Liver Flashcards
What are liver cells called?
Hepatocytes
Which vitamins does the liver store?
Fat soluble vitamins (ADEK) + B12
What is the function of albumin?
As a carrier protein of steroids, fatty acids and thyroid hormones in the blood (hydrophobic substances)
What are the 5 main functions of the liver?
Storage, Post-translational modification of coagulation factors, Synthesis of plasma proteins, Protection, Detoxification
What are liver phagocytes called?
Kupffer cells
What exogenous (originating from outside the liver) substances does the liver detoxify?
Ethanol,
Drugs,
Bilirubin
What are the two types of bile?
Hepatic bile (from liver cells) Ductile bile (from secretory cells lining the duct)
What are bile duct cells called?
Cholangiocytes
What is the purpose of the gall bladder and how does it do this?
Storage and condensing of bile
Removal of chloride and thus water
What is the purpose of bile?
To aid fat digestion
To neutralise acidic chyme (bicarb rich)
What is the blood supply to the liver?
Dual blood supply
75% hepatic portal vein (nutrient rich)
25% hepatic artery (oxygen rich)
Which substance, when in excess, crystallises to from gall stones?
Cholesterol
What is the difference between primary and secondary bile acids?
Primary: produced and secreted by liver
Secondary: primary bile acids that have travelled through the intestine and undergone changes due to bacteria
What occurs to secondary bile acids once in the intestine?
Reabsorbed back into portal circulation and re-secreted in the bile
What is the composition of bile?
Bile acids, Cholesterol, IgA, Water and electrolytes, Lipids and phospholipids, Bilirubin
What is the clinical name for gall stones?
Cholelithiasis
What is the treatment for gall stones?
If asymptomatic, nothing
If symptomatic, surgery (laparoscopic cholecystectomy)
What is the use of morphine is gall stone associated pain?
Relieves pain, however causes constriction of the sphincter of Oddi so can increase pain in some patients
What treatment can be given to reduce biliary spasm?
Atropine or GTN
What is the difference between bile acids and bile salts?
Bile salts are secondary bile acids that have been conjugated with amino acids
What is enterohepatic recycling?
The reabsorption of secondary bile salts to prevent loss in the faeces
Name a bile acid resin and give its purpose?
Colestipol
To prevent reabsorption of bile acids
Used in hyperlipidaemia or cholestatic jaundice (prevents formation of gall stones)
What is the effect of bile acid resins on cholesterol?
Indirectly lower cholesterol levels as promote conversion of cholesterol to bile acids when acids depleted due to excretion
Which is the main organ of drug metabolism?
Liver
What are the 2 phases of liver metabolism of drugs?
Phase 1: modification (add a polar group so more readily excreted)
Phase 2: conjugation (add another charged species to increase polarity)
What is hepatic encephalopathy?
Build up of ammonia in the blood due to a failure of the liver to excrete it (liver disease)
How is hepatic encephalopathy treated?
Lactulose - converts ammonia to ammonium which can enter the urea cycle and be excreted
How many hepatitis viruses are there?
5 - ABCDE
How is hepatitis A spread?
Faecal-orally
Areas of poor hygiene/overcrowding
How does hepatitis A present?
Acute symptoms- no chronic infection
Symptoms similar to viral respiratory tract infection/gastroenteritis
How is Hep A diagnosed?
Blood sample to identify antibodies (IgM)
How does Hep E present?
Similar to hep A however can become chronic in rare cases
Which strains of hepatitis virus have a vaccine?
Hep B (given to all children) Hep A (given to at risk groups)
What other infection must you have to develop a hepatitis D infection and how does it impact it?
Hep B
Hep D makes the infection worse
(can develop simultaneously or after Hep B)
Which form of hepatitis is of the greatest concern?
Hep B
How is hep B spread?
Sex, mother to child, blood-blood contact
Which Ig class is used to diagnose hepatitis?
IgM
How is hep C spread?
Similar to hep B
Sex (intercourse), mother-child (inherited), blood-blood (injection) - 3 I’s
How long must you have a hepatitis infection for it to be defined as chronic?
6 months
How is it diagnosed if a hepatitis infection is active or inactive?
Test for virus RNA by PCR
How is acute viral hepatitis treated?
Symptomatically
immunise contacts and also against other infections at risk of
How is chronic viral hepatitis treated?
Antivirals
If hepC also vaccinate against hepA/B to prevent further insult on the liver
What is the first line treatment in chronic viral hepatitis?
Suppressive antiviral drug (tenofovir)
Which is more common; primary liver carcinoma or metastases?
Metastases
If have chronic liver disease then primary carcinoma more common
What is the most common benign solid liver lesion?
Haemangioma
What are the symptoms and treatment of a haemangioma?
Usually asymptomatic
No treatment
What is a central scar with radiating branches to the peripheries of the liver classically a sign of?
Focal nodular hyperplasia
How is focal nodular hyperplasia treated?
No treatment - benign
What is the treatment of an adenoma in the liver?
Males: surgery (more likely to become malignant)
Females: conservative approach (weight loss, stop oral contraceptive pill)
What is the treatment for polycystic liver disease?
Somatostatin
What is the most common malignant liver tumour and what is the major cause?
Hepatocellular carcinoma (HCC) Caused by cirrhosis (of any cause)
What is AFP?
A HCC tumour marker
What is the gold standard for diagnosis of HCC?
Imaging followed by liver biopsy of the tumour
What is the treatment for HCC?
If small tumour = resection
If small tumour + cirrhotic = transplantation
If multi-nodular = palliative (symptomatic treatment)
Chemotherapy is mot very effective in HCC
What is ALP and what affects it?
ALP: alkaline phosphatase
Increases in bile duct obstruction and active bone formation (also some cases of coeliac disease)
How are metastases to the liver treated?
Dependent upon primary source of cancer, can be resection or chemoembolisation
What are the 4 anatomical lobes of the liver and which is biggest?
Right, left, quadrate, caudal
Right = biggest
Why can half the liver be removed and it still function effectively?
Has a large functional reserve and can regenerate cells
What is the process of development to cirrhosis?
Insult (death of hepatocytes) => Inflammation => Fibrosis (if chronic inflammation) => Cirrhosis (if advanced fibrosis - terminal)
What is ALT?
If abnormal indicates change in liver health
What is the main symptom of acute liver failure?
Acute onset of jaundice (due to bilirubin)
What are the 3 types of jaundice?
Pre-hepatic (to much haem to break down)
Hepatic (disease of liver cells)
Post-hepatic (obstruction of the biliary passage)
What is cirrhosis?
Bands of fibrosis that separate the liver into nodules and prevent access to portal veins - prevents the liver carrying out its function
What are the complications of cirrhosis?
Portal hypertension (oesophageal varices, caput medusa, haemorrhoids),
Ascites,
Liver failure
What is the progression of alcoholic liver disease?
Fatty liver => Hepatitis => Fibrosis (irreversible) => Cirrhosis
What is fatty liver?
Liver cells are full of fat - steatosis
greasy and slips through hands at biopsy
What is the main cause of NAFLD/NASH?
Obesity
non-alcoholic fatty liver disease/non-alcoholic steatohepatitis
What type of cells are associated with the start of fibrosis and why?
Hepatic stellate cells - when damaged don’t undergo apoptosis, instead undergo fibrosis
How does auto-immune hepatitis present?
Acute jaundice, hepatomegaly
What is the gold standard for diagnosis of auto-immune hepatitis?
Liver biopsy
How is auto-immune hepatitis treated?
Corticosteroids (azathioprine + prednisolone)
What is haemochromatosis and how is it treated?
Genetic iron overload
Treatment: venesection (remove blood to reduce iron quantity)
What are the 2 causes of portal hypertension?
Pre-hepatic: blockage in the portal vein (thrombosis etc)
Intra-hepatic: distortion of liver architecture
Why is the liver at risk of carcinoma?
Constant regeneration of cells so DNA damage is more likely
What is the difference between compensated and decompensated cirrhosis?
Compensated: appear clinically normal - may show up incidentally
Decompensated: liver failure (end-stage) - have signs of jaundice/ascites
What are the clinical signs of cirrhosis?
Spider naevai, Umbilical hernia, Ascites, Jaundice, Leukonychia
What are the complications of cirrhosis?
Ascites,
Liver failure,
Encephalopathy,
Variceal bleeding
What is the best nutrition advice for decompensated cirrhosis?
Small frequent meals (can feed naso-gastrically overnight(
What is the first line treatment for ascites?
Spironolactone (aldosterone antagonist) + drainage (paracentesis)
What is TIPS?
An artificial vein added to the liver which connects the portal vein to the hepatic vein - reduces the pressure
What is a major complication of ascites?
Spontaneous bacterial peritonitis (translocation of bacteria into the abdominal cavity)
What is given as prophylactic treatment to prevent vatical bleeding?
Non-selective B-blockers - propranolol
