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which lobe is larger in liver?
right sided heart failure can do what to the liver
hepatomegaly- blood backs up
if additional blood is needed in the body, where can it be pulled from
cells in liver that remove and phagocytize old defective blood cells and bacteria/foreign material from blood.
bile is produced by what cells?
where is urea made
where are clotting factors made
signs and symptoms of liver disease
weakness, weight loss, fever, bruising, spider angioma, irregular menses, liver encephalopathy, anemia, hyper/hypoglycemia, high cholesterol
liver converts excess ____ to triglycerides for storage in adipose tisssue
what does albumin transport?
hormones drugs and other proteins and fatty acids and bilirubin
albumin plays two big roles: transporting and ____
maintaining plasma colloidal osmotic pressure
oxidative deamination involves removal of amino groups from amino acids and converson of amino acids to ___ and ___
ketoacids and ammonia
ammonia released during deamination is removed from the blood and converted to ____
cholesterol can be stored or converted to ___
what does bile do to fats?
how are bile salts excreted
decreased bile flow is called
disease where bile ducts get damaged and toxins build up in liver
primary biliary cirrhosis
inflammation of bile ducts causes scarring and hardening leading to this disease
primary sclerosing cholangitis
bilirubin is made from
old red blood cells
hemoglobin is broken down into ____ and rapidly converted to ____
biliverdin and converted to free bilirubin
bilirubin travels in blood via
free bilirubin enters liver and converted to ___ making it soluble and excreted in ____
conjugated bilirubin and excreted in bile
Half of bilirubin is converted into ____ by intestinal flora
at what range does skin turn yellow from bilirubin increase
major causes of jaundice `
destruction of RBCs, impaired uptake of bilirubin by liver, decreased conjugation of bilirubin, obstruction of bile flow
what do you look at to see the liver's synthetic ability
serum protein levels, protrhombin time, and coagulation factors
what level do you look at to see cholecystitis and biliary obstruction
increased GTT with what 2 diseases/things?
chronic alcohol ingestion and acute MI
Phase 1 reactions in liver
enzymes in reduction processes are of gene family that codes for over 300 members. CYP family
Phase 2 reactions, what is important?
nutrition- conversion of lipid soluble to water soluble substances is interrupeted
viral hepatitis can be caused by
mono, herpes, liver, etc,
Hepatitis A transmitted how
fecal oral route
hepatitis b transmitted via
hepatitis c transmitted how
infected blood or needles
hepatitis e transmitted how
fecal oral route
3 stages of hepatitis- name stage and what happens with each stage
1. prodromal phase- onset abrupt or insidiuos- myalgia, malaise, arthralgia, fatigue, anorexia, n/v/d, constipation, pain, chills, fever
2. Icterus period- 5-10 days after- jaundice, itching, liver tenderness, dark urine
3. Convalescent period- 2-3 week period with improvement, harbor disease but shed virus, recovery may last up to 9-16 weeks
where can Americans get hepatitis A
contaminated water, milk or shellfish. fecal oral
Hepatitis B is more serious and can contribute to development of hepatitis ___
Hepatitis _____ is caused by a virus related to virus that causes yellow and dengue fever. can cause hepatocellular cancer
which hepatitis is commonly transferred during birth
Hepatitis B is treated with what 2 drugs
Interferon Alfa 2b or 2a, and nucleoside analogs
hepatitis c requires what therapy
triple therapy- interferon alfa, ribavirin, and protease inhibitor
Boceprevir or Telaprevir treat what?
chronic inflammatory disease is most common in ___, is _____ in origin, and what is the treatment?
most common in young women, genetic in origin, treated with immunosuppressant drugs, glucocorticoids, liver transplant, and symptomatic treatment
what can trigger chronic inflammatory disease
Alcoholic liver disease can cause alcoholic _____ and alcoholic _____
fatty liver and hepatitis
primary biliary cirrhosis is most common in and runs in families
women 40-60 years
most people with primary biliary cirrhosis also have one of three of the following autoimmune disorders:
1. Hashimotos thyroiditis
2. Sjogrens syndrome
rare disease that causes tightening and hardening of skin and tissues
autoimmune disease where thyroid is attacked
autoimmune disease manifested in dry eyes and mouth
can primary biliary cirrhosis be treated with corticosteroids
primary biliary cirrhosis signs and symptoms
weight loss, itching, jaundice, dark brown urine, pale stools,
bile acid binding drug used for pruritis and lowers lipids. - treats primary biliary cirrhosis
treatment of primary biliary cirrhosis is focused on
drug to increase bile flow
drug that prevents leukocyte migration and phagocytosis
immunosuppressant that helps with symptoms of primary biliary cirrhosis
last resort to treat primary biliary cirrhosis
autoimmune disease that is associated with ulcerative colitis that effects the liver
primary sclerosing cholangitis
elevated levels of ___ or ____ can suggest primary sclerosing cholangitis
alkaline phosphatase or GGT
cirrhosis that results from prolonged obstruction of the extrabiliary treemalignant neoplasms
secondary biliary cirrhosis
how is secondary biliary cirrhosis treated
surgery- relieve obstruction
alcohol liver disease leads to what type of attack on liver membranes
what is an end product of alcohol metabolism
with chronic alcohol use, what is the ratio of AST to ALT
2 things that can happen to brain with alcohol liver damage
Wernickes and Cephalophay psychosis
what is the end stage of chronic liver disease
cirrhosis can cause what type of hypertension?
portal hypertension. increased resistance to blood flow into/out of liver
Portal hypertension causes increased pressure in peritoneal capillaries causing ___
shunting of blood from portal hypertension leads to development of collateral channels leading to ____
caput medusae, hemorrhoids, esophageal varices
vessels around umbilical area are enlarged caused by portal hypertension
shunting of ammonia and toxins into general circulation can cause _____
spenomegaly secondary to portal hypertension can cause bleeding- why?
thrombocytopenia from anemia/leukopenia
when liver cant metabolize protein well, what does that effect?
decreased albumin and decreased clotting factors- BLEEEEDING
liver is in hepatic failure when how much of liver function is gone?
spider angiomas, gynecomastia, coagulopathy, asterixis are all symptoms of ____
enlargement of breast tissue of males
what is asterixis?
liver flap- hand flaps
how to treat hepatic failure
surgery to shunt blood, treat varices, supportive care
steroid hormone aldosterone is effected with liver failure, which causes what symptom?
ascites (water retention)
what is hepatorenal failure? when does it happen and why?
functional renal failure from decreased renal blood flow
brain damage caused from excessive jaundice
how to treat ascites from liver failure?
K sparing/loop diuretics, decrease sodium, 25% albumin, shunting surgery to bring fluid into circulation
cholelithiasis is commonly known as
risk factors for gall stones
obesity, age, sex, race, pregnancy
pancreatitis is associated with what two things?
alcoholism and gall bladder disease
injury of pancreatic ducts causes leakage of enzymes which results in _____
autodigestion of tissue
how is pancreatitis treated?
pain relif (meperdine), relief of nausea, NPO/NG suction,
gallballder contracts and sends bile to small intestine after eating foods with a lot of ___ or ____
when do gallstones begin to form?
when cholesterol concentration in bile is too high
inflammation of common duct is called
2 drugs to treat gallstones
chenodiol and ursodiol
primary cause of pancreatitis
Pancreatic b cell injury in pancreatitis can lead to ____
how to protect from pancreatic cancer
high fiber diet, vitamin c, fresh fruits, dont smook, no soy beans, refined sugars, or high meat and salt consumption
biliary cause of acute pancreatitis is suggested by which lab result?
elevated serum alkaline phosphatase
ketoacids come from amino acids and go through CAC to turn into
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