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Liver Flashcards

1
Q

Functions of liver

A 
detoxification
carb and glucose regulation
bile drainage
blood circulation and filtration
synthesis and storage of amino acids and proteins fats and viatmins
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2
Q

Ligamentum teres, falciform ligament, caudate lob, quadrate lobe - where

A

in middle of lobes is falciform

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3
Q

What are the ligaments of the liver

A

right traingluar ligament, coronary lig, left triangular ligamnet, venosum

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4
Q

Porta hepatitis, which way do the structures go

A

free edge of lesser omentum attaches here (carrying structures with it)
-Contains the Heaptic artery, portal vien and bile duct

BVA - anterior

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5
Q

Contributions from hepatic artery and portal vien

A

1/4 heptic artery , 3/4 portal vien

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6
Q

where does falciform ligament go to?

A

to umbilicus

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7
Q

Lymphatic drainage of liver

A

nodes at porta hepatits (coeliac nodes) (on hepatic artery)

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8
Q

ANS - visceral supply and pain to liver

A

coeliac plexus, parasympathtic - vagus
sympathetic - greater splanchnic nerves
Pain in epigastric region

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9
Q

cyctic duct

A

from neck of gall bladder joins with pancreas

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10
Q

how is bile released into duodenum

A

smooth muslce at distal end of bile duct and ampulla relax

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11
Q

is the gall bladder covered in visceral peritonium?

A

yes

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12
Q

Arterial supply to gall blader

A

cystic artery (from right hepatic artery) - passes through the triangle of calot

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13
Q

Venous supply gall bladder

A

Cystic vien (into portal vien)

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14
Q

nerve, pain of gall bladder

A

ans - via coeliac plexus (same as liver), epigastric region

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15
Q

lymph of gall bladder

A

cystic nodes - hepatic - coeliac

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16
Q

Cholelithiasis

A

Presence of gall stones

-cholesterol (green or yellow/whtite), and pigment stones (bilirubin, calcium salts usualy small and dark)

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17
Q

3 main places of porto-systemic shunting

-causes

A

-alternative vessels enlarge to try and divert blood back from portal circulation back to heart

Oesopahgeal varacies
Caput medusae (around umbilicus)
-Anus - anorectial varices
Due to portal hypertension - causes included cirrhosis
-in submucosa
-can rupture and bleed if pressure to high

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18
Q

Patterns of hepatic injury

A 
5 general responses
degeneration and intracellular accumulation 
Necrosis and apoptosis
inflammation 
regeneration
firbosis
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19
Q

What happens in hepatic failure and what are the clinical features

A

sudden and massive destruction/endpoint
loss of 80-90% capacity
increased demand - infection, gastrointestinal bleeding
High mortality
Clinical features - jaundice, hypoalbuminaemia, elevated ammonia (neurological function)

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20
Q

Cirrhosis process and what happens

A
  • fibrous septae
  • damage to hepatocytes
  • micro and macronodules - parancheal nodules (hepatocyes encircled by fibrosis)
  • change in structure - shunts, blood bypasses the liver
  • progressive fibrosis

Process - kupffer cells released cytokines, causes inflammatory response

  • results in change to hepatocytes
  • undergo apoptosis
  • inflammatory repsonse increase
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21
Q

Portal Hypertension

Pre, post and intra hepatic

A

increased resistance to portal flow

  • due to cirrosis blocking pathways of blood
  • prehepatic - obstructive thromobsis
  • posthepatic - server right sided heart failure
  • intrahepatic - cirrosis
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22
Q

Consequences of portal hypertension

A

Ascities, portal systemic shunts

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23
Q

Hep A

A

Self limiting
Does not cause chronic hepatitis
hygiene and sanitiation
asymptomatic , mild ilness, jaundice

24
Q

Hep B

A

acute hepatitis with resolution
chronic hepatitis may lead to cirrhosis or massive necrosis
blood and body fluid borne
immune repsone to viral antigens expressed on infected hepatocytes leads to liver damage

25
Hep C
major cause of liver disease Risk - injections and blood transfusions, medical treatments poor sanitation acute infection usually undetected chronic disease occurs in majority 20% develop cirrosis after 5-20 years -most people who get acute will develop chronic hepatitis
26
Autoimmune hepatitis
chronic progressive hepatits genetic predisposition, presence of autoantibodies -immunosuppression -association with other autoimmune disease
27
Drug and toxic induced liver injury
predictable Hepatotoxins - dose-dependent matter -and unpredicatable -may directly cell toxic, or act through ehpatic conversion to an active toxin activated -cholestasis, hepatocellular necrosis, fatty liver disease, fibrosis, granulomas, vascular lesions, neoplams -most common acute liver failure = paracetamol most common chronic - alcohok
28
Alcoholic liver disease
change in lipid metabolism decreasesd export of lipoprotien and cell injury caused by reactive oxygen species and cytokines -hepatic steatosis, alcoholic heptitis, cirrhoisos
29
Non-alcoholic fatty liver disease | -what it is associated with
- metabolic syndrome, obesity, type 2 diabetes, dyslipidemia, hypertension - initially hepatic steatosis which can progress to inflammation and then can turn to cirrosis
30
Haemochromatosis
- excessive accumulation of body iron - deposited in liver and pancreas - genetic defect - excesive iron abosption - autoskomal resessive - can get cirrosis, diabetes, skin pigmentation
31
Cholestasis of sepsis
decreased bile flow, obstruction of intra or extrahepatic bile ducts - sepsis - infection from bacteria and toxins - can result as a direct effect of intrahepatic infection (bacteria cholangitis) - can get ischaemia related to hypotension - circulation microbial products (particular in context of gram negative infection)
32
Autoimmune cholangiopathies
- primary biliary cirrhosis (autoimmune disorder leading to destruction of bile canaliculi) - primarey sclerosing cholangitis (autoimmune disoer leadign to scaring of bile ducts)
33
Passive congestion and centriolobular necrosis
Right sided cardiac decompesnation, commonly seen at autopsy, element fo preterminal circulatory failure with most deaths
34
Liver tumours
benign neoplams - cavernous haemangiomas, hepatocellular adenoms, malignant neoplasms - hepatoceellulra carcinoma, hepatoblastoma
35
Causes of jaundice - unconjugated, conjugated
unconjugated (indirect) - haemolysis, gilberrst syndrome Inside liver - cholestasis - drugs, pregnancy, thyroid diesease Obstruction inside liver - hepatitis, cirrhosis, bilary cirrhosis, large liver masses Outside liver - obstrucion outside - galstones, bilayr pancreatic cancer, pancreatitis
36
ALP
obstruction outside liver | increase with cancer, gall stones (anything blocking bile)
37
GGT
obstruction outside liver | Alcohol, drugs, phenytoin, ritampicin, also fatty liver - mainly alcohol (can have fat obstructing)
38
ALT and AST
liver specific hepatitis , inflammation and hepatocellular injury -ALT more liver specific -if these are really really high than could be acute drug poisoning
39
Albumin
liver is only source decrease with cirrosis, illness (non-specific) -long term ilness
40
Globulins
Inflamation -decreases with hepatitis, cirrhosis | -decreases if synthetic function is impaired
41
Prothrombin raito
increases with liver failyre - if syntheitic funciton is imparied
42
Glucose
liver maintains fasting glucose, inability to maintain glucose - decreases - liver failure
43
Ammonium
increases
44
CEA
cancer marker-can be fore bening cirossis and hepatitis
45
Gilberts syndrome
variant in billirubin conjugaction - so billirubin is unconjugated other liver tests normal jaudice -can test - if fasting for 48 hrs and bilirubin rises 2 times
46
Main causes of Liver function test abnormalities
Fatty liver - obesity, diabetes ect | -Viral hepatitis, alcohol
47
Old treatment for Hep C
regiems were interferon based (made cytokines), however not very good and could get flu like symptoms (injection)
48
Current treatment
Antiviral agents - tablets , better cure rates
49
How to treat varicies that have ruptured
can tie around them however need to also sort hypertension
50
Causes of portal hypertension
Pre-hepatic - portal vien thrombosis Intrahepatic - cirrhosis Post hepatic - heaptic vien thrombosis, right heart failrure
51
Hepatic encephalopathy
result of chronic liver failure Early symptoms - mood and personality change, inverted sleep Late - confusion, bizarre behaviour, drowsiness and coma -advanced cirrhosis with liver failure
52
Mechanisms of Hepatic encephalopathy
Chronic liver failure i.e functioning poorly Liver unable to detoxify substances produce by bacteiral metbaolsim -portosystemic collaters shunt blood back to portal ciruclaiton- does not go back to liver, so is not detoxified -Ammonia build up in blood brain barrier disturbs normal brain funciton
53
Treatment of hepatic encephalopathy
lactulose - just to manage symptoms (normally a laxative) | -however will convert ammonia to a non-absobable molecule
54
What is ascites
Fluid in peritoneum causing abdominal distention - can be caused by portal hypertension - increased pressure in protal vien, fluid shifts out inot circulation into perritoneum - less able to hold on to fluid in circulation
55
What can be seen with portal hypertension
Varacies, acsites, hepatic encepahlopathy
56
Budd chari syndrome - what it is - and sypmtoms - cause - management
acute thrombosis of hepatic vien outflow of blood from liver obstructed liver becomes acutely congested, hepatocellular damage Porral hypertension occurs - ascities develop Symptoms - acute rapdily progressive servere upper abdominal pain jaudice, hepatomgaly, ascities, hepatic enchaplopathy Cause - mainly no obvious cause management - protocaval shunting often performed to divert blood flow , anticoagulants, diruertics

Digestive (15 decks)

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