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34 Cards in this Set
- Front
- Back
What are the markers of hepatobiliary clearance?
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Bilirubin
Alkaline Phosphtase GGT Elevation of these indicates an cholestatic pattern LFT |
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Isolated direct bilirubin elevation indicates which two syndromes?
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Dubin Johnson Syndrome
Rotor Syndrome |
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Indirect Bilirubin Elevation with decreased uptake or conjugation indicates what two syndromes
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Gilbert's Syndrome
Crigler-Najjar Syndrome |
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Difference between conjugated and unconjugated bilirubin
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Unconjugated br is insoluble in water - exists in tight complexes with serum albumin and can't be excreted by urine
Excess conjugated be can be excreted |
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Crigler-Najjar Syndrome I & II
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Hepatic UGT1A1 completely absent (or decreased) -> unconjugated bilirubin reaches very high levels -> jaundice/icterus -> death secondary to kernicterus within 18 months
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Gilbert's Syndrome
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Milder form of Crigler-Najjarr Syndrome; Decreased UGTA1 activity -> unconjugated bilirubin mildly elevated -> generallly innocuous
HOWEVER, pts with GS may be more susceptible to adverse ffects of drugs metabolized by UGT1A1 |
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Rotor Syndrome
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Rare form of asymptomatic conjugated hyperbilirubinemia associated with multiple defects in hepatocellular uptake and excretion of bilirubin pigments.
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Dubin Johnson Syndrome
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AR disorder; chronic conjugated hyperbilirubinemia due to defect in hepatocellular excretion of bilruubin glucuronides across the canicular membrane
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What is the ratio of blood flow into the liver?
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75% = venous blood from the portal vein
25% = arterial blood from hepatic artery |
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Where do the hepatic portal vein and hepatic artery mix in the liver?
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Sinusoids
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What kind of endothelium is characteristic of sinusoids?
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Fenestrated and discontinuous endothelium; they are highly permeable with fewer tight junctions than capillaries; the purpose is to allow small and medium sized proteins (ALBUMIN) to enter and leave the blood stream
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What separates liver sinusoids from hepatocytes?
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Space of disse
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Where are Kupffer cells found?
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Sinusoids
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Where is a major fraction of the body's lymph filtered?
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As blood flows through the sinusoids, a considerable amount of plasma is filtered into the space between endothelium and hepatocytes (space of disse)
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Where are the bile canaliculi located?
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they are the dilated intracellular space between adjacent hepatocytes
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In which direction does bile flow?
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In the parallel opposite direction from the sinusoidal flow of mixed venous and arterial blood; back towards the portal triad in the bile canaliculi (dilated intracelullar space between adjacent hepatocytes)
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What is the most common cause of amebic liver abscesses?
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E. histolytica; "anchovy paste abscesses"
Diagnose w/ positive serology for antiamebic antibodies along w/ CT or ultrasound |
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Most common gram negative causes of pyogenic liver abscess?
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E. coli; klebisella (enteric bacteria)
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Most common gram positive causes of pyogenic liver abscess?
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streptococcus intermedius
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How can you differentiate between the two common gram negative causes of pyogenic liver abscess?
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E. coli: NEGATIVE VP test
k. pneumoniae: POSITIVE VP test |
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What is the most common cause of liver abscess in hemachromatosis patients?
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Yersinia enterocolitica; this organism is UNABLE TO PRODUCE THEIR OWN SIDEROPHORES (which can usually be used to sequester iron); with excess liver iron deposition this organism can now thrive
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Leukocytosis is present in 80% of what kind of liver disease patients?
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Liver abscess patients
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What organism can cause mutliple large liver cysts, leukocytosis and is transmittered fecal oral related to sheep and dogs?
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Echinococcosis
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Empyema
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Collection of pus in the space between the lung and the inside of the chest wall (pleural space)
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What is the most common pathogen of AIDS related sclerosis cholangitis?
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Cryptosporidium
Small round structure aligned along the brush border of the intestinal lumen in biopsy; detected by acid fast stain which reveals pinkish red round to oval structures in stool/biopsy; animal reservoir Normally just causes diarrhea but in AIDS patients can be life threatening fluid loss |
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A biopsy reveals distinctive eggs with shoulders around the operculum and a tiny knob at one end. What organism does this describe?
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Opisthorchis sinensis
Fish animal resevoir |
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What organism is acquired by eating contaminated water cress?
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Fasciola hepatica
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What organism causes clay pipestem fibrosis?
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Schistosoma mansoni (fibrous tissue reacting to the eggs in the liver surrounds the portal vein in a thick, grossly visible layer)
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What is the most common human worm infection?
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Ascaris lumbricoides; fecal oral transmission of infective eggs in soil contaminated food or water
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What disease carried by a mosquito vector produces hepatic coagulopathy producing hemorrhagic symptoms? (black vomit, nose bleed, bruising)
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Yellow fever
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A patient presents with hepatocoagulopathy and jaundice. What organism likely caused this?
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Flavis Virus/Yellow fever
mosquito vector in Africa and South America |
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What is the epidemiology of the gram negative organism that causes liver absesses in people with hemochromatosis?
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Y. enterocolitica; more common in European countries and colder regions of the US
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Which organism can cause biliary obstruction and chronic infection leading to adenocarcinoma of the bile ducts?
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Trematode-Chinese liver fluke =Opisthorchis sinesis; undercooked fish; China, Japan, Korea, Vietnam (east asia)
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What nematode can cause biliary obstruction world wide?
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Ascaris lumbricoides; most common worm infection
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