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UWM Patho II Exam 4

GI Part 2

QuestionAnswer
Where are RBC's made? In the bone marrow
Where are RBC's disposed of when old or damaged? In the spleen
When RBC's are disposed of, what is released? hemoglobin
What does hemoglobin break down into? heme and globin
What is globin turned into once hemoglobin is broken down? amino acids
What is heme turned into after hemoglobin is broken down? heme is turned into unconjugated bilirubin in the macrophages of the spleen
Once heme is turned into unconjugated bilirubin, what happens next? Unconjugated bilirubin is not H2O soluble so it binds to albumin and sent to liver
What is unconjugated bilirubin converted to in the liver? Conjugated bilirubin
Is bilirubin normally found in the urine? No
What is bilirubin broken down by? UV light
Jaundice Bilirubin levels >2~3 mg/dL, Yellow skin and sclera(icterus)
What are the causes of jaundice? Overproduction of bilirubin Defective hepatic bilirubin uptake Defective conjugation Defective excretion
What are the 3 types of jaundice? 1. Pre-hepatic 2. Hepatic 3. Post-hepatic
Pre-hepatic Jaundice Increased rate of hemolysis, no bilirubin in urine, increased serum unconjugated bilirubin
Hepatic Jaundice Causes include hepatitis, hepatotoxicity, and alcoholic liver disease. Bilirubin in urine. Un & conjugated bilirubin.
Post-hepatic Jaundice Biliary obstruction. From liver to bile duct (eg tumor)pale stool, dark urine, itching. Conjugated bilirubin
Can conjugated bilirubin enter the urine? Yes, it is the only kind of bilirubin that can cross the glomerula into the urine
What is physiologic jaundice of the newborn? During first week of life, liver not mature enough to breakdown bilirubin. Increased UNCONJUGATED bilirubin.
Complication of physiologic jaundice of the newborn Kernicterus - irreversible brain damage
Hemolytic anemia Increased UNCONJUGATED bilirubin.
Gilbert's Syndrome Increased UNCONJUGATED bilirubin caused by an enzyme deficiency. Unconjugated can't become conjugated.
Dubin-Johnson Syndrome Increased CONJUGATED bilirubin caused by defective bilirubin transport. Can't get to bile duct through caniculus.
Viral Hepatitis clinical presentation Asymptomatic Malaise and weakness Nausea and anorexia Jaundice (conjugated bilirubin) Urine may be dark
Lab results in viral hepatitis markedly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). (*ALT > AST in viral hepatitis),
Acute viral hepatitis: Definition: signs and symptoms < 6 months Caused by any of the hepatitis viruses Pathology: Lobular disarray Hepatocyte swelling (balloon cells) Apoptotic death of a single liver cell (Councilman's bodies) Cholestasis [Post-hepatic (or obstructive) jaundice]
Chronic viral hepatitis Definition: signs and symptoms > 6 months Caused by hepatitis virus B, C, and D (except HAV and HEV infection)
Major forms of chronic viral hepatitis Chronic persistent hepatitis: inflammation limited to portal triad, good prognosis Chronic active hepatitis: extension of inflammation, may progress to cirrhosis Autoimmune hepatitis: anti-nuclear or anti-mitochondrial autoantibodies
Hepatitis A (HAV) Fecal-oral Traveler’s hepatitis, IV drug abuser (20%), homosexuals (35%) Acute hepatitis Symptoms, anti-HAV IgM Vaccine hygiene
Hepatitis B (HBV) Parenteral, sexual Occasionally severe Chronicity - Yes (5~10%) Acute hepatitis Cirrhosis Hepatocellular carcinoma (HCCSymptoms, serum levels of HBsAg, HBeAg, and anti-HBc IgM Vaccine
Hepatitis C (HCV) Parenteral, sexual Usually subclinical Chronicity - Yes (40~60%) Most common cause of post-transfusion hepatitis, common in alcoholic liver disease (25~60%)Acute hepatitis Chronic hepatitis Cirrhosis HCC Symptoms, anti-HCV ELISA
Hepatitis D (HDV) Parenteral, sexual Co-infection with HBV occasionally severe; super- infection with HBV often severe Yes (10~40%) IV drug abuser, homosexuals Acute hepatitis Chronic hepatitis Cirrhosis Anti-HDV ELISA
Hepatitis E (HEV) Fecal-oral Normal pts: mild; pregnant: severe Poor prognosis in pregnant women (20% mortality) Acute hepatitis IgM anti-HEV and IgG anti-HEV hygiene
Acute phase of Hepatitis B See surface antibody
Window period of Hepatitis B See only core antibody (no surface)
Created by: czenecke
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