One time when I was shadowing, the provider I was with made us calculate how much Tylenol it would take to kill me...I think about that a lot (This is a joke, obviously)
Specialized phagocytes (Kupffer cells)
Why are bacterial infections in the liver rare?
bone marrow, spleen, liver
The breakdown of heme to bilirubin occurs in what organs?
liver
The metabolism (conjugation) of bilirubin occurs only in the?
jaundice
What is another name for the hyperbilirubinemia?
prehepatic
What type of jaundice is caused by processes that trigger excessive production/inadequate removal of bilirubin?
hemolysis
#1 cause of prehepatic jaundice
hemolysis, hematoma, gilberts
Types of prehepatic jaundice
unconjugated
Describe the bilirubin in prehepatic jaundice
hepatic
What type of jaundice is the result of diseases cause necrosis or destruction of parenchymal tissue?
viral hepatitis, alcoholic, drug induced, chronic hepatitis, cirrhosis
Types of hepatic jaundice
mixed
Describe the bilirubin in hepatic jaundice
posthepatic (obstructive)
What type of jaundice is triggered by disturbances of secretion of bilirubin in bile?
Gallstones in common bile duct, Carcinoma in head of pancreas, Carcinoma of the common bile duct, Carcinoma of the gallbladder
What causes posthepatic jaundices?
conjugated
Describe the bilirubin in posthepatic jaundice?
Hepatotrophic viruses (A, B, C, D, E)
Most common causes of acute viral hepatitis
mixed jaundice, fever, nausea
Symptoms of acute viral hepatitis
A
What type of viral hepatitis tends to resolve without issues?
B, C
What types of viral hepatitis are more likely progress to chronic hepatitis in some cases?
C
What type of viral hepatitis also increases the risk of cirrhosis and liver cancer in the future?
all of them
What type of viral hepatitis has the potential to become a unrecoverable disease and trigger death of liver?
cirrhosis
What is end stage liver disease, results in loss of regular structure and function, leads to fibrosis?
alcohol and hepatotrophic viruses
Major causes of cirrhosis (65%)
ascites, splenomegaly, caput medusae, hemorrhoids, esophageal varices
Clinical features of cirrhosis secondary to portal hypertension?
Spider nevi, Palmar erythema, Gynecomastia, small testes
What features of cirrhosis can be attributed to high estrogen levels?
Hepatic Encephalopathy (AMS)
What is the consequence of high ammonia in the blood?
high AST, ALT, ammonia, prolonged PT
Labs in a cirrhosis patient?
RECENT hepatic cell death
Elevated AST and ALT show
fatty liver, alcoholic hepatitis, alcoholic cirrhosis
Types of alcoholic liver disease
fatty liver disease
fatty streaking in the liver that can occur after a single night of heavy drinking, however, its reversible (days to weeks)
Alcoholic hepatitis
A patient presents to the ER with abdominal pain. Vitals are normal with the exception of a fever. While collecting a history you discover that the patient is a heavy drinker (8-10 drinks day for 10 years). Physical exam is normal with the exception of jaundice and abdominal swelling/tenderness. Diagnosis?
alcoholic cirrhosis
What is the most serious complication of alcohol abuse?
predictable
A patient presents to the ED for attempted overdose. Police report that the patient was found next to a bottle of Tylenol. What type of drug induced liver injury is this?
unpredictable
What type of drug-related liver injury can occur at anytime, at any dose and without any warning in patients who are susceptible or sensitized?
Gilbertās syndrome
An autosomal recessive disorder that results in benign recurrent jaundice with unconjugated bilirubin
Hemochromatosis
excessive accumulation of iron in many organs
Wilsonās disease
An autosomal recessive disorder that results in excessive accumulation of copper (liver, eye, CNS)
AAT deficiency
What is the leading cause of childhood cirrhosis
Alpha 1 - antitrypsin deficiency
Autosomal recessive resulting in the synthesis of an abnormal variant of alpha 1 antitrypsin which is synthesized in the liver, the defect means it canāt released.
ANA, ASM
What antibodies are found in autoimmune hepatitis
autoimmune hepatitis
A chronic form of hepatitis that typically occurs in young women
AMA
What antibodies are found in primary biliary cirrhosis
primary biliary cirrhosis
Cirrhosis as a result of a type IV hypersensitivity destruction of the intrahepatic bile ducts that typically occurs in middle age women
primary schlerosing cholangitis
Characterized by the destruction of extra and intrahepatic bile ducts, typically occurs in men younger than 40, and is associated with UC
Gallstones
formed from chemicals that are normally present in bile, just in excessive amounts, more common in whites
cholesterol stones
Most common stone in the US, caused by supersaturation of bile with cholesterol
bilirubin
Pigmented stones are oversaturated with
brown stones
What type of stone is more common in the Far East and is associated with biliary infections or infestation with biliary fluke
black stones
What type of pigmented stones are more common in the US and are seen in individuals with chronic hemolytic anemia, cirrhosis
cholecystitis is triggered, cystic or bile duct is block
Gallstones only cause symptoms if
secondary
What type of tumor is more common in the liver
metastatic tumor of the liver
results round nodular with central area of necrosis and tends to cause liver tenderness, jaundice, splenomegaly, ascites
GI system, lungs, breast
Secondary tumors of the liver commonly metastasize from
Cavernous Hemangiomas, Hepatocellular adenoma
Benign tumors of the liver
hepatocellular adenoma
What type of tumor is most common in females, especially those on oral contraceptives
Hepatocellular carcinoma, Cholangiocellular carcinoma of the liver, Gallbladder carcinoma
Malignant tumors of the liver
Hepatocellular carcinoma
Most important tumor of the liver, 5x more common in men, tend to originate in patients with cirrhosis, Hep B/C, hemachromatosis, alpha 1 antitrypsin deficiency
hyperglycermia, hyperestroginism, erythrocytosis
Paraneoplastic syndromes of Hepatocellular carcinoma
intrahepatic cholangiocellular carcinoma of the liver
What type of malignant liver tumor has very few symptoms early on
extrahepatic cholangiocellular carcinoma of the liver
What type of malignant liver tumor results in jaundice very early?
gallbladder carcinoma
What type of tumor tends to occur in older people, especially women and has a high incidence in Native and Mexican Americans?