Chempath 4: LIVER disease CPC Flashcards
how are hepatocytes arranged
a trabeculae with sinusoids between them
what 3 vessels make up the portal triad
hepatic artery
bile duct
portal vein
describe the arrangement of endothelial cells in the liver
discontinuous
spaces between the hepatocytes and the endothelium of the sinusoids
so all blood comes into contact with all the liver enzymes
space = space of disse
describe the zones in between the portal tract and central vein
zone 1 - closest to the portal tract - highest oxygen concentration
zone 3 - most susceptible to hypogea, most metabolically active cells
how can fractions of bilirubin be measured
van den Bergh reaction (amount of conjugated bilirubin in blood)
add methanol - total bilirubin
difference = unconjugated bilirubin
how does phototherapy work
converts bilirubin into lumirubin and photobilirubin
what is Gilberts syndrome
AR
worsened by fasting
phenobarbital can reduce bilirubin levels
UDP glucuronyl transferase activity reduced to 30%
no bilirubinuria (bound tight to albumin)
what is a negative uribilinogen suggestive of
biliary obstruction
should always be in the urine of normal people
what is the best marker of liver function
PT
normal 12-14 s
extrinsic pw - I,II,V,VII,X
what is a marker of the livers synthetic function
albumin
when are ALP levels highest
biliary obstruction
describe key histological features in hepatitis
lots of cells containing fat
cells containing mallory hyaline (inclusion in cytoplasm of liver cells)
neutrophil polymorphs
alcoholic hepatitis –> balloon cells containing mallory hyaline
bile accumulation in the liver - blocked flow
- liver cell damage, inflammation, fibrosis, fatty change, mega mitochondria
what might a collages stain show in hepatitis
pattern of collagen around liver cells
cirrhosis
DD in fatty liver disease
NASH
alcoholic hepatitis
malnourishment (kwashiorkor)
how does the liver regenerate after alcohol
produces lots of nodules
disorganised regeneration - rise in portal pressure