Liver Flashcards
What is the space between the hepatocytes and the endothelium
The ‘Space of Disse’ – the spaces between the hepatocytes and the endothelium (discontinuous organisation) of the sinusoids meaning that the blood comes into contact with the all the liver enzymes
What is the arrangement of hepatocytes and sinusoids
Hepatic artery, portal vein and bile duct sit on outside with sinusoid bringing these past the hepatocytes to the central vein
Difference between zone 1 and 3 damage
Zone 1 is directly hepatoxic substances
Zone 3 is hypoxic or metabolised damage due to it being closer to the central vein and further from the artery
How is paediatric jaundice treated
o Phototherapy
Converts bilirubin into lumirubin + photo-bilirubin
What inheritance is Gilberts syndrome
Autosomal Recessive
What happens in Gilberts syndrome
UDP glucuronyl transferase activity is reduced to 30%
The bilirubin in Gilbert’s is worsened by fasting
What is the main marker of liver function
Pro-thrombin time
Causes of pre hepatic jaundice
Haemolysis
Cause of hepatic jaundice
Gilberts
Infective Hepatitis
Alcoholic Hepatitis
PBC
Cause of post hepatic jaundice
Obstructive- stones
Pancreatic cancer
What can the ratio of ALT to AST inform you
ALT > AST = other forms of hepatitis
AST > ALT = alcoholic hepatitis
Hepatitis A- transmission and disease course
ofAEco-oral transmission route – food or men-on-men sex
o Contaminated water is often the major source E.G. Recent shellfish consumption
o Acute – asymptomatic, or – nausea, D+V, fever, jaundice, RUQ pain
Onset = 2-6 weeks; symptoms last = ~8 weeks
After viral titres start to drop, you get a rise in IgM antibodies and you become unwell with jaundice
If you survive the initial few weeks, you will produce IgG antibodies and from that point onwards you are cured, and you are immune
Treatment- supportive, avoid alcohol
Hepatitis B- transmission and disease course
Only 5-10% go chronic
Routes of infection:
Sex (more commonly through unprotected sex than HCV)
Vertically (mother - child)
Blood products
o Normally acute presentation (can be acute ± chronic)
Hepatitis symptoms – fever, jaundice, N+V, RUQ pain)
o Chronic carriers (bottom image) never clear the HBsAg however infectivity decreases with time
Acute- supportive, Chronic- anti-viral
Hepatitis C- transmission and disease course
60-80% go chronic
o Features of HCV:
Blood-product spread
Normally results in an asymptomatic presentation leading to a chronic infection (60-80%)
Can be treated and eradicated with anti-virals (~100% clearance rates)
What conditions are HBV and HCV associated with
o HBC and HCV may be associated with:
HCC (Hepatocellular carcinoma) – seen in SBAs with:
• “Hx of jaundice, hepatomegaly, weight loss”, “raised aFP”
History of thalassaemia (hints at recurrent blood transfusions) – leading to chronic infection:
• Blood transfusions are a major risk factor for HCV (90%) and a minor risk factor for HBV (10%)
o HCV is much more likely to become chronic than HBV
