Acute and chronic liver disease Flashcards
Acute liver failure
- severe hepatic dysfunction - hepatic encephalopathy within a 3 months from onset of symptoms
- severity according to time passed from jaundice to encephalopathy:
- hyper acute: less than 1 week
- acute: 1-4 weeks
- sub-acute: 5-12 weeks
Hepatic encephalopathy
- cerebral edema + neurological disorders due to liver problem
- personality changes, intellectual impairment, depressed level of consciousness
Causes of acute liver failure
hepatitis metabolic disorders (e.g. fructose intolerance) toxins + drugs (e.g. alcohol poisoning) hepatic vein obstruction autoimmune
Acute liver failure: effect on carbohydrate metabolism
- hypoglycemia (decreased glycogen storage + decreased gluconeogenesis)
- diminished response to glucagon
- loss of appetite
- lactic acidosis - no Cori cycle
Acute liver failure: effect on lipid metabolism
- low total cholesterol - no synthesis
- decreased VLDL, HDL levels
- increased LDL levels
- high FFA conc. (hypoglycemia - glucagon secretion - HSL activation - FAs not converted in liver - no decrease in glucagon)
Acute liver failure: effect on protein metabolism
- hypoalbuminemia - not enough synthesized
- decreased production of blood clotting factors
- decreased aromatic AA level
- branched chain AAs same
- increased alanine level (no alanine-cycle)
- increased level of old proteins (usually uptake by liver - have silica acid molecules - removed by themselves in time - bind to livers a-sialo-glycoprotein receptor)
Acute liver failure: effect on ammonia metabolism
- liver is main place for urea synthesis - not enough now
- leads to:
brain damage, encephalopathy
depression, mood disorders
drowsiness, decreased ability to speak
deep sleep, decreased ability to respond + communicate
coma, death
Treatment of acute liver failure
- glucose + insuline, while maintain normal metabolites
- making intestinal lumen more acidic - ammonia ionized - can’t be reabsorbed - excretion
Chronic liver disease
- gradual increase in hectic dysfunction over long time
- fibrosis or cirrhosis
Symptoms of chronic liver disease
abnomal nerve function fluid accumulation in abdomen jaundice kidney failure hepatic encephalopathy portal hypertension spider-like veins on skin coughing/vomiting blood general weakness weight loss, hair loss
Causes of chronic liver disease
- same as acute- different toxins + exposure to smaller dosage for longer time
- bile obstruction
- chronic alcoholism
- diabetes
Chronic liver disase: effect on carbohydrate metabolism
- hyperglycemia
- peripheral insulin resistance
- lactic acidosis - not enough cori cycle
Chronic liver disease: effect on lipid metabolism
- more fibrotic - increased release of FA from adipocytes since peripheral insulin sensitivity decreases
- liver flooded with FA - Steatosis/ fatty liver
Fatty liver reasons
- untreated diabetes
- large intake of steroids
- protein deficiency - malnutrition
- obstruction of blood flow from liver
- alcoholism
Alcoholism- Fatty liver
- increased membrane fluidity - interferes with synthesis + placement of membrane proteins - osmolarity changes - liver swells - cirrhosis
- acetaldehyde - denature proteins (especially apoproteins) - FA accumulation in liver
- increased NADPH conc. - increased FA synthesis
Chronic liver disease: effect on amino acid metabolism
- increased aromatic AA level
- branched chain AA level same
- increased ASAT - increased ASAT/ALAT ration
- amino aciduria
Chronic liver disease: effect on ammonia metabolism and urea cycle
- urea cycle works normal until progressive stages - hyper ammonemia
- Hyperammonemia: increased blood pressure in portal system - blood vessel rupture - blood to intestinal lumen - bacteria metabolizes proteins - ammonia
Chronic liver disease: effect on protein synthesis + degradation
- decreased albumin conc. - blood volume decrease, edema increase
- decreased clotting factor synthesis
- increased level of old proteins
Chronic liver disease: effect on biotransformation processes
slower drug metabolism - smaller dosage of drugs are enough
Chronic liver disease: effect on hormone metabolism
- smaller amount of liver-thyroxin, testosterone, estrogen
- loss of pubic hair, shrinking testicles
