sinusoid:

Back 52

-any of the venous cavities through which blood passes in various glands and organs, such as the adrenal gland and the liver

Front 53

What is a common condition that pts get in to liver disease?

Back 53

Portal hypertension