Liver Flashcards
What is the portal vein responsible for?
Bring blood into the liver (not a real vein)
What is the hepatic vein responsible for?
Taking blood away from the liver
Main function of the liver
Removes toxins/waste from the blood into the bile
Also synthesis: glucose, clotting factors and bile salts
Explain the metabolism of bilirubin
• a green bile pigment formed by the breakdown of RBC heme
• it travels to the liver where it becomes conjugated- additional of glucuronic acid.
• it is now called water soluble conjugated bilirubin
• it is excreted in the bile
Where is bilirubin removed from the body
Feaces
When the blood levels of conjugated bilirubin is high due to liver impairment, where does the excess go and leave the body
Urine
Which quadrant is the liver located
RUQ
Liver metabolism- phase 1
CYP450 enzyme makes compound more hydrophilic via oxidation, hydrolysis and reduction
Liver metabolism phase 2 - conjunction
Compound undergoes congugation to become more hydrophobic, in order to be excreted in urine more easily
LFTs are used to distinguish between..
Heptocellular activity and cholestasis
Types of LFT?
• billirubin (used to detect bile obstruction)
• albumin
• prothrombin time
• total protein
Ultrasounds and biopsy
Which drugs can cause liver abnormalities
• paracetamol
• penicillin
• NSAIDs
• phenytoin
• methotrexate
• statins
• herbal supplement
• tuberculosis drugs
What complications are associated with liver disease
• Varices
• Ascites
• itching skin
• abdominal pain (RUQ)
• portal hypertension
• bleeding
• odema
• encephalopathy
• jaundice
What is Varices- symptoms and management
? Abnormally dilated veins in the oesophagus, which can bleed
Symptoms: blood in vomit & dark stool
Treatment: propranolol (beta blocker)
What is Ascites and the management
? Accumulation of fluid in the abdominal region
Management
• decrease sodium and water intake
• Spiractalone
• fluid drainage
What is Hepatic encephalopathy, signs and management
? Brain is unable to clear out toxins (ammonia) properly due to liver dysfunction
Sign: confusion
Management:
• lactulose
• lower ammonia
Model of end-stage liver disease uses which serums to predicate morality at 3 months?
• billirubin
• creatinine
• INR
- only for >12s *
What is the weekly recommended alcohol amount
14 units/ week with alcohol free days
How much grams and ml of pure alcohol is in one unit
8grams
10ml
List the steps of alcohol metabolism
- ADH metabolises alcohol into acetaldehye
• this forms NADH
• NADH promotes the synthesis of fatty acids, causing: nicrosis, fibrosis, cirrhosis and inflammation - acealdehyde is metabolised into acetate by ALDH
- Acetate is converted into CO2 and H2O
Alcoholic liver disease -
What is the management of acute alcohol withdrawal?
Benzodiazepine or carbamazepine
Alcoholic liver disease - what is the management of delirium tremens
Oral lorazepam
Alcoholic liver disease - what is the management of wernickies encepalopathy and what are the symptoms?
IV thiamine 100mg, for 5 days
wernickies encepalopathy - confusion and double vision
? Due to thiamine deficiency
- weakness in eyes muscles
- loss of muscle control in arms and legs
- confusion
Which 3 drugs are used for alcohol withdrawal and their MOAs ?
Naltrexone hydrochloride 50mg
- opioid antagonist
Acamprostate 333mg
- stimulates GABA & inhibits glutamate
Disulifram 20mg
- inhibits ALDH
What is alcoholic hepatitis?
Excess alcohol triggering immune system, causing inflammation
Symptoms?
• N&V
• fever and pain
• change in appetite
• jaundice
Diagnosis
Liver biopsy
Treatment
Corticosteroids
What is malnutrition
Consuming too much or too little nutrients to sustain a healthy body
What can iodine deficiency lead to to
Thyroid issues
What can vit A deficiency lead to
Problems with eyes
What can zinc deficiency lead to
Issues with Enzyme synthesis
What can vit D and calcium deficiency lead to
Rickets
What can thiamine (B1) deficiency lead to
Wernicke encephalopathy
Who does malnutrition impact the most
• women
• infects
• children
• adolescents
What is Korsakoff syndrome
Neurological disorder with severe amnesia (memory loss)
Korsakoff syndrome - Causes
• thiamine defiency
• severe head injury
• severe chronic alcoholism
• brain disorders
