Pathophys Exam 3

from the intestine => portal vein => hepatic vein => heart

sinusoids

• eat up everything bad
• old RBCs
• foreign material

stores fat soluble vitamins

produce bile

becomes active

5-60 units/L

5-45 units/L

ALT and AST

• Albumin
• prothrombin time
• INR

3.5-5.0 g/dL

10-13 sec

1.0

• Gamma-glutamyltransferase (GGT)
• Alkaline Phosphatase

0-60 units/L

30-120 units/L

GGT

Alkaline phosphatase

0.1-1.2 mg/dl

0.1-0.3 mg/dl

0.3-0.8 mg/dL

• feces
• general circulation to urine

• oxidation (cyp450)
• reductions
• hydroxylation

• Glucuronidation
• Sulfation
• Conjugation

• CYP3A4/5
• CYP2D6
• CYP2C8/9

• generation of toxic metabolites
• acetaminophen

• hypoglycemia
• not making or storing glucose

• oxidation of FFAs to ketones in starvation
• formation of triglycerides
• synthesis of cholesterol, phospholipids and lipoprotiens for cell wall synthesis
• conversion of carbs to triglycerides for storage in fat

> 10 million

100-200,000 per year

25-30%

• absorbed from stomach and intestine
• EtOH => aldehyde via alcohol dehydrogenase

accumulation of acetaldehyde and H+ ions in the liver, intestinal lumen and pancrease

• increased lipid synthesis and production of ketones & lactic acid due to increased ratio of NADH:NAD+
• binds other molecules and prevents detox
• promotes collagen synthesis and fibrogenesis

• 40-80 g/day for many years (2 wine or 6 pack of beer)
• female > male
• hepatitis
• smoking (free radicals)

• fatty liver "steatosis"
• Alcoholic hepatitis
• cirrhosis

cirrhosis

• fat in hepatocytes
• reversis with abstinence

• mallory bodies and neutrophils (inflammatory cells)
• swelling and necrosis of hepatocytes
• 2 (AST) : 1 (ALT) ratio
• tenderness, nausea, jaundice, ascites
• nutritional deficiencies

end stage chronic liver disease

• alcoholism
• viral hepatitis
• drugs/chemicals (tylenol eating too much fat)
• iron deposition (hemochromatosis)
• copper deposition (wilson's)

• can't clear toxins from body
• fibrosis throughout liver (stellate cells)
• nodules
• formation of septae bands between nodules
• obstructs blood flow

• obstruction in blood flow
• increased pressure in the portal vein

• >12 mmHg
• Increased NO causes vasodilation
• collateral vessesl begin to form to relieve pressure
• increased blood flow

• caput medusae
• hemorrhoids
• ascites
• splenomegaly
• hepatic encephalopaty

shunting of blood in to the splenic vein

• blood elements become sequestered in spleen
• life span of rbc, platelets and wbc decrease

• occurs with portal vein HTN
• collateral vessels form and cause rupture of of thin walls
• massive bleeding shown in cough, vomit and stool

65%

50%

• blood products and fluids
• injection therapy
• band ligation
• vasoactive medications

lowered production of clotting factors5,7,9, & 10, prothrombin and fibrinogen when liver becomes fibrotic

• bleeding
• bruising
• purpura
• increased PT and INR

• mental status changes
• altered metabolism of AA
• accumulation of nitrogenous substances (ammonia)
• no conversion of NH3 to urea

asterixis (arms flap down)

• protein restriction (20g/day)
• Lactulose (gets rid of ammonia causes diarrhea)

40

• hypoalbuminemia
• decreased plasma oncotic pressure
• fluid leaks into muslces and tissues
• also contributes to ascites

collection of fluid in the peritoneal cavity

cirrhosis =>portal htn => vasodilations => arterial underfilling => activation of vasoconstrictors => Na and water retention => ascites and dilutional hyponatremia

normal sodium but retain much more water

• <1.1 g/dL: perotonitis, cancer nephrotic syndrome
• >1.1 g/dL: portal HTN, cirrhosis, CHF

• fluid shifting
• percussion
• rebound tenderness
• abd. pain
• guarding, sob, hypoactive bowel sounds

bacterial peritonitis

• similar to ascites plus
• fever
• leukocytosis
• altered mental status

down regulation of the HPA axis

• gynecomastia
• testicular atrophy
• spider angioma

2mg/dL serum bilirubin

all

• clay colored stool
• dark urine
• increased alk phos
• increased AST/ALT
• pruritis

• prodromal
• icterus
• convalescent

one to two weeks before full blown signs and symptoms

• dark urine
• light stool
• jaundice
• pruritis
• increased liver enzymes and bilirubin

• return of appetite
• disappearance of jaundice
• continued malaise and weakness

• fecal/oral
• person/sex/food
• common adult accute disease
• not chronic
• vaccine

• perenteral transmission
• sex/IVDU/perinatal
• common acute disease
• adults <10%, children common
• vaccine

• parenteral transmission
• IVDU/perinatal
• uncommon accute disease
• frequence of chronic >70%
• no vaccine

• Hep A
• shellfish
• water
• milk
• veggies

2-6 weeks

6-8 weeks

• fever
• malaise
• nausea/anorexia/abd pain
• jaundice
• increased AST/ALT and dark urine

a single stranded RNA virus which is shed in the stool before signs and symptoms develope

won't show symptoms

IgG

present in acute Hep A

double stranded DNA virus called a Dane particle

4-26 weeks (8-12 avg)

• infected blood/serum/body fluids
• perinatal

blood and wound drainage

• semen
• vag fluid
• saliva

• urine
• feces
• sweat
• tears

DNA polymerase

• sex
• IVDU
• Health care
• birth

• 30% no s/s
• jaundice
• fatigue
• abd pain/anorexia/nv

• HBsAg
• 1st detectable

• HBcAg
• cell damage during acute infection on biopsy

• HBeAg
• Ongoing active viral replication

• Anti-HBs
• protective immunity after acute infection or vaccine

• AntiHBc
• denotes prior infection
• distinguishes acute and chronic

• HBV DNA
• marker of active replication

• HBsAg: Negative
• Anti-HBC: negative
• Anti-HBS: negative

• HBsAg: Negative
• Anti-HBC: positive
• Anti-HBS: positive

• HBsAg: Negative
• Anti-HBC: negative
• Anti-HBS: positive

• HBsAg: Positive
• Anti-HBC: positive
• IgM anti-HBc: positive
• Anti-HBS: negative

• HBsAg: positive
• Anti-HBC: positivive
• IgM anti-HBc: negative
• Anti-HBS: negative

ssRNA virus

60-85%

liver cancer or cirrhosis

• jaundice is uncommon
• non-specific symptoms such as malaise, weight loss, fatigue

• rna virus present
• antibody present after 3 months