Biliary tree and Cirrhosis + pancreas Flashcards
What happens in a healthy liver?
Balanced fatty acids Hepatic fatty acids (FFAs) uptake Lipogenesis in liver FFA oxidation in liver FFA export within liver by lipoproteins Rate of FFA input = output
What happens when we take too much drugs, ethanol & fatty foods?
Simple steatosis
Is it reversible?
Yes
Once you stop the “good” life..
Eat healither, no drugs, no good taste fatty foods.
What happens in simple steatosis?
Fat accumulation in the liver
Initially ariund zone 3’, near central veins
Later, throughout the parenchyma.
Xs fat from diet, ethanol, from adipose tissue,
↪️ there is less oxidation, so Triglycerides (TG) will accumulate as lipid venules
What happens to triglycerides?
Lipase hydrolyses TGs (from fiet, adipose tissue) to FFAs that go to hepatocytes and are stored as TGs or undergo oxidation.
What happens in fat accumulation?
Rate of fatty acid input(uptake & synthesis of lipids)> rate of FFAs output. (Oxidation & secretion of lipids)
↪️ impaired fat metabolism leads to lipid accumulation in vesicles.
What happens if we continue with the bad habbits? After simple steatosis. Is it reversible?
Steatohepatitis- termed now as fatty liver disease.
Its still feversible
.
What happens in steatohepatitis?
Fat accumulation Liver cell nevrosis Inflammation (Mallon-1- Boujet) Fibrosis ↪️inflammation is associated w/ fatty changes
What is cirrhosis? Is it reversible?
This is the last stage of fatty liver disease. IRRIVERSIBLE
Fibrosis
Hyperplastic noduels
Subendothelial or pericentral fibrosis (hepatic fibrosis)
Progresses to panlodular fibrosis w/ nodule formation (cirrhosis)
❌ shrunk liver, smaller.
Whats alcohol related cirrhosis?
Typically micronodular
W/ steatosis
Whats beta oxidation of fatty acids? Where does it happen?
In the matrix of mitochondria,
Fatty acids provide more ATP than glycerol.
Catabolic process by which fatty acids broken down to generate Acetyl-CoA, entering Krebs–> NADH + FADH2 –> ETC–> energy.
However, ketone bodies also produced.
Whats lipid anabolism?
Lipid anabolism: lipogenesis
Stimulated by insulin
Liver & adipose tissue
Make lipids from glucose and amino acides (lipoproteins)
Whats ketogenesis?
Kerone bodies mainly produced in hepatocytes’ mitochondria, and their synthesis - response to unavailability of blood glucose.
After glycogen stores exhausted.
What else triggers ketogenesis?
When High levels of blood glucose that cannot be stored as glycogen in hepatocytes or muscles.
Then, makes availability of enerfhy, stored as fatty acids.
What else stimulates steatosis?
PPAR-gamma receptor sensor- when Xs energy = fat oxidation.
When defective- ⬇️ fat oxidation.
↪️ steatosis
PPAR-g stimulates steatosis.
What are the types of Fatty Liver Disease?
Alcoholic fatty liver diease and Non-Alcoholic Fatty Liver disease (NAFLD)
What hapoens in Alcoholic fatty liver disease?
Ethanol–> acetaldehyde by alcohol degydrohenase giving off NADH
↪️ Acetic acid –> Acetyl-CoA –> fatty acids in Liver
So.. Alcohol fatty liver disease:
- Xs reduced NADH+ formed–> lipid synthesis
–> from Xs alcohol - Impaired secretion of lipoproteins
↪️ lipids accumulate in liver - Increased peripheral catabolism of Fat
(+ ketone bodiess…..)
NAFLD- what is it and how is it tx?
- “Diet involved” high intake of dietary fats, e.g. fructose–> glyceraldehyde..–> G3P..
- Higher fat uptake
- Reduced fat secretion
- Reduced secretion of lipoproteins
- Increased storage of FFAs
↪️FATTY ACIDS IN LIVER.
Ask for alcohol to exclude this fx.
Dx- ⬆️⬆️AST +ALT , CHECK HEP C- causes fat to accumulate.
H/w these do not discriminate from simple steatosis.
Refer to hepatologist for amount of fat- USS and CT, again not specifi for scarring and inflammation present.
Definite: Liver biopsy.
Non alcoholic steatohepatitis.
Sx:
Silent, no sx. Maybe pain in RUQ,
O/E slight hepatomegaly and acanthiosis nigricans (patch dark discolouration of skin over neck and upper arms. )
Progression to cirrhosis is slow.
Tx
Usually there are obese, so lose wt, oprimise DM, HTN and hyperlipidaemia if present.
Drugs used in DM help, simce its a metabolic disorder of the liver to metabolise insulin.
Insulin sensitisers - clinical studies in completion almost.
Whats Metabolic syndrome?
3/5 of these:
- HTN
- Obesity
- Resistance
- Dylipidaemia
- Impaired glucose tolerance
Causes of Liver Cirrhosis
- Alcoholic Liver disease, alcohol steatohepatitis
Fat in liver, steatosis, inflammation, fibrosis,
⬆️⬆️ AST, ALT, fever, Hepatomegaly, jaundice. - Non-alcoholic + steatohepatitis, metabolic syndrome, DM, obesity, drugs, steatosis, inflammation % fibrosis. ↪️LONGER.
3. Hep C >6 months --> cirrhosis Blood to blood, asymptomatic, Acute: hepatitis Chronic: fibrosis & cirrhosis Abs- cannot detect antigen, hard diagnosis, no vaccine, interferons.
4. Hep B > 6 months --> cirrhosis Blood, sex, semen, vagina Acute infx: jaundice, hepatitis, vomiting Chronic: cirrhosis, liver cancer Interferons vaccine.
Complications of liver cirrhosis
FUCK
Portal Hypertension Oesophageal varices --> bleeding (PHTN) through portal vein. Hepatic encephalopathy. Hepatic pulmonary syndrome Hepatocellular carcinoma Oedema Itching- ⬆️ levels of uric acid Hepatorenal syndrome Jaundice Haemorrhoids- rectal varices or backflow Slpinomegaly- back flow to splenic veins - accumulation of cells- WBCs, RBCs, platelets..
Whats portal Hypertension (PHTN)
Portal vein–> liver–> hepatic vein–> IVC–> RA
Pressure is increasing, blood flows backwards,
Stomach –> gastric veins,
Rectum- rectal veins
Whats hepatopulmonary syndrome?
(Endothelin 1 –> vasoconstriction) – vasodilation by NO in abscence of endothelin 1.
So, pulmonary vasodilation induced NO, enthothelin-1 secreted by liver.
