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39 Cards in this Set
- Front
- Back
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pre hepatic jaundice |
- unconguated bilirubin - from excess RBC production/destruction - hemolytic anemias, sickle cell disease, malaria |
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intra-hepatic jaundice |
- failure to conjugate and excrete bilirubin - from liver diseases--> necrosis--> hepatocytes lose function - decreased conjugation in newborn - most common jaundice |
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post-hepatic jaundice |
- inability to excrete conjugated bilirubin - from blockage in biliary system - gallstones, carcinoma in head of pancreas - conjugated bilirubin found in urine and in blood - dark urine, pale feces |
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cirrhosis |
- end result of continuous liver damage - diffuse, fibrous, nodular from constant regeneration attempt - disorganized lobules/hepatocytes lose function (synthesis, metabolism) - disorganized blood perfusion- failure of blood flow |
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portal hypertension |
continous elevation of portal venous pressure - caused by liver cirrhosis - back up pressure in portal vascular bed --> splenomegaly, ascites, espoph varices |
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esophageal varices |
- dilated thin walled veins in esophagus - caused by portal hypertension - prone to rupture --> hematemesis |
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caput medusa |
- distended and engorged paraumbilical veins - caused by portal hypertension |
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liver failure |
- loss of 80-90% liver function - from chronic liver disease (drug, toxin, hepatitis) --> massive hepatic necrosis - causes systemic edema, bleeding/bruising, ascites, renal failure - cirrhosis |
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ascites |
fluid retention in abdominal cavity - from portal hypertension, hyperaldosterone, hypo albumin |
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grade 1 chronic liver disease |
- lymphocytes confined to portal tracts - rarely cirrhotic |
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grade 2 chronic liver disease |
- inflammation in portal tract which spills into adjacent parenchyma - liver necrosis --> cirrhosis |
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acute hepatitis |
- histology: swollen hepatocytes (hepatomegaly), focal necrosis, councilman bodies - viral infection most common cause - jaundice 1-week post onset - nausea, anorexia, malaise |
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Hepatitis A |
- from picoRNAvirus - fecal-oral transmission - acute, often asymptomatic - 2-6 week incubation - won't lead to hepatocarcinoma |
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Hepatitis B |
- from hepDNAvirus - blood, baby-making, birthing - 5% world infected - 5-10% become chronic - can lead to carcinoma |
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Hepatitis C |
- from flavovirus (RNA) - chronic, cirrhosis - over 70% lead to chronic infection - can lead to carcinoma - get through blood transfusions |
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Hepatitis D |
- only infectious if Hep B infected - won't become chronic or lead to carcinoma - RNA virus |
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Hepatitis E |
- won't become chronic or lead to carcinoma - more common in East/Africa - RNA virus |
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alcoholic liver disease |
- ATP diverted from fat metabolism for alcohol metabolism - liver shows steatosis, hepatitis, fibrosis, cirrhosis, micro nodular, mallory hyaline: balled up keratin - test shows high gamma-GT |
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auto-immune hepatitis |
- auto-immune liver disease - serum anti-smM or anti-nuclear antibodies - more common in women - abdominal distention, malaise, fatigue - can use steroids to prevent cirrhosis |
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primary biliary cirrhosis (PBC) |
- auto-immune liver disease - auto-mitochondrial antibodies - slowly progressive cholangioheptatitis - destruction of cannalliculi - more common in women, middle age - pruritus, xanthelasma, jaundice, steatorrhea, cirrhosis |
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primary sclerosing cholangitis (PSC) |
- auto-immune liver disease - chronic inflammation of cholangiocytes--> fibrosis - more common in men - 70% have ulcerative colitis |
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primary hemochromatosis |
- genetic/metabolic liver disease - autosomal recessive mutation on Xm 6 - excessive absorption of iron - iron deposited in liver (+joints, skin, pancreas etc) - rare, but higher level in Irish men - cirrhosis |
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non-alcoholic fatty liver disease |
metabolic liver disease - associated with obesity and type 2 diabetes |
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non-alcoholic steatohepatitis |
metabolic liver disease - most extreme form of NAFLD, cause of cirrhosis |
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Wilson's disease |
metabolic liver disease - copper accumulates in liver - causes Keiser-Fleischer ring |
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a1-antitrypsin deficiency |
genetic/metabolic liver disease - abnormal anti-trypsin not released from hepatocyte--> accumulates--> fibrosis--> cirrhosis |
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hepatocellular carcinoma |
commonest primary tumour of liver - secondary from hepatitis B,C, cirrhosis - jaundice, weight loss - secretes a-fetoprotein - increase incidence in Africa and China |
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cholangiocarcinoma |
adenocarcinoma of bile duct - in liver or extra-hepatic biliary tree - massive tumour and mets - prominent fibrosis |
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gallstones |
- chronic indigestion, biliary colic: constant pain 15-4 hour in RUQ, nausea, fever, vomiting - pigment (5-10%): calcium salts+bilirubin - cholesterol (10%) - mixed (75-90%): cholesterol, calcium, bilirubin |
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acute cholecystitis |
- inflammation of gallbladder due to gallstone obstruction - irritant--> inflammation, stasis of bile--> bacterial infection - fever, nausea, vomit, RUQ pain - primary cause of cholecystomy - gallbladder red, oedematous, enlarged |
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chronic cholecystitis |
- not necessarily from obstruction - gallbladder porcelain from dystrophic calcification - attacks of pain after eating fatty food - see Rokotansky-Aschoff (RA) sinuses: diverticula into muscle wall |
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biliary atresia |
- biliary congenital abnormality - common bile duct blocked/absent - leads to biliary cirrhosis - jaundice in baby - clay colour stool, dark urine, swollen abdomen |
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choledocolithiasis |
- gallstone in biliary tree (common bile duct, pancreatic duct, cystic duct) - leads to secondary problems |
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cholangitis |
- inflammation of bile duct - mostly from bacterial infection causing obstruction of bile flow - gram -ve bacteria - fever, chills, abdominal pain, jaundice |
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adenocarcinoma of gallbladder |
- more common in women - mostly from gallstones 60-90% - 1% 5 year survival, most have mets upon diagnosis, because clinically silent - associated with liver fluke and far east |
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acute pancreatitis |
inflammation of pancreas from lytic enzymes released from acinar cells-->shock - alcohol/some drugs/shock/mumps--> obstruction in common bile duct-->reflux of bile into pancreatic duct--> damage acinar cells - epigastric pain, radiates to back, vomit, retch - very high serum amylase - 40-50 |
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chronic pancreatitis |
inflammation of pancreas-->fibrosis--> damage endocrine and exocrine pancreas - rare, increasing because of alcohol - severe abdominal pain, malabsorption, steatorrhea, diabetes mellitus |
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adenocarcinoma of pancreas |
- 60% head of pancreas - from high fat diet, smoking, history of pancreatitis - 5 year survival 3% - weight loss, jaundice |
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insulinoma |
pancreatic tumour of b cell - 5% malignant |
