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What two general things can be used to determine the inderlying cause of liver disease in most patients?
- Patient History
- Laboratory Examination
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What uaually causes Jaundice in liver disease?
Excess Bilirubin
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What three things can cause jaundice in liver disease patients?
- Too many RBC dying due to hemolytic anemia
- Failure of liver to remove Bilirubin
- Blockage of bile ducts
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What is teh term for jaundice caused by blocakge of bile ducts?
Obstructive jaundice
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What is obstructive jaundice?
Blockage of bile ducts
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What two other type of jaundice exist that do not occur due to liver disease?
- Physiological jaundice
- Congenital jaundice
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What age group gets physiological jaundice?
neonatal
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What causes physiological jaundice?
Immature liver cannot process bilirubin yet
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What type of jaundice is caused by an immature liver that is yet unable to process bilirubin?
Physiological jaundice
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What is Congential jaundice?
- Inherited disease due to the lack of enzymes needed to process Bilirubin
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- defect in transport protein for Bilirubin excretion
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What type of jaundice is caused by an inherited inability to produce enzymes that process bilirubin?
Congenital Jaundice
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What are the names of diseases of congenital jaundice?
Crigler Najar and Gilbert syndromes
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Crigler Najar and Gilbert syndromes are what?
inability to produce and enzyme that breaks down bilirubin
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What is Dubin johnson syndrome?
Inability to produce protein transporters for bilirubin excretion
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What disease is characterized by the inability to produce transport proteins needed for Bilirubin excretion?
Dubin Johnson syndrome
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What is the endpoint for chronic liver damage?
Hepatic failure
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What are the symptoms of hepatic failure?
- Jaundice
- Hypoalbunemia
- hyperammonenmia
- Fetor hepaticus (sweet breath)
- coagulation failure
- palmer erythema
- spider angiomas
- gynecomastia
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What is indicatedby jaundice, spider angiomas, gynecomastia, coagualtion failure, palmer erythema, fetor hepatics, hypoalbunemia and hyperammonemia?
Hepatic failure
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What is metabolic derangement of the hepatocytes?
Hepatic failure pathology with no necrosis or inflammation
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What are the three pathologies of Hepatic failure?
- Massive necrosis
- Chronic hepatitis
- Metabolic derangement of the hepatocytes
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The pathology of Hepatic failure is based on what?
Depends on cause (etiology)
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What is Chronic encephalopathy?
Metabolic disorder of the nervous system occuring due to complications of acute or chronic liver disease
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What is the term for a metabolic disorder of the nervous system occuring due to acute or chronic liver disease?
Hepatic encephalopathy
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What does insiduous mean?
slow onset
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Elevevated levels of what can play a role in hepatic encephaopathy?
Ammonia
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Elevated Ammonia levels play a role in what disease?
Hepatic encephalopathy
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What disease has symptoms of confusion, coma, disorientation and loss of conciousness?
Hepatic encephalopathy
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Hepatic encephalopathy has what symptoms?
Confusion, comea, loss of conciousness and disorientation
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Hepatorenal syndrome is what?
Renal failure in a patient with liver disease?
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What is renal failure in a patient with liver disease called?
Hepatorenal syndrome
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When a person with hepatorenal disease is treated for hepatic failure what also occurs?
Renal function improves
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How do you improve renal function in a patient with hepatorenal disease?
Treat the liver disease and the renal disease will improve
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What are three Inflammatory liver diseases covered in class?
- Viral hepatitis
- Alcoholic liver disease
- Cirrhosis
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Viral hepatitis can be caused by what strains of the disease?
A, B, C, E, G, and delta
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What are the signs of viral hepatitis?
- Jaundice
- Anorexia
- Weight loss
- Nausea
- Fever
- Dark colored urine
- Fatigue
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A patient that presents with Dark colored urine, aundice, fatigue, anorexia, nausea and weight loss could have what disease?
Vira hepatitis
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What is icterus?
Jaundice caused by bilirubin accumulation
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What is the term for jaundice caused by bilirubin accumulation?
icterus
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What are signs seen in a physical exam that indicate Viral hepatitus?
Icterus and englarged tender liver
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An enlarged tender liver and icterus in a physical exam can point to what disease?
Viral hepatitis
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For a patient with viral hepatitis, what would you expect from their laboratory tests?
- Elevated ALT/AST
- Increased bilirubin
- Prolonged prothrobin time
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Prolonged prothrombin time indicates a defect in what?
Coagulation defect
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A person with elevated AST/ALT and bilirubin as well as prolonged prothrombin time could have what disease?
Viral hepatitis
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What is the most common strain of viral hepatitis?
A (47%)
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What is the second most common strain of hepatitis?
B (34%)
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What is the third most common type of hepatitis?
C (16%)
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What are the most common types of hepatitis in order from most common to least?
A, B, C
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What percent of viral hepatitis is strain A?
47%
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What percent of viral hepatitis is B?
34%
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What percent of viral hepatitis is C?
16%
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What percent of viral hepatitis is neither A, B or C?
3%
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What viruses that were mentioned in class other than viral hepatitis affect the liver?
- Yellow fever virus
- infectious mononucleosis
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Why does urine appear dark in patients with viral hepatitis?
Presence of conjugated bilirubin in the urine
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Conjugated bilirubin in the liver causes what?
dark colored urine
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What strains of Hepatitis are enterically transmitted?
A and E
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What strains of hepatitis are transmitted parenterally?
B, C, D and G
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What is pruritis?
Severe itching of the skin
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Severe itching of the skin is called what?
Pruritis
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What is the cause of pruritis in people with liver disease?
accumulation fo toxins under the skin
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