ChemPath: EFA (liver) Flashcards
What pathology are spider naevi, dupuytren’s contracture, gynaecomastia, palmar erythema, etc. all signs of?
Chronic STABLE liver disease
Outline enterohepatic circulation of bile salts, and what happens in biliary tree obstruction?
Bile salts/acid are produced in liver, stored in gall bladder
Secreted into duodenum when needed (after a meal) to emulsify fats
Then they are reabsorbed in the ileum
In biliary tree obstruction, bile salts can’t leave live/gall bladder, so they accumulate where the obstruction is and leak out into bloodstream -> cause pruritus
Hence remember that bile salts should never normally be in the blood. If in blood = biliary tree obstruction
Should urobilinogen normally be present in urine?
Yes
Can be tested on urine dipstick
If absent = biliary tree obstruction
What are the clinical signs/tests for obstructive jaundice?
Scratch markers
Pale stool on DRE
Negative for urobilinogen (urine dipstick) - this is abnormal
What enzyme conjugates bilirubin?
UDP glucuronyltransferase
Nutmeg liver - explain why it develops and what pathology it is a sign of
Right heart failure
If IVC is backed up (right hf) -> blood accumulates in the central veins of liver lobule (hepatic venous congestion) -> blood leaks out -> mottled, nutmeg appeaarance (dark spot = where blood leaks out, pale spots where there is congestion and blood cant flow)
How is drainage of the central vein and portal vein different? (In a liver lobule)
Central vein - drains into IVC then heart
Hence RHF affects central vein -> nutmeg liver
Portal vein - is a separate circulation. All abdo organs drain into portal vein, this gets cleaned by liver.
Hence if cirrhosis -> portal hypertension, splenomegaly, etc.
What is ALT and what does it do?
ALT = alanine amino-transferase
Transfers an amine group away from alanine
Amine group becomes urea
Rest of the molecule feeds into gluconeogenesis
Normally contained in hepatocytes
*when liver is damaged, it leaks out
