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Gastoenterology > Liver > Flashcards

Liver Flashcards

1
Q

What are liver cells called?

A

Hepatocytes

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2
Q

Which vitamins does the liver store?

A

Fat soluble vitamins (ADEK) + B12

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3
Q

What is the function of albumin?

A

As a carrier protein of steroids, fatty acids and thyroid hormones in the blood (hydrophobic substances)

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4
Q

What are the 5 main functions of the liver?

A 
Storage, 
Post-translational modification of coagulation factors,
Synthesis of plasma proteins,
Protection,
Detoxification
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5
Q

What are liver phagocytes called?

A

Kupffer cells

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6
Q

What exogenous (originating from outside the liver) substances does the liver detoxify?

A

Ethanol,
Drugs,
Bilirubin

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7
Q

What are the two types of bile?

A 
Hepatic bile (from liver cells)
Ductile bile (from secretory cells lining the duct)
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8
Q

What are bile duct cells called?

A

Cholangiocytes

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9
Q

What is the purpose of the gall bladder and how does it do this?

A

Storage and condensing of bile

Removal of chloride and thus water

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10
Q

What is the purpose of bile?

A

To aid fat digestion

To neutralise acidic chyme (bicarb rich)

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11
Q

What is the blood supply to the liver?

A

Dual blood supply
75% hepatic portal vein (nutrient rich)
25% hepatic artery (oxygen rich)

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12
Q

Which substance, when in excess, crystallises to from gall stones?

A

Cholesterol

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13
Q

What is the difference between primary and secondary bile acids?

A

Primary: produced and secreted by liver
Secondary: primary bile acids that have travelled through the intestine and undergone changes due to bacteria

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14
Q

What occurs to secondary bile acids once in the intestine?

A

Reabsorbed back into portal circulation and re-secreted in the bile

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15
Q

What is the composition of bile?

A 
Bile acids,
Cholesterol,
IgA,
Water and electrolytes,
Lipids and phospholipids,
Bilirubin
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16
Q

What is the clinical name for gall stones?

A

Cholelithiasis

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17
Q

What is the treatment for gall stones?

A

If asymptomatic, nothing

If symptomatic, surgery (laparoscopic cholecystectomy)

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18
Q

What is the use of morphine is gall stone associated pain?

A

Relieves pain, however causes constriction of the sphincter of Oddi so can increase pain in some patients

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19
Q

What treatment can be given to reduce biliary spasm?

A

Atropine or GTN

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20
Q

What is the difference between bile acids and bile salts?

A

Bile salts are secondary bile acids that have been conjugated with amino acids

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21
Q

What is enterohepatic recycling?

A

The reabsorption of secondary bile salts to prevent loss in the faeces

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22
Q

Name a bile acid resin and give its purpose?

A

Colestipol
To prevent reabsorption of bile acids
Used in hyperlipidaemia or cholestatic jaundice (prevents formation of gall stones)

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23
Q

What is the effect of bile acid resins on cholesterol?

A

Indirectly lower cholesterol levels as promote conversion of cholesterol to bile acids when acids depleted due to excretion

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24
Q

Which is the main organ of drug metabolism?

A

Liver

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25
Q

What are the 2 phases of liver metabolism of drugs?

A

Phase 1: modification (add a polar group so more readily excreted)
Phase 2: conjugation (add another charged species to increase polarity)

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26
Q

What is hepatic encephalopathy?

A

Build up of ammonia in the blood due to a failure of the liver to excrete it (liver disease)

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27
Q

How is hepatic encephalopathy treated?

A

Lactulose - converts ammonia to ammonium which can enter the urea cycle and be excreted

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28
Q

How many hepatitis viruses are there?

A

5 - ABCDE

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29
Q

How is hepatitis A spread?

A

Faecal-orally

Areas of poor hygiene/overcrowding

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30
Q

How does hepatitis A present?

A

Acute symptoms- no chronic infection

Symptoms similar to viral respiratory tract infection/gastroenteritis

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31
Q

How is Hep A diagnosed?

A

Blood sample to identify antibodies (IgM)

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32
Q

How does Hep E present?

A

Similar to hep A however can become chronic in rare cases

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33
Q

Which strains of hepatitis virus have a vaccine?

A 
Hep B (given to all children)
Hep A (given to at risk groups)
34
Q

What other infection must you have to develop a hepatitis D infection and how does it impact it?

A

Hep B
Hep D makes the infection worse
(can develop simultaneously or after Hep B)

35
Q

Which form of hepatitis is of the greatest concern?

A

Hep B

36
Q

How is hep B spread?

A

Sex, mother to child, blood-blood contact

37
Q

Which Ig class is used to diagnose hepatitis?

A

IgM

38
Q

How is hep C spread?

A

Similar to hep B

Sex (intercourse), mother-child (inherited), blood-blood (injection) - 3 I’s

39
Q

How long must you have a hepatitis infection for it to be defined as chronic?

A

6 months

40
Q

How is it diagnosed if a hepatitis infection is active or inactive?

A

Test for virus RNA by PCR

41
Q

How is acute viral hepatitis treated?

A

Symptomatically

immunise contacts and also against other infections at risk of

42
Q

How is chronic viral hepatitis treated?

A

Antivirals

If hepC also vaccinate against hepA/B to prevent further insult on the liver

43
Q

What is the first line treatment in chronic viral hepatitis?

A

Suppressive antiviral drug (tenofovir)

44
Q

Which is more common; primary liver carcinoma or metastases?

A

Metastases

If have chronic liver disease then primary carcinoma more common

45
Q

What is the most common benign solid liver lesion?

A

Haemangioma

46
Q

What are the symptoms and treatment of a haemangioma?

A

Usually asymptomatic

No treatment

47
Q

What is a central scar with radiating branches to the peripheries of the liver classically a sign of?

A

Focal nodular hyperplasia

48
Q

How is focal nodular hyperplasia treated?

A

No treatment - benign

49
Q

What is the treatment of an adenoma in the liver?

A

Males: surgery (more likely to become malignant)
Females: conservative approach (weight loss, stop oral contraceptive pill)

50
Q

What is the treatment for polycystic liver disease?

A

Somatostatin

51
Q

What is the most common malignant liver tumour and what is the major cause?

A 
Hepatocellular carcinoma (HCC)
Caused by cirrhosis (of any cause)
52
Q

What is AFP?

A

A HCC tumour marker

53
Q

What is the gold standard for diagnosis of HCC?

A

Imaging followed by liver biopsy of the tumour

54
Q

What is the treatment for HCC?

A

If small tumour = resection
If small tumour + cirrhotic = transplantation
If multi-nodular = palliative (symptomatic treatment)

Chemotherapy is mot very effective in HCC

55
Q

What is ALP and what affects it?

A

ALP: alkaline phosphatase

Increases in bile duct obstruction and active bone formation (also some cases of coeliac disease)

56
Q

How are metastases to the liver treated?

A

Dependent upon primary source of cancer, can be resection or chemoembolisation

57
Q

What are the 4 anatomical lobes of the liver and which is biggest?

A

Right, left, quadrate, caudal

Right = biggest

58
Q

Why can half the liver be removed and it still function effectively?

A

Has a large functional reserve and can regenerate cells

59
Q

What is the process of development to cirrhosis?

A 
Insult (death of hepatocytes)
=>
Inflammation
=> 
Fibrosis (if chronic inflammation)
=>
Cirrhosis (if advanced fibrosis - terminal)
60
Q

What is ALT?

A

If abnormal indicates change in liver health

61
Q

What is the main symptom of acute liver failure?

A

Acute onset of jaundice (due to bilirubin)

62
Q

What are the 3 types of jaundice?

A

Pre-hepatic (to much haem to break down)
Hepatic (disease of liver cells)
Post-hepatic (obstruction of the biliary passage)

63
Q

What is cirrhosis?

A

Bands of fibrosis that separate the liver into nodules and prevent access to portal veins - prevents the liver carrying out its function

64
Q

What are the complications of cirrhosis?

A

Portal hypertension (oesophageal varices, caput medusa, haemorrhoids),
Ascites,
Liver failure

65
Q

What is the progression of alcoholic liver disease?

A 
Fatty liver
=>
Hepatitis 
=>
Fibrosis (irreversible)
=>
Cirrhosis
66
Q

What is fatty liver?

A

Liver cells are full of fat - steatosis

greasy and slips through hands at biopsy

67
Q

What is the main cause of NAFLD/NASH?

A

Obesity

non-alcoholic fatty liver disease/non-alcoholic steatohepatitis

68
Q

What type of cells are associated with the start of fibrosis and why?

A

Hepatic stellate cells - when damaged don’t undergo apoptosis, instead undergo fibrosis

69
Q

How does auto-immune hepatitis present?

A

Acute jaundice, hepatomegaly

70
Q

What is the gold standard for diagnosis of auto-immune hepatitis?

A

Liver biopsy

71
Q

How is auto-immune hepatitis treated?

A

Corticosteroids (azathioprine + prednisolone)

72
Q

What is haemochromatosis and how is it treated?

A

Genetic iron overload

Treatment: venesection (remove blood to reduce iron quantity)

73
Q

What are the 2 causes of portal hypertension?

A

Pre-hepatic: blockage in the portal vein (thrombosis etc)

Intra-hepatic: distortion of liver architecture

74
Q

Why is the liver at risk of carcinoma?

A

Constant regeneration of cells so DNA damage is more likely

75
Q

What is the difference between compensated and decompensated cirrhosis?

A

Compensated: appear clinically normal - may show up incidentally
Decompensated: liver failure (end-stage) - have signs of jaundice/ascites

76
Q

What are the clinical signs of cirrhosis?

A 
Spider naevai,
Umbilical hernia, 
Ascites,
Jaundice,
Leukonychia
77
Q

What are the complications of cirrhosis?

A

Ascites,
Liver failure,
Encephalopathy,
Variceal bleeding

78
Q

What is the best nutrition advice for decompensated cirrhosis?

A

Small frequent meals (can feed naso-gastrically overnight(

79
Q

What is the first line treatment for ascites?

A

Spironolactone (aldosterone antagonist) + drainage (paracentesis)

80
Q

What is TIPS?

A

An artificial vein added to the liver which connects the portal vein to the hepatic vein - reduces the pressure

81
Q

What is a major complication of ascites?

A

Spontaneous bacterial peritonitis (translocation of bacteria into the abdominal cavity)

82
Q

What is given as prophylactic treatment to prevent vatical bleeding?

A

Non-selective B-blockers - propranolol

Gastoenterology (15 decks)

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