Liver Flashcards
Bilirubin pathway
Erythrocyte
Heme
Bilirubin
Bilirubin (conjugated)
Types of jaundice
Pre-hepatic
Hepatic
Post- hepatic
Extrahepatic biliary obstruction
Dilated common bile duct on ultrasound
Gallstones, cancer of pancreatic head, stricture
Intrahepatic obstruction
Cholestasis
Causes of acutely inflamed liver
Drug induced- flucloxacillin
Alcoholic hepatitis- acute on chronic
Virus- hepatitis A, B, E, CMV, EBV
Autoimmune
PBC
Unconjugated hyperbilirubinaemia vs conjugated hyperbilirubinaemia
Determined through bloods
Level of bilirubin to be visibly jaundice
> 50
Signs of chronic liver disease
Liver flap
Splenomegally
Palma erythema
Ascites
Gynaecomastia
Spider nivae
Caput medussa
Hepatitic enzymes
Transaminases
ALT/ GT
Reasonable sign of excessive alcohol
Raised gamma GT
Raised INR
Liver failure
Warfarin
DIC
Vitamin K deficiency
Vitamin K deficiency
2,7,9,10 vitamin K dependent
Can’t be produced so INR increases
Bile needed to absorb fat, can’t come out of bile duct in bile stone so vitamin K deficiency
Further blood tests
Hepatitis A ab
Hepatits C ab
Hepatitis BsAg
Autoantibodies
- antimitochondrial antibodies PBC
- anti-smooth muscle, anti nulcaer antibdoy - autoimmune hepatitis
Ferritin- hhaemochromotosis
Copper studies- Wilson’s disease
IgG- raised in autoimmune hepatitis
IgA- raised in alcoholic liver disease
IgM- raised in PBC
Autoimmune hepatitis on liver biopsy
Fibrosis
Piecemeal necrosis
Ballooning and rosetting of hepatocytes
Preservation of bile ducts
Treatment of autoimmune hepatitis
Immunosuppressants
- steroids- prednisolone
Introduce azathioprine
Side effects of prednisolone
Osteoporosis
Diabetes
Cataracts
Diagnosis of jaundice
History Examination Special investigations - blood tests - imaging - biopsy
History symptoms
Pruritis- cholestasis
Weight loss- cancer
Pain- obstructive (stones, cancer)
Fevers- (infection)
Lethargy- many liver diseases
Risk factors for jaundice
Alcohol- alcoholic hepatitis
Viral hepatitis risks
- IVDU
- travel
- blood transfusions
- tattoos
- sexual history
Routine liver tests
Bilirubin
ALT
AST - cardiac
ALP
GGT
Albumin - only useful if you know there’s liver disease
INR
Fibroscan
Transient elastography
Measure of liver stiffness
Correlates with fibrosis
Pathway of cirrhosis
Inflammation –>
Fibrosis –>
Cirrhosis
Features of reduced metabolic capacity
Coagulopathy
Reuced albumin
Hypoglycaemia
Features of portal hypertension
Ascites
Hypersplenism
Compensated cirrhosis
No symptoms/ signs
Normal LFTs
Abnormal imaging
Abnormal biopsy
Decompensated cirrhosis
Unwell, jaundice, ascites
Coagulopathy
Low albumin
Encephalopathy
Abnormal LFTs
Abnormal imaging
Causes of cirrhosis
NAFLD
Alcohol
Drug induced
VIral hepatitis
Biliary disease
Autoimmune liver disease
Portal vein comes from
Splenic vein
Inferior mesenteric vein
Superior mesenteric vein
Portal hypertension complications
Varices
Hypersplenism
Hepatic encephalopathy
Ascites
Hepatorenal syndrome
Hypersplenism
Manifests as low platelets
Thrombocytopenia
Causes of low platelets
Autoimmune disease
IDP
Bone marrow failure
Portal hypertension
Varices
Pressure builds up in portal vein and is dissipated to porto-systemic collaterals
Veins dilated, causing varices
Hepatic encephalopathy
Blood not through liver to be detoxified
Ammonia in systemic circulation through collaterals
