Liver and pancreas

Acute liver cell injury

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Pre-, hepatic, and post- hepatic causes of hyperbilirubinemia

Pre-hepatic- inc. unconjugated blr and urobilinogen, normal hepatic enzymes

Hepatic- incr. hepatic enzymes, inc. conjugated and unconjugated blr

Post- inc. conjugated blr and dec. urinary urobilinogen, raised ALT

Hepatitis

Disruption of lobular pattern

Increased portal HTN

Decreased circulation to liver

NAFLD

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Alcoholic fatty liver

Alter pattern of gene expression

Fat accumulation and hypoglycemia

Generates acetylaldehyde which can inactivate enzymes and lipid peroxidationleading to toxicity

These modified/inactivated proteins can activate against self-antigens

Resulting from excess NADH, which leads to oxidative stress and hepatocyte injury

Excess NADH also means body has to use alternative sources of energy, therefore lipogenesis and fatty liver occurs

Cirrhosis

Manifestations

Portal hypertension

Increased intrahepatic resistance

Decreased NO and increased vasoconstrictors

Increased collateral resistance

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Hepatorenal syndrome

Splanchnic vasodilation

Activation of RAAS/SNS to equalize systemic vascular resistance

Causes vasoconstriction of renal arteries

Renal failure

Due to generation of fibrosis and regenerative nodules

Electrolyte deficiencies, Na, K Po4 and Mg

Viruses

Leakage of blood transaminases, ALT>AST

Hep A.

Fecal-oral transmission and acute

Hepatitis B

Chronic, and can be immunized

Hep C.

Hep E.

Only acute, similar to A in that they both don't have envelope

Difference is that it can't be immunized and it can be dangerous during pregnancy (can lead to fulminant hepatitis)

IV drug abuse, childbirth, sex

Double stranded DNA envelope

No vaccine

HCV-IgG antibody not protective

Pancreatitis

Acute

Amylase, protease, lipase increase

Can lead to digestion of peripancreatic fat

Gets Mashed

Gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hypercalcemia and lipidemia

Epigastric pain

Complications

Fistula, chronic pancreatitis, fistula formation, acute lung injury, renal failure, infected pancreatic necrosis

Hemorrhage

Activation of elastase

Damages elastic fibers of blood vessels

Necrosis

Activation of trypsinogen and phospholipase A2