Liver Flashcards
What are examples of causes of metabolic liver disease?
haemochromatosis, Wilson’s disease, A1AT deficiency
what inheritance pattern is haemochromatosis?
autosomal recessive
what are symptoms of advanced haemochromatosis?
bronzing of skin, diabetes, hepatomegaly
What is total iron binding capacity in hemochromatosis?
decreased
What is a classic sign of Wilson’s disease, and how is it diagnosed?
Keiyser Fischer rings
Using a slit lamp analysis
What is the pathophysiology of Wilson’s disease?
Normally, copper is incorporated into caeruloplasmin. In Wilson’s, this is impaired, due to a mutation to the ATPase that acts to move Copper across intracellular membranes
What is the tx for Wilson’s?
prevention of copper absorption in the intestine via chelating agents such as zine
What are the three main pathological lesions associated with alcoholic liver disease? What are the symptoms associated with each stage? What damage is occurring at each stage?
Fatty liver -> asymptomatic. Possible hepatomegaly. Fatty droplets can lead to mitochondrial damage
Hepatitis -> rapid onset jaundice, nausea, anorexia, encephalopathy, fever, ascites. Ballooned hepatocytes, containing eosinophilic bodies (Mallory bodies), surrounded by neutrophils. Fibrosis and foamy degeneration
Cirrhosis -> may be asymptomatic. Can present with spider naevus, ascites, spontaneous bacterial peritonitis, portal HTN. Destruction and scarring of liver architecture and fibrosis
What are the LFT findings?
increased GGT, increased AST, elevated MVC
What are examples of aminotransferases and when are they released?
ALT: cystolic enzyme. specific to the liver.
AST: mitochondrial enzymes
What does high ALP indicate?
cell damage, but can locate where from. Released from damaged hepatic membranes. IF GGT also abnormal, from the liver
what is the most common acute cause of liver failure?
paracetamol OD
What is the normal aetiology of hepatocellular carcinoma?
Severe cirrhosis. Also haemochromatosis and hep B and C
What is the aetiology of cholangiocarcinoma
biliary cysts, flukes (flatworms), primary sclerosing cholangitis
What do bile salts do?
Form micelles around cholesterol/lipids. Allows action of lipase, so fat can be absorbed by the villi.
What are fat soluble vitamins?
A, B, E, K
What hormone causes gallbladder contraction
Cholecystekinin
What is secretin’s action
Stimulates biliary and pancreatic ductular cells to secrete bicarbonate and water in response to acid in the duodenum. Causes increased bile secretion
What is murphy’s sign? When is it seen?
Pain on inspiration when palpating the gallbladder. acute cholecystitis and cholangitis
What are the risk factors for gallstones?
3F’s: female, fat, forty
What is adimirand’s triad?
increased stone risk if decreased lethicin, decreased bile salts, increased cholesterol
How can sickle cell anaemia lead to gallstones?
Chronic haemolysis, in which bilirubin production is increased.
What bacteria is associated with CBD/ cystic duct obstruction?
E.coli. The stasis allows it to replicate
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is primary sclerosing cholangitis?
chronic inflammation and fibrosis of the bile ducts. Presents with Charcot’s triad
How is each form of hepatitis spread?
- Hep A: faecal-oral route. Also associated with shellfish
- Hep B: verticle transmission or via blood products
- Hep C: blood borne
What is the most common UK hepatitis and the most common global hepatitis?
- UK: Hep A
- worldwide: Hep B
How do you diagnose hep A?
- increased AST and ALT
- IgM increased from day 25
- IgG raised for life
How do you diagnose Hep B?
- HBsAg present 6 months after exposure
- HBcAg (anti HB core protein) = past infection
why might hep B get to a chronic phase, and what is the difference?
- acute: normally will be entirely cleared
- might persist due to immunocompetency or age of the patient
What is the pathophysiology of verticle hep B?
- chronic immune tolerance of HBV virus for 2 to 3 decades
- then immune clearance: hepatitis and cirrhosis
What anti viral medication is used for Hep B?
- interferon (immunostimulation)
- centecavir and tenofovir (anti viral replication)
What is the treatment for Hep c?
- anti virals: weekly peginterferon alfa-2a and daily oral ribavin. Eliminate HBV RNA to stop progress
what is bruising/bleeding around the umbilicus indicative of?
Pancreatitis
What is the pathophysiology of acute pancreatitis?
pancreas releases exocrine hormones that cause autodigestion of the organ.
What is the final common pathway in acute pancreatitis?
increased intracellular calcium, activates intra cellular proteases and pancreatic enzymes released. Acinar cell injury leads to necrosis. Inflammatory response, organ failure
What is the pathphysiology of chronic pancreatitis?
Inappropriate activation of enzymes in the pancreas. Leads to precipitation of protein plugs in the duct lumen. Leads to calcification, and ductal hypertension and pancreatic damage. Cytokine activation leads to inflammation and pancreatic fibrosis.
What test is used to see if pancreatic exocrine function is damaged?
Secretin stimulation test
What is budd-chiari syndrome?
obstruction of the hepatic vein via a tumour or thrombus. Leads to ischaemia and failure
What are signs of liver failure:
asterixis (liver flap), Dupuytren’s constractures (finger changes), leukonchyia (white nails, spider naevus
What is primary biliary cholangitis:
autoimmune condition that damages interlobular bile ducsts in the liver. Slow to present, often incidence finding due to raised ALP
What is Wernicke’s encephalopathy:
lack of B1 or thiamine in the brain of chronic alcoholics
What is the triad presentation of Wernicke’s encephalopathy?
eye paralysis, confusion, ataxia
What is Gilbert syndrome?
inherited disorder. Impairs conjugation of bilirubin. OFten no symptoms except jaundice
What is MALS?
Median arcuate ligament syndrome. compression can occur in liver disease. Coeliac artery is compressed
What is jaundice due to?
Hyperbilirubinaemia –> bilirubin is the normal breakdown production from the catabolism of haem
What is the normal pathology of bilirubin excretion?
- conjugated in the liver, making it water soluble
- excreted via the bile into the GI tract
- egested in the faeces as urobilinogen and stercobilin
- jaundice occurs when this pathway is disrupted
What are the three types of jaundice?
pre hepatic, hepatic and post hepatic
What occurs in prehepatic jaundice? What are the signs and the causes
Excess RBC breakdown. Overwhelm’s the liver’s ability to conjugate. There is normal urine, containing unconjugated bilirubin. normal AST + ALT and ALP
What occurs in hepatic jaundice? What are the signs and the causes
Dysfunction of the hepatic cells. Liver loses the ability to conjugate bilirubin, and in cases where is also becomes cirrhotic, obstruction occurs. Leads to a mixed picture. There is dark urine due to conjugated bilirubin, normal stool. Very high AST and ALT, slight increase of ALP.
What does ^^^ ALT and ^ ALP indicate
hepatocellular injury
what does ^ATL and ^^^ALP indicate?
cholestasis
What occurs in posthepatic jaundice? What are the signs and the causes
Obstruction of biliary drainage. Hyperconjugated bilirubinaemia. Dark urine, clay like stools. Slight increase in AST and ALT, but large increase in ALP.
What are the functions of the liver (7)
oestrogen regulation, detoxification, metabolises carbohydrates, albumin production, clotting factor production, bilirubin regulatin, immunity
What are the macrophages of the liver?
Kuppfer cells
What is the difference between PBC and PBS?
- women more affected by PBC
- PBC: intralobular ducts affected
- PSC: all ducts affected
how is cerebral oedema treated
mannitol (reduces ICP)
what are albumin levels like in liver disease?
low
Which hepatitis can only infected in the presence of another?
D with B
What is the difference between HB core Ab, HB surface Abm HB surface Ag?
- HBcAb: active immunity/ current disease
- HBSAb: immunity (active or passive)
- HBsAg: current infection
What is the pathology of a paracetamol OD?
not enough glutathione stores in the liver so toxic NAPQI builds up and leads to liver damage
What is wernicke-korsakoff encephalopathy and how is it treated?
lack of b1. via IV thiamine
What does raised alpha fetoprotein indicate?
HCC
PBC presenting features:
- pruritus (most common), with or without jaundice
- steatorrhoea
- malabsorption of fat vitamins (A, D, E, K)
- xanthelasma
