Gastro - The Liver Flashcards
what is the mortality of liver disease in the UK
5th most common cause of death
causes premature death - death below age of 75
what are the 3 main causes of liver disease
alcohol
hepatitis
fatty liver disease
what are liver function tests
ALT, clotting factors, INR, alkaline phosphatase, albumin, globulins and total proteins
what is DILI
drug induced liver injury
e.g. methotrexate, azathioprine
what are the 3 important things which go into the liver
portal vein
bile duct
hepatic artery
what do stellate cells contain
vitamin A
what cells form the scaring
collagen and elastin produced by stellate cells
what is the staging of F0 to F4
F0 - no fibrosis
F1 - portal fibrosis without septa
F2 - portal and few septa fibrosis
F3 - lots of septa fibrosis without cirrhosis
F4 - cirrhosis
where is AST found
in the mitochondria
what type of bilirubin can occur in urine
congugated
what are the 4 alkaline phosphatases
intestinal
placental - pregnant
placental-like - tumour
tissue non-specific - liver, bone or kidney
how does gamma GT help determine if increase in alk phos is from the liver
if raised is a liver increase in alk phos
if there is a cholestasis of bile flow what are the 2 causes
bile cells aren’t working (intrahepatic cholestasis)
obstruction (extrahepatic cholestasis)
what are causes of chronic liver injury
cirrhosis
compensated
decompensated
Acute on chronic liver failure (ACLF)
what is a cause of hepatic failure
Fulmination hepatic failure
jaundice, INR greater 1.75 and encephalopathy
what is portal hypertension in cirrhosis
a difference in pressure of more then 5mmHg from portal veins and hepatic artery
what would the LFT show in hepatic
high ALT
low alk phos
what LFT would you get in cholestasis
high Alk phos
low ALT
what LFT would you get in mixed
a mixture all jumbled - look at case for clues
primary biliary cholangitis more common in women than men
more common in women
what are signs of chronic liver disease
jaundice
parotid swelling
gynaecomasia
spider naevie
finger clubbing
what are the 3 patterns of extreme ALT elevation
ischaemia
drugs - paracetamol
acute biliary obstruction - stones
viral hepatitis
NON LIVER
haemolysis
myopathy/myosititis
strenuous exercise
sepsis
what are the main causes of raised ALT
alcohol
wilsons disease
autoimmune
drugs
alcohol
viral hepatitis
ALT of 300-400
type 1 diabetic
Fhx of autoimmunity
smooth muscle antibody positive
autoimmune hepatitis
what are the 2 most common signs of cholestasis
fatigue and itching
what antibody for you measure for primary biliary cholestasis
antimitochondrial antibody
P anca is indicative of what condition
small duct PSC
70 yr old, bleeding in stool and change in bowel - diagnosis
liver metastasis
Cancer
NASH is characterised by what
fat plus inflammation and scarring
unhealthy - fat is found where?
lots of visceral fat
what is NAFL now
non-alcoholic fatty liver
MASLD
metabolic non alcoholic steateric liver disease
PNLP3 genetic
enzyme breaks down fat in you liver
genetic history - more likely to get fatty liver
2 non-invasive strategies to determine scarring on liver
Low ALT (down with scarring)
high AST (up with cirrhosis)
what are the 4 things to account for likelihood of cirrhosis
Fib4
platelet count - decreased in portal hypertension
Age - older more likely cirrhosis
AST/ALT ratio
normal metabolism of alcohol
alcohol broken to acid aldehyde - acid aldehyde to acetate (alcohol dehydrogenase pathway)
saturated alcohol metabolism pathway
alcohol dehydrogenase saturated
Microsomal ethanol oxidising system
make acid adehyde and then acetite
(kupfer cells) makes ROS = damage
what is the genetics of alcoholism
50-60% hereditary for alcoholism
who is at greater risk of liver disease due to alcohol - male vs female
female
what other risk factors increase risk of liver disease in alcohol
nutrition - malnutrition
coinfection with hepatitis
drugs and toxins
genetics
immunological derangements (slight autoimmune phenomenon)
how does alcohol liver disease present
normal GABA and glutamate in balance
drunk GABA and alcohol more than glutamate
chronic GABA and alcohol and glutamate in balance
withdrawl: glutamate upregulated more than GABA (give symptoms of whithdrawl)
how does withdrawl present
anxiety, trmors, fever, seizures, nausea, abdo pain
what are alcoholic conditions
alcoholic steatosis, hepatitis, cirrhosis
what is alcoholic steatosis
Alcohol steatosis is a condition where fat accumulates in the liver cells due to heavy alcohol consumption. It can impair the liver function and cause inflammation and scarring. Alcohol steatosis can be reversible if diagnosed early and treated by stopping alcohol intake. Otherwise, it can lead to more serious liver diseases such as alcoholic steatohepatitis and cirrhosis.
what nutrition deficiencies do you get with alcohol
protein energy
B complex
Vit A and D
Vitamin C
Selenium, Zinc
what is the society difference in alcohol and non-alcohol LD
Alcohol - main cause of liver death
non-alcohol - main cause of LD
most common incidence of NAFLD
94% high BMI
40-70% are T2D
30-40% men
15-20% women
why does a fatty liver cause liver damage
insulin resistance
when we eat we secrete insulin - signals for laying does visceral fat
NAFLD is main cause of deranged LFTs
true
what other blood tests are used in NAFLD
raised ALT and AST - mirroring weight
what is the most common cause of viral hepatitis
EBV
HAV
HCV
HDV
leptospirosis
HEV
adenovirus
HSV-1
Hep E
