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UWM Patho II Exam 4
GI Part 2
| Question | Answer |
|---|---|
| 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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