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Physiology: GI > Hepatic system disease > Flashcards

Hepatic system disease Flashcards

1
Q

What are some functions of the liver? [8]

A

1) Xenobiotic detoxification and metabolism
2) Decomposition of erythrocytes and excretion of bilirubin
3) Bile production
4) Cholesterol synthesis
5) Carbohydrate Metabolism
6) Protein synthesis
7) Hormone production
8) Storage

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2
Q

What is jaundice?

A

An elevation of serum biirubin above the normal limit (9mmol/L) 35 mmol/L

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3
Q

How is bilirubin metabolised in circulation?

A

Erythrocytes are broken down which releases haemoglobin

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4
Q

What happens to haemoglobin after breaking down?

A

The globin is metabolised and amino acids are recycled

The haem is converted to bilirubin, bound to albumin

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5
Q

How is bilirubin metabolised in the liver?

A

Dissociates from albumin and enters hepatocytes

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6
Q

What two components is bilirubin conjugated with?

A

Two glucouronic acids

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7
Q

Which enzyme causes the conjugation?

A

UDP-glucuronyl transferase

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8
Q

What property of bilirubin allows it to be secreted into the biliary canaliculi and bile?

A

It is water-soluble

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9
Q

What can bilirubin be digested into?

A

Urobilinogen

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10
Q

How is neonatal jaundice caused?

A

Bilirubin accumulates due to low glucuronyl transferase

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11
Q

What happens to unconjugated bilirubin in blood of babies?

A

It increases which causes diffusion into basal ganglia causing toxic encephalopathy

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12
Q

How do you treat jaundice in babies?

A

Expose the baby to blue fluorescent light as it converts bilirubin to a water-soluble isomer hence they can be excreted into bile without conjucation to glucoronic acid

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13
Q

What is Haemolytic Jaundice?

A

XS RBC lysis where bilirbuin if produced faster than the rate of conjugation by the liver

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14
Q

What happens to the blood, urine and stool during haemolytic jaundice?

A

Increase in unconjugated bilirubin in the blood
In urine the urobilinogen is increased
Stool is normal

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15
Q

What is Hepatocellular Jaundice?

A

Conjugated bilirubin is not efficiently secreted into bile.

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16
Q

What happens to the blood, urine and stool during haemolytic jaundice?

A

Blood- increased BOTH unconjugated and conjugated bilirubin
ALT & AST levels are markedly elevated
Urine-Bilirubin is present in urine, yellow brownish
Stool- Normal to Pale

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17
Q

What is obstructive jaundice?

A

Bile duct obstruction wherein conjugated bilirubin is prevented from passing to intestine; passed to blood increasing circulatory conjugated bilirubin

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18
Q

What happens to the blood, urine and stool during obstructive jaundice?

A

Blood: increased conjugated bilirubin ALT is mildly elevated
Urine: Bilirubin in urine, urobilinogen reduced
Stool: Pale (low stercobilin)

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19
Q

What is hepatitis?

A

Inflammation of the Liver

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20
Q

What is acute hepatitis?

A

Inflammation develops quickly and lasts short

21
Q

What are examples of viral hepatitis?

A

Hepatits A
Hepatitis B
Hepatitis C
Hepatitis E

22
Q

Give some information on Hepatitis A?

A

RNA Virus
Short incubation period
No chronic state
No carrier state

23
Q

What is Hepatitis E?

A

Acute, self-limited, more severe liver damage, it is not lifelong, no treatment

24
Q

What is Hepatitis B?

A 
DNA Virus 
Spread by blood products, sexually
Long incubation
Carriers
Fever malaise,anorexia, nausea
5-10%
25
Q

What is the treatment for Hepatitis B?

A

Interferon alpha-2a recommended for initial treatment of adults with chronic hep B.
antivirals
5-10%

26
Q

What is Hepatitis C?

A

RNA Virus

Blood, sexually

27
Q

What is the treatment for Hepatitis C?

A

Sofosbuvir, uridine nucleotide analogue inhibits HCV polymerase, preventing viral replication
anti retrovirals
85% chronic

28
Q

What is autoimmune hepatitis?

A

Autoantibodies against hepatocytes

29
Q

What are the presentations of autoimmune disease?

A

Jaundice
RUQ Pain
May be associated with other autoimmune conditions

30
Q

How do you treat autoimmune hepatitis?

A

Immunosuppressants (steroid, azathioprine)

31
Q

What is cirrhosis?

A

Hepatocytes replaced by non-functional tissue
Hepatic failure
Portal vein hypertension adn shunting of blood aroun dliver

32
Q

What are some causes of cirrhosis?

A 
Alcohol
Drugs and Xenobiotics
Chronic Viral Hepatitis
Autoimmune Hepatits
Chronic Bile duct blockage
Wilson's disease
33
Q

What are some signs and symptoms od cirrhosis?

A 
oedema - portal hypertension
Gallstones
Coagulation defects
Peripheral neurpathy 
REduced Mental function
Oesophageal and Gastric Varices and bleeding
Jaundice
34
Q

Treatment for cirrhosis?

A

Treat oedema with salt restriction and diuretic
Treat the chronic hepatic encephalopathy with laxatives and oral antibacterials
Treat the variceal haemorrhage with platelet transfusion

35
Q

How does pathogenesis of alcoholic liver disease take place?

A

XS NADH via alcohol dehydrogenase therefore increased lipids

36
Q

What is hepatic steatosis?

A

Lipid droplets accumulate in hepatocytes

37
Q

What happens during alcohol-induced hepatocellular damage?

A

Induction of P450
Free radicals
adduct formation

38
Q

What happens during alcohol-mediated hepatitis?

A

Swelling of hepatocytes
Mallory bodies (eosinophillic cytoplasmic inclusions)
Neutrophillic reaction
Fibrosis

39
Q

What happens during alcohol-mediated cirrhosis?

A

liver becomes brown shrunked and non-fatty

entrapped hepatocytes

40
Q

What are the clinical features of alcoholic liver disease?

A

Hepatic Steatosis
Alcoholic hepatitis
Alcoholic cirrhosis

41
Q

What are the 3 hepatocyte zones?

A

1) Centrilobular (lowest O2)
2) Periportal (highest O2)
3) Midzone

42
Q

What are the factors associated with DILI?

A

Inherent drug toxicity
Dose
Drug metabolites
Genetic polymorphism

43
Q

DILI?

A

Drug Induced Liver injury

44
Q

Mechanism of DIALD HAlothane Hepatitis

A

Look up youtube video

45
Q

What is mitochondrial toxicity presesntation?

A

affects aerobically active tissues LOOk up

46
Q

Drug biotransformation and elimination is a liver function

A

Drug elimination may be reduced in patients with significant liver dysfunction - thus blood levels may be higher for longer (toxicity vs effectiveness

47
Q

Low clearance drugs

A

Often relatively little effect until end stage liver failure/cirrhosis as drug metabolism is relatively well preserved

48
Q

High clearance drugs

A

Affected by portosystemic shunts - markedly increased systemic bioavailability of oral drugs
• Drug levels in blood may get very high

Physiology: GI (6 decks)

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