Block 1: Liver Disorders

Question 1

What are the two sources of blood supply to the liver?

Answer 1

i) Oxygenated blood- Hepatic Artery

ii) Venous blood - Hepatic Portal vein

Question 2

What are Sinusoids?

Answer 2

Channels in the liver that provide exchange of blood between hepatocytes.

Question 3

How does blood leave the liver?

Answer 3

Hepatic vein

Question 4

Where is bile produced?

Answer 4

Hepatocytes

Question 5

Name 3 functions of the liver?

Answer 5

• Bilirubin elimination
• Bile salt production
• Drug & Alcohol metabolism
• Steriod hormone metabolism
• Carborhydrate, lipid and protein metabolism
• Vitamin & mineral storage
• Glycogen storage
• Synthesis of plasma proteins and clotting factors

Question 6

What is bilirubin a waste product of?

Answer 6

Breakdown of haemoglobin

Question 7

Jaundice results from an excessive accumulation of?

Answer 7

Bilirubin

Question 8

Haemolysis due to a blood incompatibility reaction would lead to elevated serum levels of?

Answer 8

Unconjugated bilirubin

Question 9

Name the 3 types of Jaundice?

Answer 9

1) Pre-hepatic
2) Intra-hepatic
3) Post-hepatic

Question 10

What is kernicterus?

Answer 10

High bilirubin in neonates that can cause brain damage

Question 11

Why is a neonate a higher risk of kernicterus?

Answer 11

Immaturity of both liver function to form conjugated bilirubin and blood brain barrier.

Question 12

How is conjugated bilirubin transported in the body?

Answer 12

Attached to protein carrier albumin

Question 13

What is Prehepatic jaundice?

Answer 13

Increased rate of RBC breakdown, from haemolytic anaemias, incompatible Rh factors or blood transfusion reactions.

Question 14

What is Intrahepatic jaundice?

Answer 14

The inability of the liver to process conjugated bilirubin or secrete it.

Question 15

What is Posthepatic jaundice?

Answer 15

Due the obstruction of bile flow between the liver and the intestine.

Question 16

Where are bile salts and acids stored?

Answer 16

Gall bladder

Question 17

What are bile salts important for?

Answer 17

Act as emulsifiers in digestion of lipids (fats)

Question 18

What is steatorrhoea?

Answer 18

Increased excretion of fat in faecal matter.

Question 19

Two enzymes involved in drug & alcohol metabolism?

Answer 19

i) Microsomal

ii) Cytochrome P450

Question 20

What vitamins and minerals are stored the liver?

Answer 20

Vitamins: A, B12, D, E, K
Minerals: Iron, copper

Question 21

Increased levels of iron storage in the liver can be a sign of?

Answer 21

Haemochromatosis

Question 22

Low albumin production by the liver leads to?

Answer 22

Oedemas and ascites (fluid build up in abdominal cavity)

Question 23

Two factors that lead to a Hepatic coma?

Answer 23

i) Hypoglycaemia

ii) Ammonia build-up

Question 24

What is Cholestasis?

Answer 24

Disorders of the liver, bile duct, or pancreas causing a reduction or stoppage of bile flow.

Question 25

What are some symptoms of Cholestasis?

Answer 25

The skin and whites of the eyes look yellow, the skin itches, urine is dark, and stools may become light-colored and smell foul.

Question 26

Name 3 clinical markers that may be elevated from cholestasis?

Answer 26

i) Alkaline phosphatase (Alk phos)
ii) gamma glutamyl transferase (GGT)
iii) Bilirubin

Question 27

Name two enzymes that if elevated may suggest hepatocyte damage?

Answer 27

i) Alanine aminotransferase (ALT)

ii) Aspartate aminotransferase (AST)

Question 28

Name the common liver function tests?

Answer 28

i) Hepatitis virus series
ii) Ultra-sound
iii) Liver biopsy
iv) CT, MRI scans

Question 29

Why is albumin important in healthy liver function?

Answer 29

It is important in maintaining normal fluid distribution between interstitial and intravascular compartments - “Oncotic pressure”.

Question 30

What is cirrhosis?

Answer 30

Cirrhosis of the liver describes a condition where scar tissue (fibrosis) gradually replaces healthy liver cells.

Question 31

Name 3 symtoms can arise from cirrhosis?

Answer 31

Portal hypertension, ascites and varices

Question 32

What is hepatitis?

Answer 32

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection.

Question 33

Name 2 clotting factors produced in the liver?

Answer 33

i) Fibrinogen

ii) Prothrombin