Disorders Of The Hepatic System Flashcards by Imaan Asif

What are the function of the liver?

Bile production
Protein synthesis
Hormone production
Storage

How well did you know this?

Not at all

Perfectly

What are the normal levels of jaundice

Normal levels of serum bilirubin are 3-17 mmol/L

How well did you know this?

Not at all

Perfectly

What is the excessive RBC lysis

Bilirubin is produced at a faster rate than the rate of conjugation by the liver

How well did you know this?

Not at all

Perfectly

Why is there a low conjugation efficiency when there is liver damage?

The conjugated bilirubin is not efficiently secreted into bile

How well did you know this?

Not at all

Perfectly

Why is bilirubin conjugated?

To make it more water soluble

How well did you know this?

Not at all

Perfectly

Why is bile secreted in to the duodenum?

The aid digestion

How well did you know this?

Not at all

Perfectly

What is bilirubin degraded to?

Bilirubin is degree to urobilinogen
80% oxidised and excrete in faeces
20% enters extrahepatic circulation and urine excreted

How well did you know this?

Not at all

Perfectly

What is bilirubin bound to?

Albumin

How well did you know this?

Not at all

Perfectly

What happens to bilirubin when it enters the liver?

Bilirubin dissociates from albumin & enters hepatocytes
Conjugated with two glucuronic acids by UDP glucuronyl transferase —> which is water soluble
This is screed into the biliary canluculi and bile
Bile is iscrete into the duodenum to aid digestion

How well did you know this?

Not at all

Perfectly

Why can neonates get jaundice?

Bilirubin accumulates as bilirubin glucuronyl transferase enzyme is low at birth

How well did you know this?

Not at all

Perfectly

What is the treatment for neonatal jaundice?

Exposure of the newborn skin to blue fluorescent light which converts bilirubin to more polar & hence water soluble isomers. These can be excreted into bile without conjugation to glucuronic acid

How well did you know this?

Not at all

Perfectly

Why can hepatocellular jaundice cause jaundice?

There is low conjugation efficiency, conjugated bilirubin is not efficiently secreted into the bile

How well did you know this?

Not at all

Perfectly

In liver damage what is the colour of urine?

Yellowish brown as bilirubin is present

How well did you know this?

Not at all

Perfectly

What happens during obstructive (post hepatic) jaundice

There is bile duct obstruction
Conjugated bilirubin is prevented from passing to the intestine
Which is passed to the blood increasing circulatory conjugated bilirubin

How well did you know this?

Not at all

Perfectly

In obstructive jaundice what is the colour of urine?

Yellowish brown colour, bilirubin is in the urine

How well did you know this?

Not at all

Perfectly

What is hepatitis

Inflammation of the liver

How well did you know this?

Not at all

Perfectly

What is acute hepatitis?

Mild changes in hepatic function
Inflammation develops quickly and lasts short period of time
Patient normally recovers

How well did you know this?

Not at all

Perfectly

What damage can chronic hepatitis lead to?

Hepatic damage leads to fibrosis and potentially cirrhosis

How well did you know this?

Not at all

Perfectly

What can viral hepatitis cause?

Acute liver injury

Chronic liver injury.

How well did you know this?

Not at all

Perfectly

Which virus does Hepatits A contain?

RNA virus

How well did you know this?

Not at all

Perfectly

Can hepatitis A lead to chronic liver disease?

How well did you know this?

Not at all

Perfectly

What is HepE?

More severe liver damage than HepA

How well did you know this?

Not at all

Perfectly

How is HepB spread?

By blood, blood products, sexually, vertically (in utero)

Which virus is HepB?

DNA virus

How long is the incubation period for HepB?

1-6 months

Why is there liver damage from HepB?

Caused by the antiviral immune response

What is the treatment for HepB?

Interferon alpha = initial treatment for adults | Then nucleoside analogues

What is the mechanism of action of interferon alpha?

Mimics interferons produced by virus infected cells Binds cell surface receptor, stimulates proteins which inhibit viral mRNA translation Inhibits viral replication and augments viral clearance from hepatocytes

What is the mechanism of antiviral nucleosides

Nucleoside analogue undergoes initial rate limiting phosphorylation step by nucleoside kinase Second phosphorylation step performed by nucleoside monophosphate kinase Third phosphorylation step by nucleoside diphosphate kinase Nucleoside triphosphates compete with deoxynucleotide triphosphates, causes chain terinnation

How is HepC spread?

Blood, blood products and possibly sexually

Which virus is HepC?

RNA

Is hepatitis C symptomatic or asymptomatic?

Often asymptomatic

What is treatment for HepC?

Sofosbuvir In combination with Peg-interferon Alfa Ribavirin

What are symptoms of Hep B?

``` Fever Malaise Anorexia Nausea Arthralgia Jaundice ```

What are the presentations for autoimmune hepatitis?

Jaundice | Right upper quadrant pain

How is autoimmune hepatitis investigated?

Type 1: anti smooth muscle antibodies (80%), anti nuclear antibodies (10%) Type 2 (children): anti liver/kidney microsomal type 1 antibodies Liver biopsy

How is autoimmune hepatitis treated?

Immunosuppressants —> steroids, azathioprine Transplant Cyclosporin, Tacrolimus, Mycophenolate in corticosteroid resistant disease

What is cirrhosis?

Hepatocytes replace and by non functional connective tissue | Portal vein hypertension and shunting of blood around liver

What are the causes of cirrhosis?

``` Alcohol Drugs Xenobiotics Chronic viral hepatitis Autoimmune hepatitis Wilson’s disease Haemochromatosis ```

What are the symptoms of cirrhosis?

Fluid retention, oedema in legs and abdomen Gallstones Coagulation defects Peripheral neuropathy Reduced mental function Oesophageal and gastric varices and bleeding Jaundice

What is the pharmacological terament of cirrhosis p?

Alcohol cessation Oedema = salt restriction and diuretics Chronic hepatic encephalopathy = laxative, oral anti bacterials Variceal haemorrhage

What is alcohol induced hepatocellular steatosis?

Generation of excess NADH and acetaldehyde dehydrogenase Increased lipid biosynthesis Impaired secretion of lipoproteins Increased peripheral catabolism of fat

Which two types of lipid droplets accumulate in hepatocytes?

Microvesicular | Macrovesicular

Why is there hepatocytes swelling in alcohol mediated hepatitis?

Accumulation of fat and water | Cell necrosis

What does the liver look like with alcohol,mediated hepatic cirrhosis?

Brown, shrunken and non fatty

What are the clinical features of alcohol liver disease?

Hepatic steatosis Alcoholic hepatitis Alcoholic cirrhosis

WHat are the three types of liver damage that cause jaundice?

Excessive RBC lysis Liver damage Bile duct obstruction

How is hepatitis A transmitted

Faecal contaminated water and food

What does HepC cause?

Causes liver damage

What does cirrhosis cause

Drug and alcohol isn’t metabolised which causes accumulation and can lead to toxicity

What is a pro drug

Drugs that are active once they’re metabolised

Why do pro drugs not work in cirrhosis

The liver cannot metabolise the pro drug p, hence the active metabolite isn’t formed

Why is there high portal vein hypertension in liver cirrhosis?

There is higher drug concentration, which means there is higher drug clearance

How does alcohol cause cirrhosis

There is an accumulation of alcohol over a short period of time, which cannot be metabolised by the liver, causing toxicity and killing hepatocytes, resulting in non functional cells

Which medication can cause cirrhosis

Paracetamol, metabolic products can accumulate which toxic causing liver damage