Term
| acute liver diseases: causes, key findings |
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Definition
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lab findings
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elevated bilirubin (esp. UCB, but more exagerated in severe liver damage)
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increase cytoplasmic enzymes
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AST and ALT 10x normal
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elevated LDH
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slight elevation of alkaline phosphatase and GGT
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causes
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Term
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Definition
- use to be most commonly viral (slow changes in enzymes)
- second most common: ethanol (slow changes in enzymes)
- currently drugs (slow changes in enzymes) and ischemic hepatitis (rapid changes in enzymes with rapid return to normal in 1-2 days) (low bp) have become most common cause of acute hepatic injury
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Term
| clinical features of acute hepatitis |
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Definition
- course
- incubation period
- asymptomatic period
- prodromal peroid of nonspecific symptoms
- if toxic or ischemic hepatitis, usually do not have prodrome
- some patients can develop jaundice, dark urine, light stools, tenderness in upper abdomen due to hepatomegally
- if hep B or C, some can develop type III HS rxn as presenting symptoms
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Term
| acute hepatitis: morphology |
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Definition
- apoptosis in viral hepatitis
- necrosis in toxic and ischemic hepatitis
- reticulin fiber network remains in tact even if liver cells lost
- hydropic degeneration of hepatocytes
- inflammatory cell infiltrate is composed of cytotoxic lymphoctes (cause hepatocyte injury)
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Term
| Hep A: epidemiology, prognosis, dx, transmission, pathogenesis |
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Definition
- epidemiology
- most common cause of acute hepatitis in children
- decline due to HAV vaccine
- by age 30, 30-40% of population has IgG Ab to virus (indicates past infection)
- route of transmission: fecal oral route
- pathogenesis- incubation peroid of 2-4 weeks, then clinical hepatitis develops due to immune response to virus
- dx- presence of IgM Ab to virus
- prognosis
- most cases resolve in weeks
- if acquired in persons with chronic liver diseases due to something else, mortality is significantly higher
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Term
| Hepatitis B (transmission, epidemiology, pathogenesis) |
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Definition
- epidemiology
- most common cause of acute viral hepatitis in US
- marked reduction since intro of HBV vaccine
- transmission
- pareneteral
- sexual
- maternal-fetal route
- pathogenesis
- much longer incubation peroid
- host immune response dtermines clinical picture (no immune system, no liver damage aka chronic carrier state)
- if chronic hepatitis/persistent infection, increased risk of hepatocellular carcinoma
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Term
| Hep B (structure and relation to clinical features) |
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Definition
- HBsAg- first marker of infection
- last viral Ag to disappear with recovery in body
- indicates presence of HBV DNA, but not necessarily infectious particles
- also allows for presence of Hep D
- HBeAg- indicates chronic HepB (found in core)
- correlates with infectivity
- HBsAb- indicates clearance of infection (or vaccine)
- HBcAg- related to infectious viral particles
- HbcAb- first evidence of host immune response to virus
- HBeAb- indicates low transmisibility
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Term
| Hep C (genetics, epidemiology, risk factors, prognosis, increas risk of what?) |
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Definition
- genetics- RNA virus (flavovirus)
- transmission- blood bourne
- risk factors
- IV drug abuse
- multiple sexual partners
- mother to child
- post transfusion
- there is an increase risk of hepatocellular carcinoma
- prognosis- tx of chronic hep C is widely available and successful mostly in erradicating virus
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Term
| Hep D: pathogenesis, epidemiology, prognosis |
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Definition
- requires HBsAg to bind to
- directly hepatotoxic
- if infection with both at same time, increased mortality (decrease likelihood of chronic hepatitis)
- if Hep B first (chronic hep B), than Hep D later, chronic hepatitis becomes exacerbated and more likely to progress to cirrhosis
- epi- esp. in IVDA
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Term
| Hep E: epidemiology, transmission |
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Definition
- epidemiology- developing countries (esp. India)
- endemic esp. with exposure to pigs and rats
- cause waterborn epidemics
- esp. worry about expectant mothers
- transmission- enteric
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Term
| Alcohol hepatitis: pathogenesis |
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Definition
- pathogenesis
- decrease protein synthesis, increase TG mobilization, decrease TG utilization in hepatocyte
- accumulation of fat in liver
- histopathology (triad)
- could potentially cause direct necrosis, leading to accumulation of neutrophils
- degeneration of cytoplasmic filaments form brightly eosinophilic, irregularly shaped inclusion known as Mallory body
- large fat vacuoles in hepatocytes
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Term
| Distinguishing alcoholic hepatitis from viral hepatitis |
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Definition
- AST and ALT elevated, but not over 10x normal
- AST is usually greater than ALT (damage to mitochondria caused by alchol)
- cells are "sicker than they look"
- PT time more proloned and bilirubin higher than expected
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Term
| toxic hepatitis using acetamenophin (risk factors, pathogenesis) |
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Definition
- pathogenesis
- accumulation of toxic metabolite
- accumulates to the point of depleting the liver's defense mechanism, glutathione
- within 24-48 hrs, after ingestion, enzymes began to rise dramatically peaking 72-96 hrs after digestion with equal increases in PT time
- bilirubin becomes abnomral in a few days
- enzymes rise and fall rapidly and if enough cells remain, recovery occurs
- risk factors
- chronic alcholics induce P450 system leading to increase in toxic metabolites
- poor nutrient intake depletes glutathione stores, so limits deposal mechanisms
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Term
| biliary tract obstruction: etiology, symptoms |
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Definition
- etiology
- biliary atresia in kids
- gallstones and tumors in adults
- symptoms
- jaundice
- dark urine
- light stools
- biliary cholic pain (acute distension of bile duct like with gallstones)
- acute cholangitis (normal fecal flora bacteria ascend through bile ducts into liver)
- if gradual onset, pruritis due to accumulation of waste products in blood
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Term
| biliary tract obstructions: lab features and reason behind each of them |
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Definition
- early obstruction features
- increase CB (inhibited excretion of CB and some goes back into plasma)
- increase alkaline phosphatase (tries to increase efficiency of exporting substances in bile, and continues to rise with time of obstruction)
- later in obstruction
- increase ALT and AST (elevated pressure in biliarty tree leads to accumulation of toxic waste in hepatocytes causing damage)
- increase UCB (damaged hepatocytes cant conjugate bilirubin)
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Term
| biliary tract obstruction: morphological features |
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Definition
- dilation of ducts seen on radiography
- ruptured ducts, leading to inflammatory rxn in portal areas
- feathery degeneration of liver cells damaged
- portal fibrosis (if obstruction persists for many months) which may lead to cirrhosis
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