question

How do you test if there is liver injury or inflammation?

answer

AST/ ALT (aminotransferases) There are usually at high levels in the liver, but released into blood when the hepatocytes are damaged

question

How do you test for bile duct damaged?

answer

ALP (alkaline phosphatase) or GGT (gamma glutamyl transferase)

question

What does bilirubin test?

answer

Bilirubin is created during breakdown of RBC and can be an indirect form in blood or direct form in liver If there is liver dysfunction and bilirubin is both forms in liver, it causes jaundice

question

What is Prothrombin Time or International Normalized Ratio?

answer

These test clotting factors in the blood since liver synthesized these Abnormal or deficiencies would show liver dysfunction

question

What does albumin mean for liver function?

answer

Albumin is produced by the liver and is a main protein in the blood, low levels can signal liver dysfunction but is less specific than othrs

question

Anicteric Acute Hepatitis and Icteric Acute Hepatitis

answer

Anicteric involves digestive troubles and influenze-like symptoms but no jaundice Icteric has non-specific symptoms like nausea, malaise that turn into jaundice

question

What are causes of Acute Hepatitis

answer

Viral (ABCDE) CMV, *EBV, HSV* Acetaminophen *Ischemia* Autoimmune Alcohol

question

Acute Liver Failure is rare but there are four hallmarks

answer

impaired blood *coagulation* *cognitive* problems change in *consciousness* eventual overt *coma*

question

Chronic hepatitis persists for at least _______ and it's main difference with acute is it leads to ____ _____

answer

Chronic hepatitis persists for at least *6 months* and it's main difference with acute is it leads to *fibrosis deposition*

question

Chronic hepatitis is asymptomatic up until the point of _______________

answer

Cirrhosis

question

alpha-1 antitrypsin deficiency, iron overload, nonalcoholic fatty liver disease, biliary cirrhosis, sclerosing cholangitis

answer

A (Autoimmune, alcohol) B (HBV) C (HCV) D (Drugs) Causes of Chronic hepatitis (ABCD)

question

How is cirrhosis caused?

answer

By fibrosis over time in the liver that thickens and intertwines more

question

What are the main complications with cirrhosis?

answer

Liver failure Portal Hypertension Hepatocellular carcinoma

question

What are the main signs of liver dysfunction?

answer

*High bilirubin* levels because liver can't metabolize it *Low albumin* levels Loss of clotting proteins (INR) gotta get BAC

question

What causes portal hypertension and what is caused by it?

answer

Cirrhosis scar tissue build up causes it It can cause *splenomegaly,* *ascites* (fluid retention in abdomen),*varices* (varicose veins and usually bleed in the esophagus), and *hepatic encephalopathy* (confusion) SAVE

question

What is the number one cause for hepatocellular carcinoma?

answer

*Cirrhosis*

question

A complication of ___ ______ (which is a complication of ____ ) are ascites, which are the develop of ___ ___ in the ____ ____

answer

These are development of fluid retention in the abdominal cavity A complication of portal hypertension

question

_____ grams of alcohol per day puts a person at __% risk for alcohol consumed per day

answer

120 grams of alcohol per day puts a person at 6% risk for alcohol consumed per day

question

Risk Factors for Alcoholic Liver Disease other than alochol

answer

Hepatitis C, obesity, Female

question

What is the first stage of Alcoholic Liver Disease

answer

*Steatosis* which means fat accumulates on the liver but it is typically asymptomatic because there is not inflammation and goes away with abstinence

question

What is often seen in patients with heavy alcohol use?

answer

Alcoholic Hepatitis Over 100 grams a day Seen as steatosis plus inflammation and fibrosis Results in severe liver failure

question

If someone has steatosis, inflammation and fibrosis, you would assume their cytoplasm would contain clumps of ___

answer

Mallory bodies due to alcoholic hepatitis/ Alcoholic liver disease Second step to liver disease

question

What is the mortality rate of alcoholic hepatitis?

answer

30%

question

Treatment for Alcoholic Liver Disease

answer

Corticosteroids Abstinence Nutrition Transplant

question

What is most common seen as a metabolic syndrome with livers?

answer

NALFD/ NASH Usually associated with Obesity, Type 2 Diabetes, Hypertension, and Hyperlipidemia

question

Pathologically, Non alcoholic fatty LD is ___ from alcoholic LD

answer

indistinguishable

question

___ ____ plays a central role in the pathogenesis of fatty liver in NFLD and NASH

answer

Insulin Resistance

question

WITH NALFD, progression to cirrhosis occurs in patients who have _______

answer

inflammation along with steatohepatitis

question

___ _____ -> hepatic steatosis -> ____ _____ -> lipid peroxidation -> NASH -> _______

answer

insulin resistance -> hepatic steatosis -> oxidative stress -> lipid peroxidation -> NASH -> cirrhosis

question

Treatment for NALFD

answer

Weight reduction Exercise Avoiding alcohol Coffee Vitamin E

question

A small RNA enterovirus travels from liver to bile to feces and can shed there for 2 weeks before jaundice appears

answer

Hep A Majority of cases are asymptomatic (more likely in children)

question

Worldwide, what is the primary risk factor for Hep A?

answer

Poor sanitation Contamination during food preparation is big

question

Majority of Hep A cases are icteric or ainteric?

answer

Ainteric because they do not produce jaundice

question

Alpha 1 antitrypsin deficiency, iron overload, and primary sclerosing cholangitis are all causes of ________

answer

Chronic hepatitis

question

What disease is commonly spread among children at day cares but does not escalate to chronic?

answer

Hepatitis A Stays A-cute

question

Hepatitis E is an ____ infection and has _______ resolution, although ______ are more likely to get _____ ___ _____

answer

Hepatitis E is an *acute* infection and has *spontaneous* resolution, although *pregnant women* are more likely to get *acute liver failure*

question

Hepatitis B is at rates of ____% in the United States, while it is ____% in Southeast Asia and Africa, most transmissions are _______

answer

0.3% 20% vertical, mother to newborn

question

Presentations of Hep B

answer

Chronic is often asymptomatic in highly endemic areas/Asia and are often childhood infections Acute displays as Jaundice, fatigue, malaise and occurs in older individuals (in US)

question

HBsAG

answer

this is the hep B surface antigen that is used in the hep B vaccine, every 5 to 7 years

question

Which Hep needs a friend?

answer

Hepatitis D (single stranded RNA) needs hepatitis B (double stranded DNA)

question

Two forms of Hepatitis D

answer

Co-infection, occurs at the same time Superinfection, occurs in later course of HBV Often D is a more aggressive infection towards cirrhosis D needs B, D-pendent

question

In the US, what is the leading cause of liver failure, hepato-cellular carcinoma and liver transplantation? in the World

answer

US- Hepatitis C (HBV) World- HBV (Hepatitis B)

question

Risk Factors for Hepatitis C

answer

Exposure to infected blood, intravenous drug use, perinatal (5%) and before 1992, exposure to infected blood products Sexual is RARE

question

Acute vs. Chronic Hepatitis C

answer

Acute are typically asymptomatic and don't require medical attention 85% become chronic, and then 1/4 develop cirrhosis over time

question

Treatment / Preventation for Hepatitis C

answer

There is NO vaccine for Hep C, but there is highly effective treatment

question

What antibody rate in the US is high and associated with hog farms, as well as contaminated water in asia/ middle east?

answer

Hepatitis E

question

Hepatitis E is usually ____ but in there is ___% _____ in pregnant due to ___ ___ ___

answer

Hepatitis E is usually *acute but in there is *25*% *mortality* in pregnant due to *acute liver failure*

question

Risks for Liver Cancer

answer

HBV is the highest worldwide Followed by cirrhosis, HCV, hemochromatosis, alcohol, NASH

question

Treatment for Liver Cancer

answer

Surgery Transplantation Ablation (microwave it) Chemoembolization or radioembolization

question

Hemochromatosis is an ____ ____ disorder, that is ___% of population due to ___ ____

answer

Hemochromatosis is an *autosomal recessive* disorder that is actually *0.5*% of population Is due to too much iron being absorbed in the gut

question

Hemochromatosis can lead to

answer

Cirrhosis, heart failure, diabetes, testicular failure, skin bronzing

question

Which disorder has a treatment of blood letting/ phelmotomy

answer

Hemochromatosis

question

What is the HFE gene?

answer

The gene that is associated with Hemochromatosis

question

___ ____ is a hereditary disease where ____ is deposited in the ___ ,___ and ____

answer

Wilson Disease copper liver eyes brain

question

Alpha-1-Antitrypsin

answer

Co-dominant Rare Produced in liver and is a big risk for emphysema

question

Cholelithiasis

answer

When a gallstone is in the cystic duct and causes pain shortly after eating

question

___% of the US population has gallstones Risk Factors?

answer

10% Risk Factors are being female, over 40, obese, fertile, diabetes

question

Cholecystitis (where?) _____ becomes constant and leads to _____, signs are elevated ____

answer

Infection of bile in gallbladder due to stone obstructing cystic duct Pain becomes constant and leads to fever/ chills, signs are elevated WBC count

question

Choledocholithiasis

answer

Gallstones in common bilt duct, results in elevated liver tests and bilirubin Flow of bile is obstructed and can cause jaundice

question

Ascending Cholangitis occurs from _____, presents as high ____, ____ ____ , and ____

answer

Occurs from Choledocholithiasis Seen as high fever, septic shock, jaundice

question

ERCP

answer

Removing gallstone endoscopically

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