Liver Flashcards
Describe liver blood supply and drainage?
Supplied by hepatic portal vein (80%) and hepatic artery (20%)
Drained by hepatic vein
Out of bile salts and bile acids, which is circulating in the blood and which is conjugated in the liver?
Bile Salts = Conjugated in the liver
Bile Acids = Circulating
Name the main constituents of bile?
Bile Salts
Lipids
CHolesterol
Lecithin
Blood drains to/from the centre canal?
Bile salts drain to/from the centre canal?
Blood drains to the central canal
Bile salts drain from the central canal
What is bilirubin produced from?
Haem (Red Blood Cell Breakdown)
Where does bilirubin production occur?
Spleen = Macrophages
Liver = Kupfer Cells
What causes jaundice?
High levels of bilirubin
Normal bilirubin levels?
Jaundice becomes visible at…?
Normal Bilirubin is 1-20
Jaundice becomes visible at 50
Describe the process in Haemolytic jaundice?
Pre-hepatic jaundice
Excessive red blood cell breakdown
Increased unconjugated bilirubin
In Haemolytic jaundice (pre-hepatic) describe the
- Total Bilirubin?
- Conjugated bilirubin?
- Unconjugated bilrubin?
Total bilirubin increased
conjugated normal
unconjugated increased
In haemolytic jaundice (pre-hepatic) describe:
- Urine
- Stools
- LFTs
Urine is normal
Stools are dark
LFTs are normal
Causes of haemolytic jaundice (pre-hepatic)?
Gilberts Syndrome
Sickle Cell Anaemia
Describe hepatocellular jaundice?
Failure of the liver to metabolise and excrete bilirubin due to liver damage
Causes increased unconjugated and conjugated bilirubin in the blood
Causes of hepatocellular jaundice?
Failure to metabolise and excrete bilirubin
- Liver cirrhosis
- Hepatitis
- Drug Induced Liver Injury
In hepatocellular jaundice, describe
- Urine?
- Stools?
- LFTs?
Pale Faeces
Dark Urine
Increased ALP, Increased ALT
Describe Cholestatic juandice?
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
Causes of cholestatic jaundice?
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Bile Duct Stricture
Head of pancreas cancer
Cholestatic jaundice
- Urine
- Stools
- LFTs
?
Urine = Dark
Stools = Pale
Raised ALP and GGT
What does ALT tell us?
Raised when there is liver damage
- HEPATOCYTE (INTRAHEPATIC) DAMAGE)
What does ALP tell us?
Raised ALP suggests cholesatic jaundice
What does GGT tell us?
Raised in biliary disease
What does raised bilirubin tell us?
Unconjugated = Pre-hepatic
Conjugated = Liver and bile duct disease
Very high conjugated - Bile duct disease
What does low albumin tell us?
Low levels suggest liver disease (made by the liver)
What does abnormal prothrombin time tell us?
Liver insult or injury
