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GI System > 6. Liver Function And Pathology > Flashcards

6. Liver Function And Pathology Flashcards

1
Q

What are the functions of the liver?

A

Storage - glycogen, vitamins, iron, copper
Synthesis - glucose, lipids/cholesterol, bile, clotting factors, albumin
Metabolic - bilirubin, ammonia, drugs, alcohol, carbohydrate, lipid

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2
Q

What are the symptoms of liver failure?

A

Jaundice
Oedema/ascites
Bleeding
Confusion

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3
Q

Why does oedema/ascites occur in liver failure?

A

Reduced ability to produce albumin - oncotic pressure

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4
Q

Why does confusion occur in liver failure?

A

Build up of ammonia as reduced ability to metabolise it

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5
Q

What can cause acute liver failure?

A

Alcohol
Paracetamol
Viral
Medications - aspirin in children

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6
Q

What is cirrhosis?

A

Scarring (fibrosis) of the liver caused by long-term liver damage
Scar tissue prevents liver working properly

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7
Q

What can inflammation of the liver lead to?

A

Fibrosis and hepatocyte necrosis

Nodules

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8
Q

What can cause inflammation and therefore cirrhosis?

A 
Drugs
Infection
Deposition
Autoimmune
Other
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9
Q

How can drugs cause cirrhosis and chronic liver disease?

A

Iatrogenic - doctor given medication

Alcoholic liver disease

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10
Q

What happens in alcoholic liver disease?

A 
Fatty change (weeks) - hepatomegaly 
Alcoholic hepatitis (years) - inflammatory cells present, jaundice, right upper quadrant pain, hepatomegaly
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11
Q

What infections can cause cirrhosis/chronic liver disease?

A

Hep B - symptoms

Hep C - IV drug use, asymptomatic

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12
Q

What can infections and cirrhosis of the liver cause?

A

Malignancy

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13
Q

What are some deposition disorders that can result in chronic inflammation and therefore cirrhosis?

A

Fat - non-alcoholic fatty liver disease (insulin resistance, triglycerides build up
Fat - non-alcoholic steatohepatitis (NASH) is when inflammation is present in NAFLD
Hereditary haemochromatosis - increased absorption of iron, therefore increased deposition
Wilson’s disease - decreased copper secretion, therefore increased deposition

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14
Q

How is hereditary haemochromatosis treated?

A

Venesection

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15
Q

What symptoms can Wilson’s disease cause unrelated to the liver?

A

CNS - seizures, memory problems, tremors

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16
Q

What treatment do patients with Wilson’s disease require?

A

Liver transplant

17
Q

What autoimmune causes are there for cirrhosis?

A

Autoimmune hepatitis - hepatocytes attacked by immune system (ASMA, ANA)
Primary biliary cirrhosis - anti-mitochondrial antibodies
Primary sclerosing cholangitis - can have association with IBD (UC)

18
Q

What are some other causes of inflammation and therefore cirrhosis?

A

Alpha-1 antitrypsin deficiency
Glycogen storage disorders
Budd-chiari syndrome

19
Q

What are the 3 main vessels in the portal venous system drainage into the portal vein?

A

Inferior mesenteric vein
Superior mesenteric vein
Splenic vein

20
Q

What is one of the main complications seen in cirrhosis?

A

Portal hypertension

21
Q

Why does portal hypertension occur?

A

Cirrhotic liver not very expansive
Veins compressed entering liver from portal venous system
Causes increase in hydrostatic pressure within portal venous system
Leads to fluid leakage (ascites) due to low albumin
Build up of pressure in spleen (splenomegaly)

22
Q

What does portal hypertension cause?

A

Blood shunts from portal system to systemic circulation - varices in oesophagus, anorectal, umbilicus (in severe cases)
Ascites - from increased hydrostatic pressure
Splenomegaly
Hepatorenal syndrome - reduced kidney function

23
Q

What happens in hepatorenal syndrome?

A

Portal hypertension
Back logs in venous system and eventually in arterial system (splanchnic)
Arterial vasodilation
Perceived reduced circulating volume, RAAS system is activated, renal artery vasoconstriction
Reduced perfusion to kidney therefore reduced kidney function

24
Q

What are gallstones composed of?

A

Cholesterol

Bile pigments

25
Q

What are some risk factors for gallstones?

A

Diet - high cholesterol
Female >40
Pregnancy

26
Q

What are the most common complications of gallstones?

A

Biliary colic - RUQ pain constant, gallstones in neck of gallbladder, no inflammation
Acute cholecystitis - RUQ pain, impacted in cystic duct, inflammation, +ve Murphy’s sign
Acute/ascending cholangitis - Charcot’s triad (RUQ pain, inflammation, jaundice)
Acute pancreatitis - autodigestion of pancreas, epigastric pain radiating to back, vomiting, Cullens + Grey Turner’s

27
Q

What are released in acute pancreatitis?

A

Amylase and lipase

GI System (26 decks)

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