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Human disease and therapeutics 2020 > Hepatic Lecture FINAL > Flashcards

Hepatic Lecture FINAL Flashcards

1
Q

what is acute cholecystitis often caused by?

A

-gallstones and obstruction

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2
Q

cholecystitis is present in ___% of the US population

A

10-20%

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3
Q

can acute cholecystitis become chronic?

A

yes

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4
Q

most gallstones are made of ___. what are other gallstones made of?

A
  • most are made from cholesterol

- other varieties include pigmented types, made from bilirubinate or hemolysis

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5
Q

what are 5 types of liver disease?

A
  • fatty liver
  • hepatitis
  • biliary disease
  • metabolic disease
  • vascular
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6
Q

what can liver diseases progress to?

A

cirrhosis

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7
Q

what is fatty liver caused by?

A

alcohol, obesity, and diabetes melitus

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8
Q

what is hepatitis caused by?

A

virus, drug, or autoimmune

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9
Q

what 3 things make up the liver?

A
  • hepatocytes
  • duct cells
  • blood vessels
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10
Q

what do the portal tracts in the liver contain?

A

the triad of bile ducts, portal veins, and hepatic artery (from the heart)

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11
Q

what do portal veins do?

A

bring blood from the gut with nutrients and recently consumed drugs

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12
Q

what is the function of hepatocytes in the liver?

A

metabolism

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13
Q

what is the number 1 cause of liver toxicity?

A

drugs

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14
Q

what is the worst destruction caused by fatty liver, and what can it lead to?

A
  • fibrosis is the worst destruction
  • leads to a collagen scar and permanent injury
  • end stage is cirrhosis
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15
Q

what is another name for fatty liver?

A

steatosis

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16
Q

in fatty liver, what happens when hepatocytes die in large sheets?

A
  • the areas fill up with blood

- blood can build up due to heart failure and backflow

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17
Q

how can a patient with cholestasis become jaundiced?

A

cannuliculi in the liver fill with bile

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18
Q

what is hepatitis?

A

inflammation of the liver

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19
Q

is hepatitis contagious?

A

yes, if it is caused by a virus

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20
Q

what are the causes of hepatitis?

A
  • toxins and drugs

- hepatitis viruses

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21
Q

what are examples of toxins and drugs that can cause hepatitis?

A

alcohol and acetaminophen

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22
Q

T or F:

chronic hepatitis usually resolves itself

A
  • false

- acute hepatitis can often resolve itself, but chronic is less likely to recover

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23
Q

why is chronic hepatitis less likely to resolve itself?

A
  • fibrosis is often a part of chronic hepatitis

- increase is fibrosis worsens prognosis

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24
Q

what is acute hepatitis caused by?

A

-hepatitis A, B, C, E, and rarely D

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25
Q

do acute hepatitis infections caused by hep A and E tend to progress to chronic?

A

no

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26
Q

describe the progression of hepatitis caused by hep B, C, and D viruses

A
  • start with as acute hepatitis
  • frequently progress to chronic
  • can lead to cirrhosis and even hepatocellular carcinoma
  • less likely with hep D
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27
Q

what is the timeline for acute vs chronic hepatitis infections?

A
  • acute <6 months

- chronic >6 months

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28
Q

what type of inflammation is characteristic of acute hepatitis infections? what about chronic?

A
  • acute - lobular inflammation (surrounding hepatocytes)

- chronic - portal inflammation (necroinflammatory, and hepatocytes are the target)

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29
Q

which type of hepatitis (acute or chronic) has fibrosis?

A
  • chronic

- fibrosis bridges to cirrhosis

30
Q

which hepatitis viruses are characteristic of acute hepatitis infections?

A
  • hep A (picornavirus) and hep E (calicivirus)

- heps B, C, and D start out as acute, but typically progress to chronic

31
Q

which hepatitis viruses are characteristic of chronic hepatitis infections?

A
  • hep B (hepadnavirus), C (flavivirus), and D (deltavirus - this is rarely expressed)
  • these begin as acute infections and progress to chronic
32
Q

what are the sources of hepatitis A virus?

A
  • close personal contact
  • contaminated water or food
  • blood exposure
33
Q

hep C is easily transmitted by ___ and ___

A

blood and needles

34
Q

during the ___ stage, hep C usually shows no symptoms

A

acute

35
Q

is the incidence of hep C infection high or low in the US?

A
  • low (1-2 million)

- very high in places like China

36
Q

hep C virus is found in how many carriers worldwide?

A

> 170 million

37
Q

what is the treatment for hepatitis C infection?

A

-combination of antivirals (usually including ribavirin)

38
Q

can hepatitis C infection be prevented?

A

-currently there are no immunizations available to prevent

39
Q

is hepatitis C infection treatment effective?

A

yes (also very expensive)

40
Q

hepatitis B infection is transmitted by ___ and ___

A

blood and needles

41
Q

which stage does hep B infection not show symptoms?

A

acute

42
Q

___% of the population is infected with hepatitis B

A

2-10%

43
Q

what is the most common blood-borne infection in health care workers (including dental personnel)?

A

hepatitis B infection

44
Q

1/2 of hepatocellular carcinomas are associated with ___ infections

A

hepatitis B viral infections

45
Q

what is the treatment of hepatitis B infections?

A
  • immunization (pre/post exposure) to prevent infection

- antivirals

46
Q

what are the antivirals used to treat hepatitis B infections?

A

-lamivudine and adefovir

47
Q

related to dentistry, what are the vectors of hepatitis B virus?

A

blood, saliva, and nasopharyngeal secretions

48
Q

where in the mouth is the highest concentration of hepatitis B virus?

A

gingival sulcus

49
Q

what are the oral manifestations of hepatitis B virus infection?

A
  • lichen planus
  • periodontal disease
  • candidiasis
  • increased oral bleeding
  • increased incidence of type II diabetes
  • sjogren’s syndrome
50
Q

what is cirrhosis?

A
  • regenerative hepatocyte nodules

- fibrosis surrounding nodules

51
Q

is autoimmune hepatitis common?

A

no

52
Q

what population is autoimmune hepatitis most common?

A

obese middle-aged females

53
Q

what is the treatment for autoimmune hepatitis?

A

steroids

54
Q

autoimmune hepatitis often goes on to advanced ___

A

fibrosis

55
Q

in fatty liver disease, the liver tends to appear what color?

A

yellow

56
Q

which fatty liver disease type is described as fat accumulation in the liver that is temporary and does not have any cellular damage?

A

steatosis

57
Q

which fatty liver disease type is characterized by damage to the liver with fibrosis present (chronic)?

A

steatohepatitis

58
Q

metabolic disease is often associated with ___ overload, and can progress to ___

A
  • iron

- cirrhosis

59
Q

what is a metabolic disease characterized by a copper metabolic defect that goes on to hepatitis and then cirrhosis?

A

wilson’s disease

60
Q

hepatocellular injury causes accumulation of ___ pigment in liver ___ cells

A
  • ceroid (lipid residue of lysosomal digestion)

- kupffer

61
Q

___ is the destruction of bile ducts, causing bile to back up in the liver and cause inflammatory cells to surround ducts

A

biliary disease

62
Q

biliary disease may form ___

A

granulomas

63
Q

what are the main causes of chronic hepatitis?

A
  • infection (hepatitis B and C most common, rarely D)
  • drugs
  • autoimmune diseases
64
Q

how is accidental hepatitis B exposure managed?

A
  • carefully wash wound - DON’T RUB (imbeds virus)
  • use antiviral disinfectant (iodine or chlorine formulations)
  • initiate HBV vaccine series
65
Q

what are the 2 objectives of managing hepatitis C virus?

A
  • eliminate the virus

- prevent progression to fibrosis and cancer

66
Q

what are the guidelines of hepatitis C viral infection treatment?

A
  • > 18 years of age
  • compensated liver disease meaning no encephalopathy or ascites
  • willingness by patient to adhere to treatment requirements
67
Q

___% of those treated for hepatitis C viral infection remain virus free for 1 year

A

92%

68
Q

___% of those treated for hepatitis C viral infection have severe side effects

A

2%

69
Q

treatment of hepatitis C viral infection is contraindicated in what patients and why?

A
  • patients with severe liver disease

- due to metabolism problems

70
Q

what is the cost in the US to treat hepatitis C viral infection?

A
  • $90,000/12 week regimen

- much cheaper in some other countries

Human disease and therapeutics 2020 (60 decks)

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