Liver Flashcards
What is the structure of a liver lobule?
Hepatic vein in the center of the lobule with hepatocytes surrounding it funneling endocrine, secretory and metabolic hormones into the vein.
There are about 50-100k lobules per liver
What are the vessels that run into and out of the liver and where do they come from?
Hepatic artery runs from heart to liver
Hepatic portal vein runs from intestines to liver
Hepatic vein runs from liver back to heart
What is the role of the liver?
Secrete glycogen for glucose homeostasis
Metabolize fats, proteins, bilirubin and drugs and hormones
Detox blood
Produce prothrombin
What lab tests can you do for liver damage? Which are most commonly used and which one is most specific?
AST and ALT most common
ALT most specific (Liver damage only)
AST: liver, heart and skeletal muscle damage
ALP: Liver, bile ducts and bone damage
GGT: liver, heart, kidney and brain damage
Serum/urine bilirubin concentration (Conj and unconj)
Prothrombin time and INR
What causes the yellowing of the skin seen in jaundice?
Bilirubin buildup in blood
Where would you see yellowing in jaundice
Fornices of eyelids and conj
Skin
Mucous membranes (like inside of cheeks)
What’s the normal path of bilirubin starting as old hemoglobin?
Old hemoglobin to spleen to become unconjugated bilirubin to liver to become conjugated bilirubin to stool
What symptoms do you see if the bilirubin path is dysfunctional?
Pale stools (no bilirubin) and dark urine (Bilirubin spillover)
What gene abnormality leads to Wilson’s Disease? What inheritance pattern is it?
ATP7B copper transport dysfunction. Autosomal recessive
What is dysfunctional in Wilson’s Disease?
ATP7B copper transport
Where does the copper tend to build up in Wilson’s Disease?
Liver, brain and eyes
When does Wilson’s disease manifest?
Between ages 12-20
Wilson’s disease leads to disease of the eye, brain and liver. What liver symptoms do you see in Wilson’s?
Liver failure, hepatitis and cirrhosis
Wilson’s disease leads to disease of the eye, brain and liver. What eye symptoms do you see in Wilson’s?
Sunflower cataract (PSC and ASC)
Kaiser flescher ring
50% likely if only liver affected
100% if brain affected too
Wilson’s disease leads to disease of the eye, brain and liver. What neurological symptoms do you see in Wilson’s?
Parkinson’s like symptoms + drooling
What clinical manifestations would you note for Wilson’s disease?
Liver biopsy, psych changes, ocular manifestations
What lab tests could you do to test for Wilson’s disease?
Decrease serum ceruloplasmin (100mcg/day)
Poor ALT and AST
Gene tests
What are treatments for Wilson’s disease
Chelate copper with EDTA
Increase zinc in diet
Decrease copper in diet (mushrooms, shellfish, liver, nuts harder for vegetarians)
Check drinking water
What is the route of transmission for Hepatitis A?
Fecal oral
In whom is Hepatitis A more prevalent
Low socioeconomic status
Can you be vaccinated for Hep A?
Yes
How long does it take for HepA to incubate?
30 days
What are symptoms of HepA?
Prodromal = fatigue, fever, nausea, anorexia, upper right quadrant pain
Jaundice
How would you test for HepA?
HAV antibodies
Treatment for HepA?
Supportive therapy
Self limiting disease
Most recover in 3 months
Almost all recover in 6 months
True or false? HepB is typically Chronic
False. HepB is typically acute
How is HepB transferred?
Sex, drugs (and rock and roll)
Where is HepB found in the world?
Africa and SE Asia
Symptoms of acute HepB?
Typically asymptomatic
May have flulike symptoms
Rarely get jaundice or liver failure
What’s serum sickness?
Body allergic to Hepatitis B. Get hives, fever and joint pain
Symptoms of chronic HepB?
Cirrhosis, carcinoma, liver failure
What are the antigen tests for HepB?
HB(s)Ag, HB(e)Ag, HB(c)Ag
IgM or IgG test for acute or chronic testing for HB(c)Ag
How would you test to differentiate acute and chronic HepB?
IgM or IgG test for acute or chronic testing for HB(c)Ag
How do you treat acute HepB?
Supportive therapy
How do you treat chronic HepB?
Antivirals
“-Vudine”
“-Ovir”
“-voxil”
What’s the most common cause of liver disease and transplant?
HepC
Is HepC more often acute or chronic?
Chronic. 30% end up getting cirrhosis within 30 years
Symptoms of acute HepC?
Asymptomatic
Fatigue, myalgia, N/V and poor appetite
Upper right abdominal pain
Symptoms of chronic HepC?
Asymptomatic until liver damage
True or false? HepC can also be coinfection with HepD and HepE
False. Coinfection with HepA and HepB
What tests can you run for HepC?
ALT and AST
HAV antigen test
RT PCR for HAV RNA
Liver Biopsy
Treatment for HepC?
Antivirals "-evir" "-virin" peginterferons Check at the end of therapy and 6 months later to ensure still good
What drugs are choice but very expensive for HepC?
Sofosbuvir and ribavirin
What eyesigns are associated with which drugs for HepC?
Interferon retinopathy. Get cottonwool spots, ONH edema and BRAO that can lead to RD
What is required for a HepD infection to take hold?
HepB in body as well
Differene between HepD and HepB coinfection vs superinfection?
Coinfection = acute Superinfection = chronic
How do you test for HepD?
HBV antigen test
HepD RT-PCR
Treatment for HepD? What doesn’t it do?
Interferon alpha. Doesn’t treat viral or liver disease
Prognosis for HepD?
75% chance progressive liver disease
How is HepE spread?
Poo water
There are 4 genotypes with 24 subtypes of HepE. A higher mortality exists in pregnant women. The presentation’s not yet understood
Free card
Similar to HepA in tx and symptoms
HepE
How would you diagnose HepE?
HepE antigen test (IgM)
HEV detection
How many drinks may result in alcohol liver disease?
Women: 14 drinks per week
Men: 21 drinks per week
What liver problems occur with alcohol liver disease?
Hepatic steatosis
Symptoms of hepatic steatosis?
asymptomatic
Symptoms of alcoholic hepatitis?
Ascities, jaundice, anorexia
Fever, muscle wasting and pain
What’s cirrhosis?
Fibrosis of liver and regenerative nodules
What are some general symptoms of cirrhosis that you may notice with alcohol liver dz?
Finger clubbing, palm erythema, asterixis
Gynecomastia
Jaundice, ascities, splenomegaly
What diagnostic tests can you run for alcohol liver dz?
Elastography
MRI to quantify steatosis
What are causes of cirrhosis?
HepB and HepC, alcohol liver disease, hepatic steatosis
What’re the symptoms of cirrhosis?
Ranges from itching to liver dysfunction to infertility
How would you diagnose cirrhosis?
Imaging
ALT/AST
Treatment for cirrhosis?
Protect liver
Liver transplant
Prognosis for cirrhosis?
40x increase in hepatocellular carcinoma
Epidemiology for hepatocellular carcinoma?
Black or asian males 50-60yo
What tests would you NOT do for hepatocellular carcinoma?
Lab tests not definitive
What tests would you do to test for hepatocellular caricnoma?
Biopsy and ultrasound
If nodules greater than 1 cm, do MRI or CT scan
PET scan to monitor metastases
What is hepatocellular carcinoma?
Fibrosis/nodular regeneration of liver
Symptoms of hepatocellular carcinoma?
No symptoms other than chronic liver disease. Similar to cirrhosis
Risk factors/reasons to screen for hepatocellular carcinoma?
Fhx, alcoholic, HepB/C, autoimmune hepatitis, Primary biliary cirrhosis, nonalcoholic steatohepatitis, hemochromatosis
How would you treat hepatocellular carcinoma?
Liver resection/transplant
Radiofrequency or transarterial chemoembolization ablation
