7.3 Liver Diseases Flashcards
The liver produces hepcidin. What is the role of hepcidiin?
Decreases blood iron levels by
- Decreasing absorption
- Inhibiting release from storage
Bilirubin is produced during the breakdown of…
Heme (and therefore RBCs)
Jaundice is caused by an elevated level of ????. The three types of jaundice are ???
- Elevated bilirubin concentration
- Three types are pre-hepatic, hepatocellular, and post-hepatic
Explain pre-hepatic jaundice
- Elevated RBC breakdown secondary to diseases such as ????
- Increase in unconjugated bilirubin
Explain hepatocellular jaundice
- 2° to liver or gall bladder disease
- Usually both conjugated and unconjugated are elevated (conjugated for biliary dysfunction; unconj for liver)
Explain post-hepatic jaundice
- Failure of excretion of conjugated bilirubin in bile
- It is released in circulation instead of GIT, causing bilirubinuria and pale stools
Three most common chronic liver disease differentials are…
- MAFLD
- Alcoholic liver disease
- Viral hepatitis
Which gender is more sensitive to alcoholic liver disease?
Women
Signs and symptoms of liver failure
- Jaundice (skin, sclera)
- Ascites
- RUQ pain
- Disorientation/confusion
- Nausea/vomiting
- Fatigue (earlier…)
- Easy bleeding
List three complications of chronic liver disease, and how they come about
- Ascites: portal hTn causes distended veins, and lower oncotic pressure caused by decreased albumin production
- Encephalopathy: decreased detoxification causes cog impairment
- Coagulopathy: liver causes decreased production of some clotting factors
What is cirrhosis?
Irreversible scarring and fibrosis of the liver.
What is haemochromatosis?
Abnormal increase in body iron stores.
List three ways that alcohol damages the liver during metabolism
- Steatosis (usually first)
- Hepatitis
- Cirrhosis (last)
MAFLD criteria
- Hepatic steatosis, plus at least one of…
- Obesity/overweight
- T2DM
- Metabolic dysregulation
Acute hepatitis symptoms
- Pain/bloating in abdomen
- Dark urine/pale stools
- Fatigue
- Jaundice (sclera/skin)
- Nausea/vomiting
MAFLD symptoms
- Often none
- Can cause fatigue, malaise, and RUQ pain
MASH symptoms
- Spider naevi
- Palmar erythema
- Jaundice (eyes/sclera; itching)
- Ascites
- Splenomegaly
Portal hypertension symptoms
- Ascites
- Caput medusae
- Internal haemorrhoids
- Peripheral oedema (why?…)
What type of collagen is involved in liver regeneration/cirrhosis? What is the difference between the two processes?
- Type I and Type III collagen is important
- In regeneration, collagen provides a temporary scaffold for new hepatocytes to grow, and is later broken down by enzymes (MMPs) later
- In cirrhosis, chronic injury leads to persistent, irreversible scarring
List three causes of cholestatic liver damage
- Drugs
- Infiltration (e.g. malignancy)
- Biliary obstruction
List three causes of hepatocellular liver damage
- Infection
- Alcohol
- Steatohepatitis (e.g. MASH)
What is Gilbert’s syndrome?
Unconjugative hyperbilirubinaemia, caused by dysfunction of the gene that encodes an enzyme responsible for bilirubin breakdown.
How does the ALT/AST ratio differ in alcogolic vs other causes of hepatocellular liver damage?
Alcoholic: >2:1 AST to ALT (more generalised damage)
Other causes: ALT > AST usually
Hepatocellular vs cholestatic LFT pattern
- Hepatocellular: elevated ALT and AST
- Cholestatic: elevated GGT and ALP
What does isolated elevated GGT indicate? ALP?
GGT: alcohol excess
ALP: bone disease (e.g. Paget’s)
What Hep B serology marker tells us if a patient has infection? Which tells us if they’re acute or chronic? Which is elevated if someone is vaccinated?
- High HbsAG (surface antigen) indicates infection of some kind
- High IGM anti-HBc indicates acute infection (igG comes before IgM)
- Vaccination causes raised anti-HBs (s for syringe)
Which Hep C biomarker tells us if a patient has been infected at some time? Which tells us if they’re infected right now?
At some point: non-reactive antibody
Right now: RNA
What is Wilson’s disease? What might we test to evaluate it?
- Wilson’s disease is the abnormal accumulation of copper in the body
- We can test caeruloplasmin (which we would expect to be decreased)
Indications for liver biopsy
- Investigating abnormal LFTs
- Establishing degree of fibrosis
- Evaluating metabolic disease
An elevated result on a fibroscan indicates…
Increased stiffness/fibrosis
