Chap 38 Liver Diseases

Vocabulary flashcards covering liver patholoy, including jaundice causes, hepatocellular failure signs, portal hypertension, hepatic encephalopathy treatments, liver enzyme ratios, and hepatitis types.

Jaundice

A common finding in liver disease caused by hyperbilirubinemia, which refers to high levels of bilirubin.

Hepatocellular Failure

A condition characterized by jaundice, decreased clotting factors, hypoalbuminemia, altered metabolism of lipoproteins (dyslipidemias (hypertriglyceridemia), decreased vitamin D (osteomalacia), decreased vitamin K (poor blood-clotting factor production), and impaired processing of estrogen (feminization).

S/S of Hepatocellular Failure

Jaundice, Muscle wasting, Ascites, Impaired absorption of fat-soluble vitamins: A, D, E, and K, Altered lipoprotein processing, Dyslipidemias: hypertriglyceridemia, Abnormal storage and release of glucose in the form of glycogen: Hyperglycemia, Hypoglycemia; Inadequate protein metabolism (Decreased production of clotting factors + Hypoalbuminemia), Impaired clearance of exogenous drugs + toxins

S/S of Hepatocellular Failure in Men/Women

Men: gynecomastia, impotence, testicular atrophy, palmar erythema, female hair distribution, spider telangiectasia

Women: irregular menses, palmar erythema, spider telangiectasia

Prehepatic Jaundice

Jaundice caused by factors relating to RBCs or the spleen, such as hemolysis or the reabsorption of large hematomas.

Hepatic Jaundice

Jaundice caused by liver-specific issues, such as immature or mutated UDPGT or physiologic newborn jaundice.

Posthepatic Jaundice

Jaundice caused by factors in the bile or gallbladder, typically due to mechanical obstruction of the bile ducts.

Portal Hypertension

Increased pressure in the portal circulation that leads to GI congestion, splenomegaly, ascites, hemorrhoids, caput medusa (severe case), anorexia, and the development of esophageal or gastric varices.

Ascites

The accumulation of fluid in the peritoneal cavity, which occurs with portal hypertension and hypoalbuminemia; treat with dietary sodium restriction.

Hepatic Encephalopathy + treatment

A complex neuropsychiatric syndrome caused by excess ammonia derived from patient metabolism and GI microbiomes (cause increase protein consumption by bacteria which increased ammonia).

Treatment: Restricting dietary protein (60g or less); > 400g carbohydrate daily; peripheral or central IV infusions with vitamins; amoxicillin + rifamixin

Amoxicillin

A treatment in Hepatic Encephalopathy used to suppress intestinal flora that breaks down protein and releases ammonia.

Lactulose

A treatment for hepatic encephalopathy that enhances the elimination of nitrogenous wastes.

Kernicterus

Permanent brain damage in newborns caused by severe, untreated unconjugated hyperbilirubinemia; treatment includes phototherapy (blue light) (first line) and exchange transfusion.

ALT (Alanine Aminotransferase)

An enzyme found predominantly in the liver used as an indicator of liver disease.

AST (Aspartate Aminotransferase)

An enzyme found in the liver, brain, heart, pancreas, and muscles.

AST/ALT ratio < $1$

A laboratory finding where ALT is significantly higher than AST, suggesting non-alcoholic fatty liver disease.

AST/ALT ratio = $1$

Where ALT is equal to AST, suggesting acute viral hepatitis or drug-related liver toxicity.

AST/ALT ratio > $1$

A laboratory finding where AST is higher than ALT, suggesting cirrhosis.

AST/ALT ratio > $2:1$

A laboratory finding where AST is more than twice as high as ALT, suggesting alcoholic liver disease.

Gastroesophageal varices Patho + S/S + Treatment

Collateral venous pathways surrounding the proximal stomach and esophagus that dilate in response to elevated portal pressure; will present with a history of alcoholism with hematemesis and profound anemia.

S/S: Hematemesis, melena, bright red rectal bleeding, anemia , shock

Treatment: Fluid resuscitation; parental vitamin K, fresh frozen plasma, platelets, recombinant factor VII; vasopressine + Nitroglycerin, Emergency EGD + Endoscopic Ligation

Hepatitis A (HAV) + treatment

Enteric hepatitis (Hepatovirus related to picomavirus) caused by an RNA virus spread by the fecal-oral route; it is self-limiting and never causes chronic disease. Incubation period of 2-4 weeks, diagnosed with the detection of serum IgM antibodies or Anti-HA V IgG.

Treatment: AVOID ATOH, acetaminophen, hepatotoxins

Hepatitis B (HBV)

Serum hepatitis caused by a double-stranded DNA virus spread through parenteral contact with infected blood/plood products/ sexual contact; incubation period 1-4 months; it has a 10% frequency of chronic liver disease.

HBsAg

Hepatitis B surface antigen, which indicates early, active, or chronic infection.

HBsAb

Hepatitis B surface antibody, which indicates resolution + immunity.

HBcAg

Hepatitis B core antigen, which appears first in active infection.

HBcAb

Hepatitis B core antibody, which indicates seroconversion.

HBeAg

Hepatitis B e antigen that indicates easy to spread →viral replication and infectivity.

HBIG + HBV

Hepatitis B immune globulin, which contains high levels of surface antibody and is given post-exposure (within $7$ days) (HBIG) → needed for Babies born to HBsAg-positive mothers, Non-immune people after needlestick or sexual exposure to hepatitis B, and Patients with hepatitis B after liver transplantation to prevent recurrence.

Hepatitis B Risk Factors

Perinatal, health care settings (3%); transfusions and dialysis (1%); acupuncture, tattooing, extended overseas travel, residence in an institution

Hepatitis C (HCV) + Diagnostic Test

Also called Non-A, Non-B hepatitis; single-strained RNA virus (flavivirus); most common cause of end-stage liver disease with cirrhosis (80% frequency); spread by parenteral/intranasal~ cocaine use is a risk factor, incubation of 7-8 weeks.

Test for HCV: PCR for HCV RNA + 3rd gen ELISA for antibody detection

NAPQI

A toxic metabolite produced during acetaminophen poisoning (doses > $140\,\text{mg/kg}$) that causes hepatocyte damage.

Acetylcysteine

A pharmacological agent used for detoxification in cases of acetaminophen poisoning. Can also use induced emesis or lavage and activated charcoal.