liver Flashcards
pre hepatic
- conj/unconj
- causes
- effect
- unconj (any conj is excreted as normal so it is the build up of UNconj!)
- Hamolysis eg haemolytic anaemia, Gilberts syndrome (Reduced enzyme activity converting unconj–> conj. phase 1 ila thinks this is intrahepatic)
- nomral urine/stool. no itching. normal LFTs, yellow skin/sclera
(intra) hepatic
- conj/unconj
- causes
- effect
- conjugated and unconjugated mixture
- (Ischaemia- prehep?), hepatitis, hepatocellular cancer, congestions, haemochromatosis, alcoholic liver disease, PBC,PSC
- dark urine pale stool. itching. abnormal LFTs
post hepatic
- conj/unconj
- causes
- effect
- conj
- intramural - gallstones.
mural- cholangiosarcoma, strictures, inflammation
extramural - pancreatic / abdominal cancer
- intramural - gallstones.
- dark urine pale stool. itching. abnormal LFTs
where do most gall stones form
gall bladder
risk factors for gall stones
female fat fertile (less than 50) liver disease ileal disease
gall stones symptoms
jaundice
weight loss
pain
looks like malignancy
LFTs
enzymes released from hepatocytes due to damage
AST/ALT
gall stones in gall bladder vs bile duct
- effects
- treatment
gall bladder
- cholecystitis (gall blad)
- no cholangitis (bile duct)
- no pancreatitis
- maybe obstructive jaundice
- choltsteomy (laproscopic)
- -bile acid dissolution
bile duct
- no cholecystitis (gall blad)
- cholangitis (bile duct)
- pancreatitis
- obstructive jaundice
- ERCP - examine and remove stones (basket/balloon, crushing)
- surgery if large stones
congestion
venous congestion from right sided heart failure
diverticulitis
infected diverticula
= pockets in the lining of the large bowel that develop with age
compensated liver
liver function maintained
decompensated liver
fucntion decline
- jaundice
- low albumin
- ascites
- coagulopathy
- encephalopathy
acute liver failure =
acute on chronic liver failure =
= acute liver injury with encephalopathy and deranged coagulation in a patient with a previously normal liver
= liver failure as a result of decompensation of chronic liver disease
asterixis=
- what
- associated with what
liver flap, flapping tremor (extend wrists back the wrists flapping tremor)
hepatic encephalopathy, cirrhosis, acute liver failure, opiate overdose, Wilsons
fulminant liver failure
1) =
2) classification
massive hepatocyte necrosis –> severe function impairment
classification based on onset of encephalopathy after jaundice onset
- hyperacute = within 7 days
- acute - 8-28 days
- subacute - 5-26 weeks
- reduced risk of cerebral oedema with less acute classes
