LIVER Flashcards
Describe Wernicke’s and korsakoff’s
common in alcoholic liver disease nystagmus - weird eye movements, confusion caused by thiamine deficiency - by alcohol
If WE left untreated - Korsakoff’s syndrome
- confabulation - make up events
- cannot remember previous memories
- and cannot form new memories
whats the livers function?
metabolism - carbs, proteins, fats, bilirubin, drugs
synthesis - proteins e.g. albumin, clotting factors, fibrinogen, gluconeogenesis
immune - kuppfer cells - macrophage system
storage - fat soluble vitamins
homeostasis - glucose
bile production
clearance - bilirubin, drugs, toxins
explain stages from fibrosis to cirrhosis
F0 - good blood flow, pink
f1 - f3 - active deposition of collagen, forming scar tissue, disruption of blood flow, fibrosis
f4 - cirrhosis, nodules form, erratic regenerating to compensate for lack of blood flow, constant damage
what is the classification of liver disease?
classified according to pattern of damage seen and time course over which damage occurs
cholestatic or hepatocellular - can lead to fibrosis and cirrhosis
cholestasis - disruption of bile flow - stagnation of bile in bile ducts, intrahepatic - affects bile ducts in liver, extrahepatic - affects bile ducts outside liver
- impaired biliary secretion - reduces absorption of fatty substances - leads to fatty stool - as its not absorbed but excreted
- accumulation of bile salts can damage hepatocyte
hepatocellular - damage to hepatocyte
- hep A, B, C, D, E
- fatty infiltration - accumulation of fat in hepatocyte, MACROVESICULAR - single large fat droplet + smaller fat droplets occupy cytoplasm of hepatocyte - push nucleus to periphery
MICROVESICULAR - cytoplasm filled with tiny lipid droplets, nucleus stays central
- inflammation - hepatits
- cell death - necrosis
interpret bilirubin
bilrubin - product of RBC breakdown
- normal range 5-20 micromol/L
transported to liver attached to albumin
liver transforms it into a conjugate - then excreted via bile into intestines
bilirubin increased due to:
- more RBC breakdown
- cholestasis - obstruction in bile duct - cannot be excreted via bile, goes into blood - high blood bilirubin
- liver disease - cannot conjugate bilirubin
clinical jaundice - bilirubin is >50 micromol/L
interpret LFTs - AST and ALT
transaminase enzymes
elevated in liver disease
AST:ALT ratio is typically 2:1 in alcohol liver disease
AST 0-40 iu/L normal range
ALT - 5-30 iu/L normal range
interpret LFTs ALP and GGT
ALP 30-120 iu/L
GGT 5-55 iu/L
if both levels increased - probably due to cholestasis
interpret albumin
albumin 35-50 g/dL
one of the proteins produced by liver
in chronic liver disease - decreased albumin
- liver cannot synthesise properly
- affects highly protein bound drugs
- more free drug available - more therapeutic effect - can become toxic
interpret INR
clotting factors produced by liver
INR measures how long it takes for blood to clot
in liver disease - INR will be raised - results in bleeding
what are the signs and symptoms of liver disease?
jaundice
ascites
unexplained bruising/bleeding
HE
abdominal pain
spider naevi
gynaecomastia
fatty stool
pale stools + dark urine
what is ascites and its management?
ascites - accumulation of fluid in the peritoneal cavity - swollen abdomen
portal hepatic vein transports nutrients to liver if obstruction - pressure builds up
portal HTN - renal sodium retention - increased blood vol - ascites
management:
- fluid/sodium restriction
- spironolactone - aldosterone antagonist
- furosemide - loop diuretic
- terlipressin
paracentesis - sterile needle into abdomen - drains fluid
what is spontaneous bacterial peritonitis and its management?
SBP - infection of ascitic fluid
- neutrophils >250 per mm3
management - 3rd gen cephalosporins, co-amoxiclav
ciprofloxacin as prophylaxis
what is hepatic encephalopathy and its management?
HE - brain dysfunction caused by liver insufficiency or portal systemic shunt - leads to neurological/psychiatric abnormalities
asterixis - flapping hand tremor - sign of HE
precipitating factors of HE
- increased protein load
- reduced ammonia secretion
- electrolyte imbalance
- dehydration
- infection
high levels of ammonia as liver cannot metabolise it properly into urea - crosses BBB and enters astrocytes in brain
- ammonia converted to glutamine in astrocytes - causes oedema
management:
- 1st line - lactulose - pee out ammonia
- rifaximin antibiotic
- other options - metronidazole
what is variceal bleeding and portal HTN and its management?
PHTN - due to increased resistance to flow
- collateral vessels form - enable blood to bypass liver
terlipressin and somatostatin analogues
infection is common in upper GI bleed in cirrhotic patients
- broad spectrum antibiotic prophylaxis
- 7 day antibiotic prophylaxis - broad spectrum tazocin
- ciprofloxacin in penicillin allergic patients
secondary prophylaxis to prevent re-bleeding
- non selective beta blockers
- propranolol and cardivelol
what is spider naevi
central red arteriole surrounded by capillaries - represents legs
- due to raised oestrogen
in liver disease - failure to metabolise oestrogen
