What is one injury mechanism that the liver has that no other internal organ has?
The ability to regenerate. 25% of a liver can regenerate to full functional size in appropriate settings
What is Jaundice?
Jaundice (or icterus) is yellow-green pigmentation of the skin or sclerae caused by an increase in bilirubin!
Excess bilirubin (breakdown product of erythrocytes) is over 2-3mg/dl.
Etiology: overproduction, reduced hepatocyte uptake of bilirubin and obstruction of bile flow.
Unconjugated: virtually insoluble (can't even urinate it out)
Conjugated: soluble, nontoxic.
Etiology of Jaundice: explain the 4 etiologies:
1. Overproduction of bilirubin caused by increased breakdown of RBC (e.g. intravascular hemolyis-hemolytic anemia).
2. Impaired uptake of bilirubin from blood secondary to liver disease (e.g. sepsis, drug toxicity)
3. Decreased conjugation of bilirubin in the hepatocyte (e.g. hepatitis, neonatal jaundice, Gilbert's syndrome)
4. Impaired secretion/excretion of biirubin either intrahepatic (e.g. Dubin-Johnson's Syndrome, recurrent jaundice of pregnancy) or extrahepatic (e.g. obstructive gallstones, carcinoma of head of pancreas).
Hepatitis: what is it?
Viral Hepatitis: what is this/ what types?
inflammation of the liver
Many etiologies (drugs, autoimmune disease, infections, viral)
Viral Hepatitis: This term is reserved fro infection by a group of hepatotropic viruses, hepatitis A, B C Delta, E and G
Type of virus?
Common, Self limiting infection, no carrier state or chronic disease. Acute severe sickness that resolves.
RNA virus, transient viremia (not long term)
Fecal or oral transmission
incubation 15-45 days.
Type of virus?
Risk of malignancy?
Chronicity: 5-10% progress to chronic hepatitis, 90% are self-limiting infection.
Serology-remains in blood, chronic, cirrhosis.
Incubation 30-180 days
Some risk of malignancy (10%) become chronic hepatitis/cirrhosis.
Vaccine to Hep B 95% antiHB antibody response
Type of virus:
Risk of malignancy? Chronicity? Hallmark feature?
Hep C is the worst type of Hepatitis!
RNA virus: majority progress to chronic hepatitis.
Incubation 7-8 weeks
Transmission: Parental, sexual spread
High risk of malignancy/progression to chronic hepatitis.
Persistent infection + chronic hepatitis = hallmark feature of Hep C (85%) (BAD)
No vaccine because of genomic instability/viral change
Other Hepatitis Viruses
Hep D: RNA virus, associated with Hep B
Hep E: Rare in US. RNA virus, usually self-limited, waterborne, animal reservoirs.
Hep G (not hepatotropic) No increase in serum aminotransferases, replicates in bone marrow and spleen.
Disease states of Hepatitis: (5)
Fulminant Hepatic necrosis
Carrier states (varies for each type of Hepatitis)
Histopathology of Hepatitis:
Acute hepatitis: diffuse liver injury with lobular disarray.
Necrosis of random, isolated liver cells (Councilman bodies).
Chronic Hepatitis: Portal tract inflammation with interface hepatitis.
Acute viral Hepatitis:
What does fulminant hepatitis mean?
Progression in what types?
Resolution in 8 weeks (like type A and some type B)
Inflammation of the pancreas. Sudden onset of abdominal pain associated with elevated serum pancreatic enzymes (amylase, lipase). Secondary inflammation and necrosis (parenchymal and fat necrosis) of the pancreas.
What are some etiologies of acute pancreatitis?
Cholelithiasis (gall stones) and alcoholism are the two main ones.
Also, trauma, drugs, septisemia, infection (mumps), metabolic: hypercalcemic and hyperlipic states.
What is it?
Progressive destruction of the pancreas, chronic relapsing pancreatitis is a better term.