Pathophys Exam 3

Front 1

3 major diseases of the liver

Back 1

alcoholic liver, viral hepatitis, hepatocellular carcinoma

Front 2

Viral Hepatitis

Back 2

-infection of the liver
-A, B, C, D, E, G
-produce similar illnesses
-anorexia, nausea, vomitting, fatigue, malaise, headache, pharyngitis
- 2 wks before jaundice
- AST, ALT show increase and precede rise in bilirubin

Front 3

Acute viral hepatitis

Back 3

caused by any agent except G
systemic infection
symptoms are variable

Front 4

Jaundice

Back 4

usually visible in sclera or skin when serum bilirubin exceeds 2.5 mg/dL

+20 mg/dL = severe disease

Front 5

Hep A

Back 5

-fecal oral
-not chronic
-blood typically not screened
-diagnosed with IgM

Front 6

Hep B

Back 6

-acute
-chronic
-necrosis
-comorbid with hep D
-found in sweat, semen, stool, tears, breast milk, blood
-not found in stool
-transmitted by transfusion, blood products, sexual practices
-good recovery rate
-double stranded
-HBsAg appears before onset followed by HBeAg, HBV-DNA

Front 7

Hep C

Back 7

-major cause of liver disease worldwide
-most common chronic blood-borne infection
-sexual transmission, IV drug use
-progresses to chronic diseases in 20% of pts
-antigen variability makes it difficult to come up with a vaccine
-serolic diagnosis: HCV RNA detectable for 1-3 weeks

Front 8

Hep D

Back 8

-comorbid with B
-serologic diagnosis: HDV RNA, IgM anti-HDV

Front 9

Hep E

Back 9

enterically transmitted, water borne
-young to middle aged adults with high mortality rate in pregnant women
-serologic diagnosis: HEV RNA and HEV virions detected in stool and liver

Front 10

Alchoholic liver disease and Cirrhosis

Back 10

-cirrhosis among top 10 causes of death in W World
-etiology: alcohol abuse, viral hepatitis, biliary disease, iron overload
-pathologic features reflect irreversible chronic injury of parenchyma and include extensive fibrosis
-hepatocyte necrosis, collapse of supporting reticulum network with connective tissue deposition, distortion of vascular bed, nodular regeneration of parenchyma

Front 11

Clinical features of alcoholic liver disease and cirrhosis

Back 11

-jaundice, edema, coagulopathy, metabolic abnormalities
-portal hypertension and sequelae (varices, ascites, and splenomegally)

Front 12

Alcoholic cirrhosis

Back 12

mos tcommon type of cirrhosis in NA, SA, and Western Europe
-diffuse scarring, faily uniform loss of liver cells, small regenerative nodules
-often accompanies other forms of alcohol induced liver injury

Front 13

Hepatic steatosis

Back 13

liver is enlarged, yellow, greasy, and firm
-hepatocytes distended by cytoplasmic fat vacuoles
-impaired fatty acid oxidation, increased uptake, esterification of fatty acids to form triglycerides
-clinical: minimal or absent
-Diagnosis: hepatomegaly, deranged liver function tests, can be cormobid with hepatitis or cirrhosis

Front 14

Alcoholic hepatitis

Back 14

characterized by hepatocyte swelling, necrosis, mallory bodies, neutrophilia, fibrosis
-clinical: resembles viral or toxic liver injury, anorexia, nausea, vomitting, malaise, weight loss, abd pain, jaundice
-Diagnosis: jaundice, fever, enlarged tender liver, ascites

Front 15

Alcoholic cirrhosis

Back 15

final irreversible form of alcoholic liver disease that evolves slowly and insidiously
-brown, shrunken, nonfatty organ
-clinical features: clinically silent, discovered at autopsy, insidious in onset usually after +10 years
-firm nodular liver may be early sign, jaundice, palmar erythema, spider angiomas, parotid and lacrimal gland enlargement, finger clubbing, splenomegally, muscle wasting, ascites
-diagnosis: physical signs of chronic liver disease

Front 16

Signs in men vs women
(Alcoholic liver disease)

Back 16

Men: decreased body hair, gynecomastia, testicular atrophy
Women: virilization or menstrual irregularities

Front 17

Other signs in alcoholic liver disease

Back 17

patient may stabilize if drinking discontinues, emaciation, weak, chronically jaundiced, ascites, portal hypertension
hepatic coma leads to death and is usually preceeded by esophageal varices or intercurrent infection

Front 18

Other diagnostic tests for liver

Back 18

Biopsy
Ultrasonography

Front 19

Jaundice and Cholestasis

Back 19

Bile: emulsifies fats, eleminates waste products
-primary pathway for elimination of bilirubin, cholesterol, and xenobiotics
-disruption = yellow discoloration of skin nad sclerae due to retention of pigmented bilirubin
-cholestasis: systemic retention of bilirubin and other solutes in bile