Liver

Question 1

Describe liver blood supply and drainage?

Answer 1

Supplied by hepatic portal vein (80%) and hepatic artery (20%)

Drained by hepatic vein

Question 2

Out of bile salts and bile acids, which is circulating in the blood and which is conjugated in the liver?

Answer 2

Bile Salts = Conjugated in the liver

Bile Acids = Circulating

Question 3

Name the main constituents of bile?

Answer 3

Bile Salts

Lipids

CHolesterol

Lecithin

Question 4

Blood drains to/from the centre canal?

Bile salts drain to/from the centre canal?

Answer 4

Blood drains to the central canal

Bile salts drain from the central canal

Question 5

What is bilirubin produced from?

Answer 5

Haem (Red Blood Cell Breakdown)

Question 6

Where does bilirubin production occur?

Answer 6

Spleen = Macrophages

Liver = Kupfer Cells

Question 7

What causes jaundice?

Answer 7

High levels of bilirubin

Question 8

Normal bilirubin levels?

Jaundice becomes visible at…?

Answer 8

Normal Bilirubin is 1-20

Jaundice becomes visible at 50

Question 9

Describe the process in Haemolytic jaundice?

Answer 9

Pre-hepatic jaundice

Excessive red blood cell breakdown

Increased unconjugated bilirubin

Question 10

In Haemolytic jaundice (pre-hepatic) describe the

• Total Bilirubin?
• Conjugated bilirubin?
• Unconjugated bilrubin?

Answer 10

Total bilirubin increased

conjugated normal

unconjugated increased

Question 11

In haemolytic jaundice (pre-hepatic) describe:

• Urine
• Stools
• LFTs

Answer 11

Urine is normal

Stools are dark

LFTs are normal

Question 12

Causes of haemolytic jaundice (pre-hepatic)?

Answer 12

Gilberts Syndrome

Sickle Cell Anaemia

Question 13

Describe hepatocellular jaundice?

Answer 13

Failure of the liver to metabolise and excrete bilirubin due to liver damage

Causes increased unconjugated and conjugated bilirubin in the blood

Question 14

Causes of hepatocellular jaundice?

Answer 14

Failure to metabolise and excrete bilirubin

• Liver cirrhosis
• Hepatitis
• Drug Induced Liver Injury

Question 15

In hepatocellular jaundice, describe

• Urine?
• Stools?
• LFTs?

Answer 15

Pale Faeces

Dark Urine

Increased ALP, Increased ALT

Question 16

Describe Cholestatic juandice?

Answer 16

This is caused by an obstruction in the bile duct

The liver is able to conjugate bilirubin but cannot excrete it

Causes high conjugated bilirubin

Question 17

Causes of cholestatic jaundice?

Answer 17

Primary Biliary Cirrhosis

Primary Sclerosing Cholangitis

Bile Duct Stricture

Head of pancreas cancer

Question 18

Cholestatic jaundice

• Urine
• Stools
• LFTs

?

Answer 18

Urine = Dark

Stools = Pale

Raised ALP and GGT

Question 19

What does ALT tell us?

Answer 19

Raised when there is liver damage

• HEPATOCYTE (INTRAHEPATIC) DAMAGE)

Question 20

What does ALP tell us?

Answer 20

Raised ALP suggests cholesatic jaundice

Question 21

What does GGT tell us?

Answer 21

Raised in biliary disease

Question 22

What does raised bilirubin tell us?

Answer 22

Unconjugated = Pre-hepatic

Conjugated = Liver and bile duct disease

Very high conjugated - Bile duct disease

Question 23

What does low albumin tell us?

Answer 23

Low levels suggest liver disease (made by the liver)

Question 24

What does abnormal prothrombin time tell us?

Answer 24

Liver insult or injury

Question 25

What is acute liver injury?

Answer 25

Insult to the liver that causes damage in a previously normal liver

Less than 6 months duration

Question 26

How do you treat itch often seen in GI?

Answer 26

Sodium Bicarbonate Bath