GI clinical sessions Flashcards
what are the main functions of the liver
- cholesterol metabolism
- drug metabolism
- carbohydrate metabolism
- -FA metabolism
- NH3 metabolism
- protein synthesis
- bile formation
what are the 4 clinical problems we can get with the liver
acute hepatitis
chronic liver disease
extrahepatic billary obstruction
fatty liver disease
what is Hep A? how is it spread? how does it affect the liver
RNA virus
spread via the faecal-oral route
- causes hepatocyte necrosis and inflammation as it replicates in hepatocytes
what are the symptoms of hep A
jaundice dark urine (bilirubin metabolism is altered) pale stools malaise anorexia nausea abdominal pain
what are the clinical features of hep A
jaundice
hepatomegaly
splenomegaly
rash
what are the consequences of hep A
can cause relapsing hepatitis or cholestatic hepatitis (prolonged phase of jaundice) which can be recovered from
or acute liver disease which can lead to death if no liver transplant (v rare)
can people be asymptomatic with hepA
yes- for most people lines normally short and no treatment is required
what is chronic liver disease
a permeant and progressive pathological change throughput the liver (associated with repeat liver injury)
how does chronic liver disease effect the structure of the liver
changes the lobular architecture - portal tracts separated from portal viens
what can chronic liver disease lead to
fibrosis and cirrhosis
what are the causes of cirrhosis
alchohol fatty liver disease hep C and B primary billary cirrhosis auto immune liver disease
what are the morphological changes in cirrhosis
- hepatocytes damaged and function poorly
- sinusoidal/canalicular pathways disturbed
- disrupted intrahepatic biliary drainage
- disturbed vascular perfusion
what are the clinical effects of cirrhosis
- jaundice
- ascites
- encephalopathy (abnormal brian function)
- portal hypotension
- splenomegaly
- renal failure
- heptocelluar carcinoma
- bleeding tendency
how can portal hypertension cause renal failure
increased pressure in portal vein openes up channels in liver that are normally not needed leading to the liver becoming differ and the sinusoidal channels disrupted = blood flow in liver is disrupted and flows around the liver = urea and waste not removed
what are the symptoms of liver disease
jaundice anemia heptomegaly splenomegaly thin: muscle wasting liver palms clubbing dilated periumbical viens spider nevai
what are spider nevi
spider like marking on the skin
what characteristic is associated with portal hypertension
distended abdomen - larger than pregnancy
what are liver palms ? why do they happen
dilated hands- sex steroid hormones not verbalised and accumulate
what is billary obstruction ? what are the main causes ?
obstruction of the extraheptic billary system leading to decreased excretion of bile
commonly due to gallstones or pancreatic cancer
what is billary obstruction also known as
obstructive jaundice
what are the clinical effects of biliary obstruction
- jaundice
- dark urine
- pale stools
- itching
- steatorrhoea
- weight loss
- vit déficiences (lipid soluble ones:AKED)
- pain
- disturbed lipid metabolism
what can cause fatty liver disease
lots of things: alchohol drugs diabetes obesity
what is the metabolic syndrome? what is it also known as
also known as the deadly quartet :
- abdominal obesity
- hypertension
- diabetes mellitus
- dyslipidaemia
what is the 2 immunological cells in the liver and what are they involved in
kupfer cells- bacterial degradation
pit cells –> liver NK cells