ch 13 Flashcards
Overview of the Liver
Largest gland in the body (~1400-1800 g)
Hepatocytes form ~80% mass, crucial to:
Detoxification of drugs and vits and hormones
metabolism of AA + ammonium
biochemical oxidative reaction
> 500 known functions (see Nelms Table 16.1)
“Secretory gland” (i.e. bile)
Huge functional reserve
~80-90% liver cells must be injured before
s/s of physiological dysfunction appear
Remarkable regenerative capacity
Blood Circulation To and From the Liver
Liver receives blood from:
Hepatic artery
Arterial blood that provides the livers o2 supply
Hepatic portal vein- venous blood drains from the digestive tract to the liver for nutrient processing/storage
Blood leaves the liver from:
Hepatic vein
Bile
Yellow/green fluid composed of:
Cholesterol, bile acids (salts), bilirubin, water, K, Na, bicarbonate, copper and other metals
Produced in the Liver__________
Stored in the gallbladder________
Emulsifying agent
Decreases surface tension and allows intestinal agitation to break up fat globules
Bile salts aid in absorption of fatty acids, monoglycerides, cholesterol, and other lipids by forming micelles that are soluble in chyme
Acute liver failure:
large proportion of hepatocytes are destroyed; often self-limiting (i.e. resolve in time with treatment, i.e. acute heptatis; obviously if get to certain state, may require liver transplant)
acute hepatitis, shock liver, acute liver failure
acute on chronic liver failure
Chronic liver failure
defined by increased inflammation, infiltration of lymphocytes, plasma cells and hepatocyte apoptosis; will review each of the phases (fibrosis, cirrhosis etc in a couple slides)
fatty liver, steatosis
fibrosis
cirrhosis
hepatocellular carcinoma
Compensated liver disease:
Decompensated l
a person will not have symptoms related to their cirrhosis
iver disease: a person will present with symptomatic complications related to liver disease/cirrhosis (jaundice, ascites, HE, esophageal varices etc).
k
causes of liver disease
toxins: alcohol, meds
metabolic causes: obesity, wilsons disease
infection: viral hep a, s, c,e, bacterial - tuberculosis
immune mediated:autoimmune, primary biliary cirrhosis
other: carcinoma
Primary biliarycholangitis (PBC), also known asprimary biliary cirrhosis,
is an autoimmune disease of the liver. It results from a slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to build up in the liver, a condition called cholestasis.
Primary sclerosing cholangitis(PSC)
) is a chronic liver disease characterized by a progressive course of cholestasis with inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts. The underlying cause of the inflammation is believed to be autoimmunity.
Amyloidosis
is a rare disease that occurs when a substance called amyloid builds up in your organs. Amyloid is an abnormal protein that is produced in your bone marrow and can be deposited in any tissue or organ.
Progression of Chronic Liver Disease
goes from normal liver to early cirrhosis to cirrhosis to wither a liver transplant or hepatocellular carcinoma
if the removal of the underlysing cause it taken away at early cirrohosis - the liver can go back to normal- if cirrhosis cannot iprove but can maintain
what are the primary causes of liver disease
alcohol, obesity, viral hep
Key Laboratory Parameters
“Liver function tests” / “liver panel” Enzymes: ALP, ALT, AST, GGT, LDH Proteins: Albumin, Total protein Clotting studies: PTT, INR Ammonia (present in blood in ionized form NH4) Bilirubin Total (unconjugated) Direct (conjugated)
Jaundice (Icterus)
Yellowish tint to body tissues
Eyes: Icteric sclerae
↑bilirubin
↑ RBC destruction
↓ bilirubin uptake / ↓ liver function
Bile duct obstruction
Pruritis
Itchy skin. ? Related to ↑bilirubin
Portal Hypertension
Elevated blood pressure in the hepatic vein
Blood flow forced backward, causing veins to enlarge
Primary symptoms/complications:
Ascites
Esophageal varices
Hepatic encephalopathy
Ascites
alterations is systemic hemodynamics and build up of pressure causes fluid leaking into abdominal space.
(also why peripheral edema occurs, along with decreased albumin resulted in decreased oncotic pressure in blood vessels resulting in leaky vessels and fluid shifting in interstitial space)
How do they think ascites could impact nutrition/diet:
Full full quickly; anorexia, poor intake
Possible Fluid and Na restrictions (more on this later)
Physical observation muscle wasting! Ribs, clavicle, arms
Use of PEG tubes in pt’s with ascites: mortality has been shown to be high and thus is not recommended.
