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lab di final

QuestionAnswer
two main functions of the liver synthesizes substances, and proesses or breaks substances down into waste for elimination
what does the liver do with endogenous and exogenous compounds? biotransformation, detox, and exretions
Bilirubin metabolism, starting with heme steps Heme --> biliverdin --> bilirubin (water insoluble form,/unconjugated/indirect)
bilirubin is water ___ insoluble
what is unconjugated bilirubin bound to? albumin
unconjugated bilirubin cannot what, but can do what it cannot be excreted in bile or urine, but does dissolve in lipid, crossing the BBB and placenta
What are the 3 phases the bilirubin must go thru in the liver? UPTAKE by hepatocytes, CONJUGATION by hepatocytes and EXCRETION into bile.
What is the rate limiting step of bilirubin metabolism inthe liver? excretion into bile
interference with any step in bilirubin metabolism in the liver results in what? JAUNDICE
A lack of the enzyme glucuronyl transferase results in what? jaundice (it conjugates bilirubin with glucuronic acid)
conjugated bilirubin is water _____, and therefore? soluble! Therefore it can abnormally appear in the urine when plasma levels are increased
What does impaired excretion of conjugated bilirubin result in? jaundice
What colors your POOP stercobilin ( a metabolite of urobilinogen)
What creates urobilinogen? reduction of conjugated bilirubin by anaerobic bacteria in the colon
What happens to 20% of the created urobilinogen? Reabsorbed thru the colon wall, and returns to the liver via the enterohepatic circulation.
What happens to the other 80% of created urobilinogen? excreted in urine, or in stool (stercobilin)
What happens to urobilinogen at the kidney? oxidized to urobilin, which is excreted in the urine
What gives urine its color? Urobilin (from kidney oxidizing urobilinogen)
What type of bilirubin can be found in urine? direct (conjugated) bilirubin
where does excess bilirubin depoist in the eyes for jaundice? in the conjunctiva, altho docs say yellow sclera
With jaundice name all the areas that get yellow skin, sclera, gums, nail beds, tympanic membranes, and soft palate
what type of lighting is best to see jaundice? natural light
in early jaundice what may appear yellow before the skin? eyes
What else can bilirubin cause intensely in the skin? intense pruritis and scratching
What are the 3 basic forms of jaundice prehepatic hepatic post hepatic
What type of bilirubin is present in prehetpatic jaundice? unconjugated (indirect) hyperbilirubinemia
What is the mechanism of prehepatic jaundice? overproduction of indirect bilirubin, with typically normal liver function, usually caused by HEMOLYTIC ANEMIA of some form.
Due to increased indirect bilirubin in prehepatic jaundice, what else is therefore increased? Increased conjugation @ the liver, and therefore increased direct bilirubin excreted into the GI tract, and therefore increased urobilingoen formed in GI tract.
What are the lab findings of prehepatic jaundice? VERY elevated INDIRECT bilirubin, possibly elevated direct bilirubin, elevated urobilinogen. All of these levels depend on the severity of the underlying cause
What is the overall mechanism of hepatic jaundice? problems @ the hepatocyte, could be trouble with conjugation, uptake, and excretion.
What disease could cause a problem with excretion, uptake, and conjugation, causing what tpye of jaudince? Acute hepatitis, causing hepatic jaundice
What disease has decreased uptake and conjugation? Gilberts dz (hepatic jaundice)
what dz has decreased conjugation only? Crigler-Najjar syndrome (hepatic jaundice)
What type of dzs (mechanism) have impaired excretion of conjugated bilirubin? any disorder that interferes with transport of conjugated bilirubin to the radiologically visible intrahepatic bile ducts. (ex: primary biliary cirrhosis)
normal pH of blood is? 7.35-7.45
leukomoid rxn number? WBC count >50,000
platlet count cutoff for spontaneous bleeding? <20,000
impaired fasting glucose range? 110-126 mg/dl
threshold of glucose spilling into urine? 180 mg/dl
normal cholesterol <200 mg/dl
normal LDL cholesterol <130 mg/dl
Normal HDL level >45 mg/dl
Why would there be elevated direct bilirubin if there is impaired uptake and conjugation with hepatitis? because liver still functions to some degree, some conjugation still occurs, but theres impaired excretion therefore conjugated bilirubin regurgitates into plasma
What are the lab findings of acute hepatitis with impaired uptake and conjugation? increased levels of indirect bilirubin
what are the lab findings of acute heptatis with impaired conjugation and excretion? increased levels of direct bilirubin
What is Gilberts syndrome, and what are the lab findings? common in men, causes a mild increase in unconjugated bilirubin d/t impaired uptake and conjugation. Worsened by fasting and alcohol.
What is Crigler-Najjar syndrome, and the lab finding with it? impaired Conjugation due to deficiency of lack of UPD-glucuronyl transferase. Types I and II, genetic disoder, primary unconjugated hyperbilirubinemia
What is primary biliary cirrhosis and the lab findings? Destruction of the interlobular bile ducts, resulting in impaired excretion (cholestasis), resulting in liver cirrhosis and increased conjugated bilirubin
What does the urine of a pt with acute hepatitis look like? darkens/amber color
What is the mechanism of post-hepatic jaundice? usually obstruction of the common bile duct by multiple causes, such as stones, tumors, spasms or strictures.
What usually causes obstruction in post-hepatic jaundice? stones, tumors, spasms or strictures.
In post-hepatic jaudince what is not produced? urobilinogen, because bilirubin does not get to the GI tract.
What are the lab findings of posthepatic jaundice? very high direct (conjugated) bilirubin, and total bilirubin, and urine bilirubin.
Within 1-5 days of post hepatic jaundice what happens to the stool color? white/clay colored stool (steatorrhea)
What can elevated Alk Phos indicate in the presence of liver dz? can indicate bile duct obstruction
What enzyme is the most sensitive to chronic alcoholic liver dz? GGTP, GTP, gamma-GTP
GGTP is also mildly elevated in what conditions? kidney and biliary dz
If ALP elevated and GGTP elevated helps what? confirm that the elevated ALP is from a liver problem, and not other cause
AST was once called what? SGOT
AST elevated levels are ____ to liver damage, but not ___ sensitive to liver damage, but not specific
AST might be elevated by how much? many times nroaml depending on the condition - 1000s
ALT was once called? SGPT
LDH 1 & 2 vs LDH 3 and LDH 5 LDH 1&2 - RBCS, heart kidney, LDH 3 - lung LDH 5 - liver and skel mm
When does LDH elevate? and what is important? in certain types of liver disorders, but the HX is essential to interpret and elevated LDH.
What elevates in pneumocystis carinii pneumonia>? LDH
What should decrease in long standing liver dz? albumin and cholesterol (b/c liver can't make it anymore)
In alcoholic liver dz what are the levels of AST and ALT? AST is 2x ALT, 2:1 ratio
Alcohol inhibits ___ production ALT
What enzymes are elevated in acute viral hepatitis AST and ALT can increase up to 10-20 times ref range, total LDH elevates, ALP and GGTP can increase to 3 times ref ranges.
What are causes of hepatitis? infection (usually viral), toxicity (alch, drugs), pharmacologic, and autoimmune
When is hepatitis considered acute? if lasts <6 months, if more it's chronic
What is hepatitis? hepatocellular injury and necrosis that can be focal or extensive
What are the viruses which cause acute viral hepatitis? Hep A-G, CMV, and EBV.
What are some sx of acute viral hepatitis? JOINT PAINS/ARTHRITIS, MYALGIAS, RUQ pain, naseau, jaundice, steatorrhea, bilirubinuria (dark urine which foams when shaken), headache
What are physical findings associated with viral hepatitis? hepatomegally, splenomeg, jaundice, fever
What are lab findings of acute viral hep/ AST, and ALT elevated 20X, ALP mildly elevated, Direct bilirubin moderately to highly elevated, indirect bilirubin normal to mildly elevated, urine bilirubin elevated.
Hep A AKA? infectious hepatitis
Transmission of hep a? poop-mouth. or sex.
What is the incubation of Hep a? 2-6 weeks, can be mild to severe
Hep A infection never becomes... chronic
What is a test for Hep a? Anti-HAV IgM, Anti-HAV IgG
What is MC cause of cirrhosis and liver cancer worldwide? Hep B
How is Hep B transmitted? sex, blood transfusion, vertical (mom to infant), IV drug users, dialysis.....rarely pooop-mouthhhh
What is the incubation of Hep b? 1-6 months
Hep B can develop into what? carrier state or chronic state
What is the prognosis of chronic hepatitis based on? the causative agent, the grade of injury and the degree, location, and amount of distortion of norm liver architecture.
What are tests for hep b? HBV surface antigen (HBsAg), and Antibody to HBV core antigen (Anti-HBc)
Which Hep virus causes the most chronic hep? Hep C (70-85% of cases)
How was Hep C transmitted? transfusion, IV drug users, rarely tatoo needles, occasionally sex.
What is the incubation of hep c? 15 weeks, but SX may not appear until 20-30 years after exposure.
What are tests for HCV? ANTI-HCV.
what is the progression of alc liv dz? fatty liver (reversible) --> alc hepatitis (may or may not be revers) --> cirrhosis (irreversible)
Findings with fatty liver pt may have RUQ pain, jaundice is rare, ALT and AST may be mildly elevated, as well as GGTP.
how is damage of fatty liver reversible? if pt stops boozin
What are SX and Phyiscal findings of alcholic hep? sx: anorexia, nausea, vom, wt loss, RUQ pain. Phys findings: hepatomeg, fever, splenomeg, jaundice
What occurs within the liver in cirrhosis? (4 things) repeat hepatocellular regeneration (forms nodules), fibrous scarring with adhesions, and distortion of normal architecture. The vascular bed becomes distorted leading to portal HTN
What is the mc cause of cirrhsis in the western world? alc and HCV
what is the mc cause of cirrhosis in the 3rd world countries? HBV
What are the features of cell dysfunction in cirrhosis? jaundice, spider angiomas, palmar erythema, mantiitttties, body hair loss, testicular atrophy, dupuytren's contracture, mm wasting, bruising, fetor hepaticus (mercapten breath), signs of encephalopathy.
What are the features of portal tension d/t cirrhosis splenomeg, ascites, caput medusae, bleeding esophageal varices.
What are the lab findings of cirrhosis? hyperbilirubinemia, hypoalbuminemia, prolonged bleeding time, prolonged prothrombine time, elecated ammonia, decreased vit K, decreased cholesterol, often Macrocytic anemia in alcoholic pt.
Why would a pt bruise easily with cirrhosis? damage to extrinisic pathway
Why does one with cirrhosis develop man boobage liver can't process sex hormones
what is hepatic cancer associated with? a hx of hep B or C, also may be mets
sucessful passing of a gallstone cholelithiasis
Most gallstones are composed of what? cholesterol
how do cholesterol stones form? from supersaturation of bile with cholesterol in the gall bladder (saturation increased by estrogens, obesity, terminal ileum dz, mult pregnancies
Where is the usual site of trouble when stones either transiently obstruct the duct or lodge there? the cystic duct
What are other names for acute cholelithiasis? acute biliary colic, acute gallstone attack, gall bladder attack
What is acute cholelithiasis from? from transient cystic duct obstruction
What are some sx of acute cholelithiasis? RUQ AND/OR EPIGASTRIC PAIN, which lasts mins to 6hrs, PAIN RADIATES TO RT SHOULDER, RT INFRASCAP REGION, OCCASIONAL RLQ, AND SOMETIMES SPINE. Often naseua and vomitting, may occur after eating
What are physical findings and lab findings of acute cholelithiasis? usually absent!
what is the imaging of acute cholelithiasis? ultrasonography, sometimes x-rays.
Where is the mercedes benz sign seen? in acute cholelithiasis
unsuccessful passing of a stone cholecystitis
Sx of acute cholecystitis? Low grade FEVER, possibly High Grade Fever and shaking and chills (gangrene of gallbladder), pain patterns the same in both cholecystitis and cholelithiasis
Physical findings of acute cholecystitis? palpable gall bladder, but hard to do betcause Murphys sign exists.
Lab findings with acute cholecystitis? Mild leukocytosis, mild elevation in total bilirubin, serum amylase, ALP, ALT, and AST.
Ultrasound of acute cholecystitis? shows lodged stone in cystic duct
Radionuclide imaging of acute cholecystits shows? if common bile duct is visualized but the gall bladder is not, there is likely an obstruction. This is the most accurate method for cholescystitis.
What is choledocholithiasis? gallstone in the common bile duct
Where are choledocholithiasis from? most from the gall bladder, but some form de novo in the biliary tree apart from the gall bladder.
If the common bile duct is completely obstructed there may be secondary ______, which is what? secondary cholangitis, which is infection of the CBD, and is life threatening condition
What is charcots triad? fever, jaundice, and biliary pain - suggestive of infection from obstruction cholangitis.
What do the lab studies of choledocholithiasis show/ Elevated ALP AST ALT, bilirubin, and pssible amylase levels.
What is the best study for choledocholithiasis endoscopic retrograde cholangiopancreatography (ERCP), which shows CBD stones and can iamge the pancreatic duct.
What is porcelain gallbladder a precursor to? to carcinoma of the gall bladder, d/t calcification of the gall bladder wall from crhonic inflamm and scarring
Created by: margaretrhager