Liver Flashcards
liver function
processes blood and breaksdown, balances and creates nutrients. metabolises drugs and produces clotting factors
acute liver failure
sudden insult to liver, function lost is rapid
aetiology of acute liver failure
paracetomol poisoning, toxins, cancer
consequences of acute liver failure
rapid death from bleeding, encephalopathy [impairement of brain function due to high toxin level in blood]
treatment for acute liver function
acetylcystein to block alternative pathways
recover over time, transplant only option
chronic liver failure
occurs over many years
aetiology of chronic liver failure
hepatitis, alcohol abuse, toxins, autoimmune disease
consequences of chronic liver failure
cirrhosis, ascites, oesophageal varices
cirrhosis
damage, fibrosis and regeneration of liver structure, portion of liver lost each recovery
gradual loss of liver, loss of normal function
cirrhosis aetiology
alcohol, biliary cirrhosis, viral disease, autoimmune, hepatitis, haemocrhomatosis, cystic fibrosis
more than one cause
cirrhosis signs/symptoms
often none, acute bleed, jaundice, oedema, ascities, encephalopathy
spider naevi + palmar erythema [redness]
portal hypeetension, hepatic dysfunction
ascites
fluid accumulating in peritoneal, around bowel
high portal venous pressure, low plasma protein synthesis
needs manual draining
cause - build up of fluid moving into tissue
oesophageal varices
dilations of little veins at end of oesophagus
build-up of blood products, could rupture when swallowing, internal bleeding = death
hepatitis
inflammation of liver, function affected
through virus, toxins, medications
fever, weight loss, jaundice, none
conseq - cirrhosis, malfunction, jaundice
liver function tests
hepatic cell enzyme levels [ALT, GGT] = raised in liver inflammation
INR = synthesis of clotting factor, if not 1, significant liver dysfunction, not enough clotting factors [not on warfarin]
management of liver failure
very little, identify risk, reduce damage
supportive, transplant [need abstainance]
- risky, high change of bleed/death
artificial liver systems
consequences of liver failure
too much fluid in brain, cerebral oedema
drug metabolism different
clotting factors too little, bleeding problems
infections, kidney failure
liver disease and dental aspecta
end stage - clotting disorder and abnormal drug metabolism [extractions]
prolonged sedative effect, avoid IV
reduce drug dose - careful antifungals, use paracetmol, NSAIDS INCREASE BLEEDING RISK
bleeding increased
more prone to infections
no issues with LA
extractions and liver disease
lower clotting ability, higher chance of bleeding
apply pressure, haemostatic gauze, suture gums
prescribe paracetomol not NSAIDS
jaundice
skin, whites of eyes turn yellow. sign of liver disease
accumulation of bilirubin in the skin, not metabolised properly
haem circulation + bilirubin
haem from RBC is converted t bilirubin.
needs conjugated and secreted from liver to form bile, if not, it will go into blood and skin and present as jaundice
if conjugated - into bile
3 classifications of jaundice
pre-hepatic - incrased haem load [autoimmune, spleen, abnormal RBC]
hepatic - liver cell failure [cirrhosis, hepatitis]
post-hepatic - biliary, gall bladder, pancreatic disease
pre-hepatic jaundice
excess bilirubin, accumulation in blood
due to factors before liver metabolism
haemolytic anaemia, post transfusion, neonatal
hepatic jaundice
issues with hepatic cell, not conjugated passed into bowel or blood. no pigment in stool/urine
due to liver failure - cirrhosis, drug induced
no metabolism of RBC
post-hepatic jaundice
bilirubin conjugated, blockage causes backflow, pale stools/dark urine
obstruction - biliary sclerosis, gall stones, pancreatic carcinoma
clinical features of jaundice
colour changes in urine / faeces
pale stool/dark urine = post hepatic
urine/stool normal = pre hepatic
gall bladder
accumulation site for bile being produced, stored until needed
gall stones
block biliary tree, cause jaundice, inflammation
acute cholecystis
inflammation of gall bladder
symptoms of gall stones
pain in shoulder tip, abdominal pain on right radiating to back, pain by eating fatty food
investigations for jaundice
ultrasound - bile channels, biliary tree
radiograph - shows gall stones
ERCP - cannula, dye injected, contrast of biliarybtree
cholangiocarcinoma and pancreatic cancer
tumour blocking biliary tree / pancreas
both obstructing biliary tree
pancreatic disease
secretions blocking pancreatic pathways
cystic fibrosis, diabetes
pancreatic maligancy = poor prognosis
management of jaundice
pre hep - identify and treat cause
post - remove obstruction
biliary tree stent
prevent gall stone recurrence - remove gall bladder, low cholesterol diet
neonatal jaundice
birth trauma, premature, brain-blood barrier not formed
serious
managed by phototherpay to break down bilirubin and pass through kidney, blue light
hepatitis C in mouth
bleeding issues, predisposed to white/red ulcerations in mouth
strogen syndrome
