Chem path 4s - Liver disease CPC Flashcards
What does the portal triad consist of?
Hepatic portal vein
Hepatic artery
Bile duct
What does the portal triad consist of?
Hepatic portal vein
Hepatic artery
Bile duct
Why is the liver epithelium unique?
Fernestrated, means bloods comes in to contact with all the liver enzyme so by the time it reaches the central vein to be drained, all toxins have been removed.
What is the name given to the space between the hepatocytes and the endothelium?
Space of Disse
Which areas are zones 1 and zones 3?
Zone 1 = periportal
Zone 3 = Centrilobular (around central vein - least oxygenated)
Which zone most likely to become ischaemic?
Zone 3
Damage to zone 1 leads to a rise of which liver enzxyme?
ALP (portal triad close to bile ducts)
If you suspect a diagnosis of Gilbert’s, what investigaiton should you do?
Fasted bilirubin (Causes a further increase in bilirubin levels)
What investigations do you need to do for a pre-hepatic cause of jaundice?
Blood film + FBC
How do you measure the split bilirubin?
Using the van den Bergh reaction
What is the Van den Bergh reaction?
A direct reaction measures the conjugated Br
Then add methanol, allows you to measure total bilirubin
The difference between these two values is the unconjugated bilirubin (indirect)
Gilbert’s mode of inheritance and population prevalence who carry the gene?
Autosomal recessive
50% carry the gene
What % of the population actually have Gilbert’s?
6%
Pathophysiology of Gilbert’s
UDP glucuronyl transferase is reduced to 30%
Do you normally find bilirubin in the urine in Gilbert’s?
NO, unconjugated bilirubin is tightly bound to albumin and does not enter urine
What bilirubin product is found in the urine of normal people and what does the absence of this suggest?
Urobilinogen, sign of intact enterohepatic circulation
Absence suggests obstruction of biliary tree
What do bacteria in the bowel convert bilirubin in to?
Stercobilinogen and urobilinogen
Which marker is most representative of liver function?
Prothrombin time
What is a general rule regarding PT and time since paracetamol OD?
If the PT is higher than the hours since overdose, the patient should be trasnferred to a liver unit for transplant
Which three markers are representative of liver function?
Clotting factors (PT, aPTT
Albumin
Bilirubin
3 main features of hepatitis
Fever, jaundice and raised AST/ALT
Of the hepatitis viruses, which is the only DNA virus?
Hep B
When do you have onset of symptoms in hepA?
~2-6 weeks after exposure
Can you be infected by hepA more than once in your life?
NO
