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ALI > 12. Liver function > Flashcards

12. Liver function Flashcards

1
Q

Functions of the liver (7)

A

1) acid/base balance
2) fluid and electrolyte homeostasis
3) detoxification
4) antimicrobial
5) clotting factors
6) protein synthesis
7) glycogen storage

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2
Q

Single most abundant serum protein

A

Albumin

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3
Q

What clotting factors does the liver synthesise?

A

2, 7, 9, 10

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4
Q

what antithrombotic factors does the liver synthesise?

A

Antithrombin III

protein C

protein S

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5
Q

Where is Carbamoylphosphate synthetase found?

A

all but last 1- 2 hepatocytes round terminal hepatic venule

ammonia metabolism

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6
Q

‘Fed’ state

A

liver synthesises glycogen from glucose

perivenular hepatocytes

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7
Q

‘Fasted’ state

A

liver synthesises glucose

periportal hepatocytes

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8
Q

Bile composition

A

Phospholipids

Cholesterol

Water

Inorganic electrolytes

Bile acids

Bile pigments

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9
Q

How much bile is excreted per day?

A

500ml – 600ml

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10
Q

What are primary bile acids synthesised from?

A

cholesterol in the liver

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11
Q

\What are secondary bile acids synthesised from?

A

degradation of primary bile acids by bacteria in the gut

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12
Q

What does bile acid conjugation do?

A

↓ passive diffusion

accumulation in gut lumen

facilitates fat digestion and absorption

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13
Q

Enterohepatic circulation of bile salts

A

Hepatocyte

Biliary tree

Small bowel

Enterocytes

Portal blood

Hepatocyte

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14
Q

How much of the bile salts are conserved in enterohepatic circulation?

A

90%

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15
Q

How many times does the bile acid pool circulates daily

A

5-15 times

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16
Q

Bilirubin metabolism

A

haem →biliverdin by Haemoxygenase

biliverdin → unconjugated bilirubin by Biliverdin reductase

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17
Q

What percentage of bilirubin is derived from haem released by breakdown of erythrocytes?

A

80%

18
Q

Paracetamol overdose: clinical features

A

Fresh bruises

Liver flap

Abdominal pain

Mildly jaundiced

Patient is drowsy but obeying commands

Pear drops

19
Q

Prothrombin time

A

A measure of clotting of the blood

20
Q

Urea and electrolytes (U+Es)

A

Na, K, U, Creat

renal function and electrolyte balance

21
Q

Liver function tests (LFTs)

A

AP, ALT, Bil, Alb

Reflect liver damage

22
Q

pH

A

Measure of acid/base balance

23
Q

Paracetamol overdose: management

A

Central venous access and fluid replacement

Arrange for transfer to FRH

N-acetyl cysteine administration

Transfer to ITU

Intubation and ventilation

24
Q

Chronic liver failure: clinical presentation

A

Jaundice

Leuconychia

Clubbing

Palmar erythema

Gynaecomastia

Bleeding varices

ascites

umbilical hernia

dilated abdominal wall veins

25
Q

Chronic liver failure: management

A

Banding of varices

Endoscopy

Vitamins/nutrition

Diuretics

Liver screen

Abdominal U/S

26
Q

Sub-acute liver failure

A

development of encephalopathy within 5 - 12 weeks of the onset of jaundice

27
Q

Hyper-acute liver failure

A

development of encephalopathy within 7 days of the onset of jaundice

28
Q

What are the clinical abnormalities (signs) of acute liver failure?

A

0-24 hrs: Patient may appear well – however nausea + vomiting

48–72 hrs: Anorexia, Right subcostal pain

72hrs+: Jaundice, Encephalopathy, Cerebral oedema

29
Q

Phase I of paracetamol OD

A

1 - 24 hours patient complains of nausea, vomiting and diaphoresis.

30
Q

Phase II of paracetamol OD

A

24 - 48 hours there may be no symptoms or clinical evidence of liver disease

31
Q

Phase III of paracetamol OD

A

2 - 10 days

overt liver disease

32
Q

What causes jaundice seen in liver failure?

A

conjugation and excretion of bilirubin

33
Q

What causes encephalopathy?

A

metabolism of ammonia and detoxification of benzodiazepine like compounds

34
Q

What causes Ascites and oedema?

A

impaired synthesis of albumin

35
Q

What causes bruising?

A

impaired synthesis of clotting factors

36
Q

CAGE Questionnaire

A

Have you ever felt you should CUT down on your drinking?

Have you ever felt ANNOYED by people criticising your drinking?

Have you ever felt GUILTY about your drinking?

Have you ever had a drink first thing in the morning? As an EYE OPENER

37
Q
A

Rigler’s sign

gas either side of the lumen

38
Q
A

Small bowel obstruction

Dilated >3cm small bowel

Centrally placed

Valvulae conniventes are readily defined (coiled spring sign)

39
Q
A

large bowel obstruction

40
Q
A

calcification in the left kidney

41
Q

Causes of liver Cirrhosis (5)

A

Chronic infection

Alcohol abuse

Biliary disease

Iron overload

Autoimmune hepatitis

42
Q

Where is glutamine found?

A

Last 1-2hepatocytes

scavenge any remaining ammonia

ALI (22 decks)

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