Liver Flashcards
Describe the path of the portal vein
Drains nutrient rich blood from the gut into the liver to be filtered
Which vein does the filtered blood leave the liver through
Hepatic vein
Location of the liver in the body
Upper Right sextant of the abdominal cavity, directly underneath diaphragm
what blood vessel supplies the liver itself
Hepatic artery
Name the structure that filtration happens in
Acini (which are arranged in groups of 6 to create a liver lobule)
How is blood filtered in the kidneys
Blood enters acini through portal tract, travels down low-pressure sinusoid pathways, exits through hepatic vein
what is the product created in the liver from the breakdown of red blood cells
Bilirubin
name 3 exocrine functions of the liver
excretion of bilirubin
creation of bile salts
synthesise cholesterol
why do drugs need to be metabolised in the liver before going to the kidney?
- drugs are bound with plasma proteins to be transported in blood, these are too large for kidney filtration
- a fat-soluble drug will be able to diffuse right back through the membrane back into the blood
what is first pass metabolism
the drug passes through an organ, and gets altered on use/exit so it leaves the organ deactivated (lidocaine first pass in gut so it won’t work orally)
explain interaction with warfarin and Cytochrome P450
group of enzymes, warfarin is metabolised by Cyt P450
Name 3 things that can impact Cyt P450 and what drug this can interact with
Interacts with WARFARIN
- Erythromycin inhibits CytP450, which would cause less warfarin breakdown than expected (INR spikes)
- Miconazole inhibits CytP450
- Grapefruit juice enhances CytP450
Name mechanical causes of liver disease
Portal hypertension, abnormal enlarged veins in oesophagus, ascites (fluid collects in abdomen)
What is Dupuytren’s contracture?
contraction and thickening of fascia in palm of hand, causing contraction and paralysis of ring and little finger - sign of alcohol related liver disease
Signs and Symptoms of liver disease
- Jaundice (body stops being able to break down bilirubin, you go yellow)
- finger clubbing
- Dupuytren’s contracture
- Gynecomastia (interferences with sex hormones)
- Sialosis (bilateral smooth salivary gland swelling)
Causes of Acute Liver Disease
Extreme alcohol consumption, drugs, infections (esp hepatitis)
what happens to the liver in chronic liver disease
cirrhosis
how does alcohol destroy the liver
ethanol metabolised acetaldehyde (highly reactive, toxic, kills hepatocytes) before being broken down again into acetate
How does metabolism of paracetamol work
in a small proportions, around 5% will be metabolised into toxic metabolites, which you can cope with
in an overdose, you oversaturate the non-toxic reaction pathways, forcing it to be metabolised into the highly reactive toxic metabolite killing hepatocytes
Signs and symptoms of hepatitis
abdominal pain UR abdomen, fever, jaundice, pale bowel motions, dark urine, itchy skin
How do you manage liver disease preventatively
Prevention: hepatitis vaccination, reduce alcohol, limit paracetamol usage
How do you manage liver disease
large supportive - manage nutrition, drug choice, try to optimise remaining function
liver transplant
nutrition - need ways to get the right amount of fat-soluble vitamins into pt
What is the function of the pancreas
Exocrine: secretes digestive enzymes produced by acini, secreted as pro-enzymes then converted in duodenum
why does the pancreas secrete ___-enzymes?
Pre-enzymes, otherwise the digestive enzymes would eat through the pancreas itself
What is the endocrine function of the pancreas?
Insulin, glucagon, somatostatins to regulate blood glucose levels
How can gall stones cause pancreatitis?
Liver, gall bladder, pancreas all drain into duodenum through common bile duct
stones from gall bladder obstructing the common bile duct will obstruct pancreas, no path for pro-enzymes, some can get activated and cause auto-digestion
Risk factors for pancreatitis
Trauma, gall stones, diabetes, gall bladder surgery, alcohol, pancreatic cancer
Signs and symptoms for pancreatitis
severe upper abdominal pain > radiating to back
vomiting, weight loss, jaundice, increased serum amylase
Management of pancreatitis
Fluids, antibiotics if necessary, correct glucose/electrolyte imbalance, surgery if necessary to remove physical obstruction
how can gallstone appear
cholesterol deposits in the gall bladder
calcification of salts
Risk factors for gallstones
old age, F>M, high BMI, rich people, high fat diet
Signs of gallbladder disease
(only really become systematic if obstruct drainage)
abdominal URQ pain, pain worse at mealtimes, nausea/vomiting, fever, jaundice
Management of gall stones
stopping high-fat diet, treat acute infection, cholecystectomy (removal of gall bladder)
