LECTURE 22 - liver case studies

Question 1

what does elevated AST and ALT indicate

Answer 1

hepatic inflammation

Question 2

what does elevated GGT and ALP indicate

Answer 2

choestasis ie bile stasis or obstruction

Question 3

what does elevated billirubin indicate

Answer 3

causes jaundice (yellow scelra and skin) 
can be due to billary obstruction or hepatocellular injury

shows that flow of billirubin is impaired

Question 4

what does abnormal albumin and clotting factors indicate

Answer 4

suggests impaired liver synthesis

Question 5

how are hepatitis B and c transmitted

Answer 5

blood or bodily fluids

Question 6

Portal circulation

Answer 6

GI tract and spleen –> portal vein –> liver –> hepatic vein –> ivc –> heart

Question 7

what happens in portal hypertension

Answer 7

high tension in portal vein (often caused by cirrhosis)
difficult for blood in the portal vein to return to the heart

therfore porto-systemic collaterals begin to form - try to deivert blood from the portal circulation back to the heart

Question 8

how do varices form in portal hypertension

Answer 8

when pressure starts to increase in the collaterals

Question 9

what are the 3 causes of portal hypertension

Answer 9

1. pre- hepatic= portal vein thrombosis
2. intra-hepatic= cirrhosis (most common)
3. post-hepatic= hepatic vein thrombosis, right sided heart faliure

Question 10

how does portal hypertension present

Answer 10

with ascites
varices
hepatic encepalopathy
hypersplenism

Question 11

what is the difference between fibrosis and cirrhosis

Answer 11

fibrosis= prolonged or repeated liver inflammation- 
cirrhosis=  irreversible fibrosis- if the cause of inflammation is not removed and fibrosis continues and it eventually becomes irreversible

Question 12

what is fibrosis

Answer 12

prolonged or repeated liver inflammation

– potentially reversible if the liver is allowed time to regenerate by removing the cause of inflammation

Question 13

cirrhosis

Answer 13

when fibrosis becomes irreversible

and the liver starts to not function normally

Question 14

what causes hepatic encepalopathy

Answer 14

result of chronic liver faliure

Question 15

what are the early and late symptoms of hepatic encepalopathy

Answer 15

early- mood and personality change, inverted sleep pattern

late- confusion and bizarre behaviour, drowsiness, coma

Question 16

what is the mechanism of hepatic encepalopahty

Answer 16

in chronic liver faliure the liver is unable to detoxify substances prodduced by bacterial metabolism

build up of ammonia in the blood

passes the blood brain barrier and disturbs normal brainfunctio

Question 17

what is the treatment for hepatic encepalopathy

Answer 17

lactulose

Question 18

what is ascites

Answer 18

a build up of fluid in the peritoneum- presents as abdominal distension

due to pressure gradient between circulation and abdomen

Question 19

what is the mechanism of ascites

Answer 19

• elevated hydrostatic pressure in the portal vein causes the fluid to shift out of the circulation and into the peritoneum
• also low oncotic pressure in the portal vein (due to low serum albumin) means you are less able to hold onto fluid in the circulation

Question 20

what is Budd-chiari syndrome

Answer 20

acute thrombosis of hepatic veins

Question 21

budd chiari mechanism

Answer 21

acute thrombosis of hepatic veins
outflow of bloood from liver is obstructed
the liver becomes acutely congested resulting in hepatocelllular damage
portal hypertension
ascites