Hepatitis, cirrhosis, liver metastases Flashcards
What is meant by hepatitis?
Inflammation of hepatocytes of liver
How does hepatitis affect the liver itself?
Damaged hepatocytes
reduced liver function
What are the consequences of reduced liver function?
Increases susceptibility to infections
Increased susceptibility to drugs and toxins
Increased blood ammonia
What type of infections is a patient with reduced liver function more susceptible to?
Bacterial
Fungal
Why does a patient with reduced liver function have increased susceptibility to drugs and toxins?
Reduced metabolism of drugs and toxins by liver
Why does a patient with reduced liver function have increased blood ammonia?
Disturbed urea cycle
What is a consequence of increased blood ammonia?
Hepatic encephalopathy
What is hepatic encephalopathy?
Reduced consciousness due to high levels of ammonia in the blood which is due to reduced liver function
What normally produces ammonia in the body?
Colonic bacteria deaminating amino acids
What are the signs and symptoms of hepatitis?
Fever
RUQ pain
Moderate jaundice
Dark urine
Anorexia
What are the abnormal LFT results with hepatitis?
High conjugated bilirubin in the blood
high unconjugated bilirubin in the blood
High ALT
What is cirrhosis?
Fibrosis of the liver
What does a cirrhotic liver look like?
Shrunken
Nodular
What are the causes of cirrhosis?
Viral hepatitis
Chronic excessive alcohol consumption
Fatty liver disease
What are the causes of hepatitis?
Viral
Acute excessive alcohol consumption
Fatty liver
Drugs, toxins
How does cirrhosis affect the liver itself?
Reduced hepatocytes
Compression of hepatic sinusoids, portal veins
Compression of bile canaliculi, hepatic ducts
What are the consequences of compression of the hepatic sinusoids and portal veins?
Portal hypertension
What are the signs and symptoms of cirrhosis?
Ascites
Swollen legs
Easy bleeding and bruising
Jaundice
Hepatic encephalopathy
Oeosphageal varices, haemorrhoids, caput
medusa
Weight loss
What is ascites?
More than 25ml of fluid in peritoneal cavity
Why does a patient with cirrhosis get ascites?
Portal hypertension
increased capillary hydrostatic pressure before portal vein
transudation of fluid into peritoneal cavity
Why does a patient with cirrhosis get swollen legs?
Reduced hepatocytes
reduced albumin production
reduced oncotic pressure in the blood
transudation of fluid
Why does a patient with cirrhosis get easy bleeding and bruising?
Reduced hepatocytes
reduced production of clotting factors
reduced coagulation
Why does a patient with cirrhosis get oesophageal varices, haemorrhoids and captus medusa?
Portosystemic shunting
What is portosystemic shunting?
Blood shunts from the portal venous circulation to the systemic venous circulation
What causes portosystemic shunting?
Portal hypertension
How are the portal and systemic circulations related to each other?
Anastamoses between them
Where are the portosystemic anastamoses located?
Oesophago-gastric junction
Ligamentum teres
Ano-rectal junction
Why does a patient with cirrhosis get weight loss?
Reduced blood containing nutrients from the gut reaching the liver due to portal hypertension, portosystemic shunting
reduced hepatocytes, so reduced storage and metabolism of nutrients from gut
What are the abnormal LFTs with cirrhosis?
Low albumin
Prolonged protrombin time/INR
Raised conjugated bilirubin in the blood
raised unconjugated bilirubin in the blood
Raised ALT if ongoing inflammation
Raised Alk Phos
Raised Gamma GT if excessive alcohol consumption
How often do metastases spread to the liver?
Commonly spread to the liver
Why do metastases commonly spread to the liver?
Rich blood supply, portal and systemic
Hepatic sinusoids filter blood, metastases lodge here
What organs do liver metastases come from?
GI tract organs via the portal circulation
Breast, lung via the systemic circulation
What are the abnormal LFTs with liver metastases?
Raised conjugated bilirubin in the blood
Raised ALT
Raised unconjugated bilirubin in the blood
Raised Alk Phos
Raised Gamma GT
