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19 Cards in this Set

  • Front
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3 major diseases of the liver
alcoholic liver, viral hepatitis, hepatocellular carcinoma
Viral Hepatitis
-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
Acute viral hepatitis
caused by any agent except G
systemic infection
symptoms are variable
Jaundice
usually visible in sclera or skin when serum bilirubin exceeds 2.5 mg/dL

+20 mg/dL = severe disease
Hep A
-fecal oral
-not chronic
-blood typically not screened
-diagnosed with IgM
Hep B
-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
Hep C
-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
Hep D
-comorbid with B
-serologic diagnosis: HDV RNA, IgM anti-HDV
Hep E
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
Alchoholic liver disease and Cirrhosis
-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
Clinical features of alcoholic liver disease and cirrhosis
-jaundice, edema, coagulopathy, metabolic abnormalities
-portal hypertension and sequelae (varices, ascites, and splenomegally)
Alcoholic cirrhosis
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
Hepatic steatosis
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
Alcoholic hepatitis
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
Alcoholic cirrhosis
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
Signs in men vs women
(Alcoholic liver disease)
Men: decreased body hair, gynecomastia, testicular atrophy
Women: virilization or menstrual irregularities
Other signs in alcoholic liver disease
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
Other diagnostic tests for liver
Biopsy
Ultrasonography
Jaundice and Cholestasis
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