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OPT Liver
Term | Definition |
---|---|
hepatic failure | can be slow or sudden; occurs after 80-90% of liver function lost |
3 patterns of hepatic failure | 1. hepatic necrosis 2. chronic liver disease 3. hepatic dysfunction |
fetor hepaticus | musty/sweet and sour odor from undegraded GI bacteria |
hepatorenal syndrome | alterations in blood flow from hepatic failure that also result in renal failure |
hepatopulmonary syndrome | alterations in blood flow from hepatic failure that also result in pulmonary dysfunction |
hepatic encephalopathy | CNS alteration from shunted blood flow due to hepatic insufficiency; behavior problems, coma and death |
icterus | aka jaundice; yellow discoloration of skin, eyes and mucosa secondary to bilirubin accumulation |
unconjugated bilirubin | bilirubin bound to albumin from RBC breakdown in spleen; not water soluble and unable to excreted |
conjugated bilirubin | bilirubin converted by liver so can be excreted |
cholestasis | retention of bilirubin and other biliary components especially bile salts and cholesterols -elevated serum alkaline phosphatase -intestinal malabsorption |
jaundice | result of cholestasis but with additional symptoms |
pruritus | deposition of bile acids in peripheral tissues, especially the skin |
skin xanthomas | from excess cholesterol accumulation in cholestasis |
cirrhosis | diffuse alteration in liver of fibrous bands circling islands of hepatocytes forming nodules in liver |
cryptogenic cirrhosis | cause of cirrhosis is unknown |
causes of death from cirrhosis: | 1. progressive liver failure 2. complications of portal hypertension 3. hepatocellular carcinoma |
4 main clinical syndromes associated with liver disease: | 1. hepatic failure 2. jaundice and cholestasis 3. cirrhosis 4. portal hypertension |
portal hypertension | elevation of blood pressure in portal circulation |
4 clinical consequences of portal hypertension: | 1. ascites 2. portosystemic venous shunts 3. splenomegaly 4. hepatic encephalopathy |
ascites | collection of fluid in peritoneal cavity, can lead to hydrothorax |
portosystemic venous shunts | venous flow is slowed to bypass the liver |
esophageal varices | dilated esophageal veins to bypass portal circulation |
caput medusae | enlargement of fetal umbilical veins forming superficial pattern around umbilicus |
splenomegaly | spleen enlargement from from prolonged congestion |
3 patterns of alcoholic liver disease | 1. hepatic steatosis 2. alcoholic hepatitis 3. alcoholic cirrhosis |
hepatic steatosis | aka fatty liver; intracytoplasmic accumulation of lipid material in hepatocytes secondary to drinking, reversible |
alcoholic hepatitis | hepatic degeneration from alcohol consumption; ballooning degeneration and necrosis |
Mallory bodies (Mallory-Denk bodies) | eosinophilic cytoplasmic inclusions indicative of cell damage |
alcoholic cirrhosis | follows 15-20 years of alcoholic consumption; fibrosis of liver with collagenous bands surrounding hepatocyte nodules, higher risk of hepatocellular carcinoma |
nonalcoholic steatohepatitis (NASH) | pattern of steatosis, hepatitis and cirrhosis in non-drinkers; obesity and insulin-intolerance are predisposing factors |
Reye syndrome | disorder that creates fatty change in the liver and encephalopathy secondary to the loss of hepatic mitochondrial function |
hepatitis A virus (HAV, epidemic/infectious hepatitis) | RNA virus, acute, self-limited hepatitis; spread fecal-orally |
icteric hepatitis | jaundice present in hepatitis |
anicteric hepatitis | no jaundice present in hepatitis |
hepatitis B virus (HBV, serum hepatitis) | DNA virus, predisposes to hepatocellular carcinoma; has acute, chronic and carrier states -can test serum markers to determine stage of disease (Anti-HBs IgG persists for life, used for vaccine) |
hepatits C virus | RNA virus, mostly spread by blood, acute, chronic, and carrier states, and predisposes to hepatocellular carcinoma |
hepatitis D virus (Delta agent) | RNA virus, can only infect in presence of HBV |
hepatitis E virus | RNA virus, like hepatitis A (fecal-oral); dangerous for pregnant women |
asymptomatic infection | serologic evidence of infection but no symptoms, elevated transaminases |
acute infection | symptomatic disease shortly after incubation period |
fulminant viral hepatits | acute liver failure from massive liver necrosis that occurs in 2-3 weeks |
chronic hepatitis | symptomatic with biochemical or serological evidence of hepatic disease for more than 6 months |
subacute hepatic necrosis | cases of acute liver failure that develop more slowly |
carrier state | infection without clinical systems but still contagious |
autoimmune hepatitis | immune-mediated chronic liver destruction without an associated virus |
hemochromatosis (pigment cirrhosis) | group of genetic disorders that produce excess iron deposited in liver, creating fibrosis and predisposes to hepatocellular carcinoma |
secondary iron overload | acquired forms of excess iron from other sources |
bronze diabetes | skin and pancreatic alterations of excess iron increasing pigmentation |
diagnostic triad of hemochromatosis: | 1. skin pigmentation 2. diabetes mellitus 3. hepatomegaly |
Wilson disease | cirrhosis that develops from copper overload |
cavernous hemangioma | benign tumor of dilated vascular channels; can bleed if biopsied |
hepatic adenoma | benign tumor of encapsulated mass of hepatocytes in sheets and cords; after longterm contraceptive use |
hepatocellular carcinoma (liver cell carcinoma, hepatoma) | malignancy of hepatocytes, shows elevated alpha-fetoprotein |
aflatoxin | released by fungus Aspergillus flavus; increases cancer risk in conjunction with HBV |
cholelithiasis | aka gallstones; found in people who are fat, forty, female and fertile |
biliary colic | blocked biliary duct that results in extreme pain |
cholecystitis | inflammation of the gallbladder, usually associated with gallstones {calculous cholecystitis} |
carcinoma of the gallbladder | most common in biliary tract and associated with cholelithiasis |
cholangiocarcinoma | cancer that arises from epithelial lining of biliary ducts, both inside and outside the liver |
pancreatitis | inflammation of the pancreas |
acute pancreatitis (acute pancreatic necrosis) | reversible, inflammatory lesions associated with alcoholism/gallstones |
acute edematous pancreatitis | mild, self-limiting disorder |
acute hemorrhagic pancreatitis | severe, life-threatening disorder; elevated amylase and lipase |
chronic pancreatitis (chronic relapsing pancreatitis) | irreversible destruction of exocrine pancreas that leads to fibrosis |
calcifying pancreatitis | intraluminal plugs that form dystrophic calcifications |
carcinoma of the pancreas | carcinoma of exocrine portion, extremely deadly cancer; exhibits Trousseau sign |
diabetes mellitus | metabolic disorders that cause hyperglycemia due to defects in insulin secretion or action |
type 1 diabetes mellitus | insulin-dependent and juvenile-onset; severe lack of insulin from autoimmune attack -polyuria, polydipsia, and polyphagia -ketoacidosis |
type 2 diabetes mellitus | insulin-resistant and inadequate host response; genetic factors including {obesity} and {stress} |
insulitis | lymphocytic infiltration of islets, only in type 1 |
amyloid deposition | amylin released in islets, only in type 2 |
diabetic microangiopathy | thickening of basement membrane in small arterioles |
diabetic nephropathy | renal changes in diabetic patients |
diffuse glomerulosclerosis | thickening of basement membrane of glomerular capillaries |
nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) | ball-like deposits in matrix of mesangium |
retinopathy | eye problems associated with diabetes mellitus |
pancreatic neuroendocrine tumors | islet cell tumors |
insulinoma | beta-cell tumor; causes hyperinsulinism and hypoglycemia |
gastrinoma | tumor that increases gastrin secretion, usually in duodenum or pancreas; causes {Zollinger-Ellison syndrome}- combination of pancreatic islet tumor, gastric acid, and severe peptic ulcers |