Dutec 105 Test 1

Front 1

You prove this by demonstrating the thickened gallbladder wall, free fluid in the gallbladder fossa, and a 7mm stone jammed into the neck of the gallbladder---your patient has cholecystitis.

What things will be Elevated?

Back 1

Elevated

-conjugated bilirubin

-white blood cells

-Alkaline phosphatase

Front 2

Your patient has cirrhosis and is in clinic for a liver biopsy. Because of the depleted function of his liver, he has low levels of clotting factors. Which enzyme, will be tested to make sure your patient is not at risk of bleeding out during the procedure?

Back 2

Prothrombin

The clotting factor prothrombin is a precursor to thrombin, which is needed for the formation of normal blood clots.

Front 3

What cell did the liver use to convert into bilirubin?

Back 3

Red Blood cells

Results from the degradation of heme by reticuloendothelial liver cells, causing a reddish bile pigment.

Front 4

Portal hypertension leads to varices in the abdominal wall and gastrointestinal system.

What elevated clotting factor would lead to a thrombus (blood clot) obstructing the Portal Vein?

Back 4

Platelets

Collateral circulation develops when the normal venous channels become obstructed. The most common collateral pathways are through the coronary and esophageal veins, as occurs in 80% to 90% of patients with portal hypertension.

Front 5

What are Varices?

Back 5

Varices are tortuous dilations of veins that may develop because of increased pressure in the portal vein, usually secondary to cirrhosis. Bleeding from the varices occurs with increased pressure.

Front 6

Blood Urea Nitrogen is excreted by the liver so it can then be eliminated from from the body by the kidneys.

If the liver can't convert the toxin ammonia into into urea, what can condition can a patient develop?

Back 6

Loss of brain function occurs when the liver is unable to remove toxins from the blood.

This is called hepatic encephalopathy

Front 7

What is Bilirubin?

Back 7

A waste product that is formed when hemoglobin breaks down. It is insoluble in water and is carried to the liver bound to albumin.

It is made water soluble in the liver by conjugation with glucuronic acid. After it is convert into a soluble form, it is a part of bile and passes through the Common Bile duct into the gallbladder to be stored or passes right away into the gut.

Front 8

What does it mean to higher-than-normal levels of Direct/conjugated bilirubin serum in the blood?

Back 8

This may indicate the liver is not clearing the bilirubin properly.

Maybe a blocked bile duct

Front 9

How do you measure indirect/ unconjugated bilirubin and why would you have an elevated level of it?

Back 9

Indirect/ unconjugated bilirubin is usually measured by subtracting direct bilirubin from the total bilirubin.

Elevated levels may indicate a deficiency is an enzyme that helps break down (Gilbert's syndrome)

Front 10

What is the Porta Hepatis made up of and where do they flow?

Back 10

Flow into the Liver

- Hepatic Artery

-Portal View

Flow away

- Hepatic Duct

Front 11

What is a liver cell called and how are they arranged?

Back 11

Hepatocytes and are arranged in units called Acini-- cylinder with a collection of 3 vessels at the center of each acinus. Portal track includes the portal vein, hepatic artery and a tiny bile duct.

Front 12

What is the average weight of an adult liver ?

Back 12

1500g

in Lecture, she said 3-5lbs

Front 13

Describe sinusoids and the structure with the liver?

Back 13

Central vein leads into the hepatic vein

Front 14

What are the 9 main liver functions listed on the hand out?

Back 14

1) Carbohydrate metabolism

2) Fat metabolism

3) Protein metabolism

4) Production of Urea

5) Synthesis of proteins such as clotting factors and albumin

6) Detoxification of drugs, alcohol and hormones

7) Storage

8) Production of Bile

9) Excretion of Bilirubin

Front 15

What does the liver store?

Back 15

Glycogen (storage from of glucose)

iron

copper

vitamins A, D, K and others vitamins

Front 16

What is the process in which Carbohydrates are metabolized in the liver for storage and release?

Back 16

After eating, Blood glucose levels are high. Insulin is released by the pancreas which cause glucose to to enter the hepatocytes. In the liver, glucose is converted to glycogen and stored.

When blood glucose is low, pancreas releases glucagon to break down glycogen to maintain plasma glucose levels.

Front 17

What does the liver do to fatty acids?

Back 17

The liver oxidizes the the fatty acid and produces acetyl CoA which is used in the citric acid cycle (aka tricarboxylic acid cycle) for energy production.

Front 18

What can the liver convert protein into?

4 were listed on the handout

Back 18

-Convert to something that will make ATP in the tricarboxylic acid cycle

-Convert them into glucose (process called gluconeogenesis(glucose+new+creation))

-Convert them into fat

-Inter-convert some amino acids into others

Front 19

What does the liver do with ammonia?

Back 19

Convert it into urea which is them eliminated through urine.

Front 20

How does bile leave the liver?

Back 20

Bile is secreted by the liver cells(hepatocytes) into the bile canaliculi which drain into the bile ductules which drain into the bile ducts. From the Bile ducts, they drain into the right and left hepatic ducts which unite to form the common hepatic duct. This leads into the Gallbladder where it is stored until needed.

Front 21

What does bile do?

Back 21

Bile is like a detergent and will help the body absorb fat in the small intestine and gut (by making them stay in a solution)

Front 22

What is Hemochromatosis?

Back 22

An excessive accumulation of iron, which is deposited in the cells of organs --mostly liver and pancreas.

Front 23

What is a normal amount of total body iron stored in an adult and how much in the liver?

What is the total body amount of iron stored in an adult with HHC (Hereditary hemochromatosis)?

Back 23

Normal total body ranges from 2-6 gms

about 0.5 gm stored in liver

HHC amount may be as high as 50gm

Front 24

Clinically, what 3 things do HHC patients have?

Back 24

1)Cirrhosis (fibrosis of the liver)

2)Diabetes mellitus(due to the destruction of the pancrease to secrete insulin)

3)Skin Pigmentation

Front 25

Is the progression of hemochromatosis preventable and how?

Back 25

Yes, regular phlebotomy to remove excess iron

Front 26

What are signs and symptoms of hepatitis?

Back 26

- right upper quadrant pain

- fever

- jaundice

Front 27

A classic sign of liver failure is jaundice.

What is jaundice?

Back 27

The liver in unable to conjugate bilirubin(breakdown product of RBC). Bilirubin builds up in the blood and is deposited in tissues of the skin and eyes.

Front 28

What things can happen when bilirubin can not be conjugated?

Back 28

-stools may become "clay-colored"

-urine may become dark due to bilirubin converted into urobilin

Front 29

Name 4 things that are tested for Liver function tests.

Back 29

1)Bilirubin

2)Serum enzyme assays

-Alanine aminotransferase (ALT)

-Aspartate Aminotransfererase (AST)

-Alkaline Phosphatase

3)Serum proteins (albumin and blood clotting factors)

3) Blood ammonia

Front 30

What does elevated levels of alkaline phosphatase mean?

Back 30

elevated levels usually mean impaired biliary tract function (Bile duct system)

Slight to moderate increases occur in hepatitis and cirrhosis.

Front 31

What are the 3 alcohol-induced hepatic illnesses and if they are reversible?

Back 31

1) alcoholic fatty liver; Reversible

2)alcoholic hepatitis ; Reversible

3)alcoholic cirrhosis; not Reversible

Front 32

Alcohol is in your intestines and is on a path to your liver via Portal blood.

What happens next?

Back 32

Alcohol is oxidized by the enzyme ADH(alcohol dehydrogenase) top convert into acetaldehyde.

Acetaldehyde (VERY TOXIC) is metabolized into acetate by ALDH(aldehyde dehydrogenase).

Acetate can be used to make energy.

Front 33

Name 3 ligaments on the liver

Back 33

- Falciform Ligament

- Teres Ligament

- Coronary Ligament

Front 34

What are the 4 main consequences due to portal hypertension?

Back 34

1)ascites

2)formation of porto-systemic venous shunts

3)congestive splenomegaly

4) hepatic encephalopathy

Front 35

What is a treatment for portal hypertension?

Back 35

Transjugular intrahepattic porto-systemic shunt (TIPS)

It will lower portal vein blood pressure but it does not improve survival rates

Front 36

What is GEJ (gastroesophageal junction)?

Back 36

The most common natural porto-systemic shunts that develop so pressure and reversed blood flow from the portal vein is relieved.

Front 37

name 3 techniques used to stop Variceal bleeding

Back 37

- vasoconstrictor medicines

- balloon tamponade

- endoscopic sclerosis of varices (sclerotherapy)

Front 38

What is ascites and 4 know factors that contribute to it

Back 38

It is an excess accumulation of fluid within the peritoneal cavity

1) kidneys retain excessive salt and water

2)decreased urine output

3)reduced albumin-less protein to hold fluid in blood

4)increased blood pressure int the portal veins - forces fluid out of the blood vessels

Front 39

What is spontaneous bacterial peritonitis (SBP)?

Back 39

occurs within patients with cirrhosis and ascites

-bacterial infection of the fluid that can develop without known source

-patient develops chills, fever, abdominal pain, and have cloudy ascitic fluid.

-Antibiotic treatment is usually effective