Ouch my liver :(
Obstruction or damage to liver canaliculi can result in this condition
Intrahepatic cholestasis
This crucial serum protein is decreased in cases of liver failure, inflammation, or protein malnutrition,
Albumin
This hyperbilirubinemia results from >80% total bilirubin being indirect
Unconjugated Hyperbilirubinemia
This phase of hepatitis infection is associated with very aminotransferase levels, sometimes greater than 1000 U/L
Acute hepatitis
You're a heavy drinker and notice you've been bruising more easily. Your buddies say man up...but you're not about toxic masculinity and also a hypochondriac. After paying 30% co-insurance your labs come back:
total bilirubin: Elevated
indirect bilirubin: normal
Vitamin K: normal
Albumin: normal
INR: elevated
Liver synthetic dysfunction
This clotting measurement is an early and sensitive marker for liver dysfunction
INR
These amino transferases transfer aminogroups to ketoglutaric acid
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
This hyperbilirubinemia results from either impaired hepatic secretion or decreased hepatic uptake/function (advanced liver injury)
Conjugated Hyperbilirubinemia
This compound can reverse acetaminophen induced DILI
N-acetylcysteine
In liver failure, the prolonged INR improves with vitamin K administration (T/F)
False.
Vitamin K administration will improve INR when the liver has a normal synthetic function but vitamin K is not being adequately absorbed from the gut, as occurs in cholestasis
Name three potential causes of extrahepatic cholestasis
Tumors, stones, cysts
Elevation in alkaline phosphatase indicates either of these two conditions
Cholestasis (intrahepatic or extrahepatic obstruction to bile flow)
Infiltration of liver parenchyma
This modality is used to differentiate intrahepatic vs extrahepatic cholestasis
Endoscopic retrograde cholangiopancreatography (ERCP)
Ultrasound/MRI
This strain of hepatitis is responsible for a majority of fulminant hepatic failure cases
Hep B
A 43-year-old woman with a long history of non-insulin dependent diabetes mellitus was noted to have an alanine aminotransferase (ALT) that was twice the upper limit of normal on routine screening. She said that she did not drink alcohol and never had done. She was obese (BMI 28). Which is the most likely cause for her elevated ALT?
Hepatic Steatosis
During your last CE shift your spidey senses twitch. Youre the only one to notice the patients characteristic yellowing and empathically sense pain originating from their RUQ
You dont need labs. You taste their blood directly and find:
Elevated direct bilirubin, elevated indirect, elevated AP
AST and ALT of 900
Normal albumin and INR
Hepatitis.
AST/ALT higher than AP --> hepatocellular
Even when the liver is really sick, bilirubin conjugation is conserved
Your patient has markedly elevated AST and ALT (>1000) and is negative for all hepatitis titers and negative for DILI. What would you tests would you order next and what is the treatment plan
Most likely autoimmune
Test for ANA or ASMALower inflammation with corticosteroids
A predominantly direct hyperbilirubinemia is present in all of the following causes of jaundice, except:
a. Hemolysis
b. Bile duct obstruction
c. Drug-induced liver injury
d. Primary biliary cirrhosis
Hemolysis
Youre holding a human liver in your hand. You mull over its intricacies, hearing Dr. Zhang appreciate each individual feature. You know this liver's owner was suffering from jaundice, but this jawn (liver) looks fine. Inspired, you lurk on EPIC and find the biopsy results confirming your suspicion of priary biliary cholangitis.
The halmark antibody and pathology of PBC is
Anti-mitochondrial antibody (95% of cases)
Microscopic destruction of canalicular cells
Stranded, hungry, cold. Youve survived in the artic wilderness for weeks. Despite your Bear Grylls style survival skills, your primary biliary cholangitis starts to act up.
What animal can you feast upon to stabilize your hepatocytes and which compound is responsible for the protective effects