Pathophysiology Chapter 38: Liver Disorders (Exam 1)

What are the major functions of the liver?

Metabolism, detoxification, protein synthesis, bilirubin processing, bile production, and storage.

What proteins are synthesized by the liver?

Albumin and many clotting factors.

What happens in liver failure?

Decreased detoxification, gluconeogenesis, albumin/clotting factor production, and bilirubin processing.

What are the main liver injury enzymes?

AST and ALT.

What does elevated alkaline phosphatase suggest?

Biliary obstruction.

What AST:ALT ratio is associated with alcoholic liver disease?

About 2:1.

What is fatty liver (steatosis)?

Accumulation of fat in the liver.

What are major causes of fatty liver?

Obesity, alcohol, and diabetes.

What is jaundice?

Yellow discoloration caused by excess bilirubin.

At what bilirubin level does jaundice usually become visible?

About 2.5–3 mg/dL.

What is unconjugated bilirubin?

Indirect, water-insoluble bilirubin not yet processed by the liver.

Can unconjugated bilirubin be excreted in urine?

No.

What is conjugated bilirubin?

Direct, water-soluble bilirubin processed by the liver.

What causes clay-colored stools?

Lack of bile pigment reaching the intestine.

What can bile salt deposits in the skin cause?

Pruritus (itching).

What are the 3 major types of jaundice?

Prehepatic, hepatic, and posthepatic.

What causes prehepatic jaundice?

Excessive hemolysis.

What causes hepatic jaundice?

Impaired bilirubin metabolism or transport by the liver.

What causes posthepatic jaundice?

Obstruction of bilirubin/bile excretion.

What is portal hypertension?

Increased pressure in the portal venous system due to impaired blood flow through the liver.

What are major complications of portal hypertension?

Varices, splenomegaly, ascites, and hepatic encephalopathy.

What are gastroesophageal varices?

Dilated veins caused by portal hypertension.

Why are esophageal varices dangerous?

They can rupture and cause massive, life-threatening bleeding.

What are signs of bleeding esophageal varices?

Hematemesis, melena, anemia, and shock.

What is a major emergency treatment for bleeding varices?

Endoscopic band ligation or sclerosis.

What medication commonly lowers portal pressure in variceal bleeding?

Octreotide.

What is hepatic encephalopathy?

Brain dysfunction caused by liver failure and accumulation of toxins, especially ammonia.

What is the classic sign of hepatic encephalopathy?

Asterixis (liver flap).

What are manifestations of hepatic encephalopathy?

Confusion, lethargy, neurologic changes, stupor, and coma.

What is lactulose used for in hepatic encephalopathy?

To increase elimination of ammonia/nitrogenous wastes.

What is ascites?

Pathologic accumulation of fluid in the peritoneal cavity.

What are the major causes of ascites in liver disease?

Portal hypertension and hypoalbuminemia.

How is ascites commonly treated?

Sodium restriction, diuretics, and paracentesis.

What is hepatitis?

Inflammation of the liver.

What can cause hepatitis?

Viruses, toxins, drugs, autoimmune disease, and metabolic disorders.

What are common symptoms of acute hepatitis?

Nausea, vomiting, abdominal pain, fatigue, dark urine, clay stools, and jaundice.

What is the route of transmission for hepatitis A?

Fecal-oral.

What is the route of transmission for hepatitis E?

Fecal-oral.

Easy way to remember hepatitis A and E transmission?

The vowels hit your bowels.

Is hepatitis A usually chronic?

No.

Is hepatitis A vaccine-preventable?

Yes.

What is the main transmission route of hepatitis B?

Blood and body fluids, including sexual transmission.

Is hepatitis B vaccine-preventable?

Yes.

What does HBsAg indicate?

Active hepatitis B infection.

What does HBsAb indicate?

Immunity to hepatitis B.

What does HBeAg indicate?

Active viral replication and high infectivity.

What is the main transmission route of hepatitis C?

Blood exposure, especially injection drug use.

Is hepatitis C vaccine-preventable?

No.

Which hepatitis virus has a high risk of chronic infection?

Hepatitis C.

Which hepatitis viruses increase the risk of hepatocellular carcinoma?

Hepatitis B and C.