Liver Patho

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?

Gilbert’s syndrome

An autosomal recessive disorder that results in benign recurrent jaundice with unconjugated bilirubin

Hemochromatosis

excessive accumulation of iron in many organs

Wilson’s 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 can’t 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?