Liver Flashcards
Briefly describe the location and anatomy of the liver
- The liver is located under the right diaphragm
- It is divided into two lobes
- The building block of liver tissue is known as a hepatic lobule
- Each lobule consists of a portal triad, hepatocytes (liver cells that produce bile), central vein (feeds deoxygenated blood into hepatic vein) and a sinusoid (drain into the central vein)
Describe the portal triad
Consists of three branches:
• Hepatic artery: carries oxygenated blood to the hepatocytes
• Portal vein: carries blood with nutrients from the small intestine to the lobule
• Bile duct: carries bile products from hepatocytes to the gall bladder
List the functions of the hepatic system
- Processes dietary amino acids, carbohydrates, lipids and vitamins
- Synthesis plasma proteins, clotting factors
- Excretion of billirubin
- Synthesis of bile salts
- Storage of glycogen, vitamins, minerals
- Detoxification of drugs and hormones
- Activation of vitamin D
List primary diseases of the liver
- Alcoholic Liver Disease
- Non-alcoholic fatty infiltration
- Viral hepatitis
- Hepatocellular carcinoma
List the consequences of hepatic injury
- Jaundice
- Cirrhosis (scarring/ fibrosis)
- Portal Hypertension (increase in pressure within the portal vein due to vessel blockage)
- Hepatic failure (liver stops functioning properly or at all
- Hypoalbuminemia associated hypotension (the liver produces the protein albumin. If the liver doesn’t work, then blood pressure drops)
Provide reasons for the following symptoms of hepatic failure: • Peripheral odema • Ascites • Fetor Hepaticus • Palmar erythema/Spider angiomas • Gynocomastia/hypogonadism • Coagulopathies • Encephalopathy • Hepato-renal syndrome • Hepato-pulmonary syndrome
- Peripheral odema: due to portal hypotension which causes back flow of blood
- Ascites: due to portal hypotension which causes back flow of blood into the stomach area
- Fetor Hepaticus: musty breath odour due to build up of ammonia and ketones
- Palmar erythema/Spider angiomas: PA = rare skin condition where palms are reddish. SA = collection of small, dilated arterioles clustered very close to the surface of the skin)
- Gynocomastia/hypogonadism: diminished function of the gonads = diminished production of sex hormones. Decreased sex hormones in men causes the development of breast tissue
- Coagulopathies: Inability to clot due to the liver’s inability to make clotting factors and splenomegaly caused by postural hypotension, and this results in excessive destruction of the platelets
- Encephalopathy: damages that affect the structure and functioning of the brain due to build up of ammonia
- Hepato-renal syndrome: progressive kidney failure due to liver damage
- Hepato-pulmonary syndrome: shortness of breath and low oxygen levels due to vasodilation in the lungs in patients with liver disease
Explain briefly, the MOA of alcohol on the liver
- Alcohol is hepatotoxic
- Acetaldehyde, a toxic by-product from the breakdown of alcohol, is fibrinogenic (increases fibrosis)
- Alcohol leads to the influx of endotoxins from gut into portal circulation, increased chemokine release
- Chemokines damage hepatocytes
List and describe the three types of alcohol liver disease
- Fatty liver: Fatty liver is excessive accumulation of fat inside liver cells. The liver becomes enlarged, causing upper abdominal discomfort on the right side
- Alcoholic hepatitis: Acute inflammation of the liver accompanied by the destruction of liver cells, followed by permanent scarring. The symptoms might include jaundice, fever, right-sided abdominal pain, weakness and nausea.
- Cirrhosis: The destruction of liver tissue, leaving non-functional scar tissue.
List the symptoms of alcoholic liver disease
- Ankle Oedema
- Jaundice
- Ascites (abnormal build up of fluid in abdomen/ peritoneal. Cavity)
- Splenomegaly (enlarged spleen)
- Hepatomegaly (enlarged liver)
- Nausea/vomiting
- Anorexia
List the oral effects of alcoholic liver disease
- Excessive bleeding
- Unpredictable metabolism of certain drugs
- Increased risk of infection
- Nutritional deficiencies – thiamine, iron
- Petechiae/ecchymoses
- Parotid enlargement
- Oral cancer
Discuss the transmission, infection, cure and prognosis of hepatitis B
Transmission:
Blood, sexual contact and parenteral means (injections) and saliva
Infection:
Affects DNA by integrating its DNA with healthy cells DNA
Cure:
No
Prognosis:
Chronic hepatitis -> stable disease
Chronic hepatitis -> cirrhosis (death) -> hepatocellular carcinoma -> death
Acute infection -> fulminant hepatitis
Discuss the transmission, infection, cure and prognosis of hepatitis C
Transmission:
Blood, sexual contact and parenteral means (injections)
Infection:
RNA integrates itself with DNA
Cure:
Yes
Prognosis:
Acute -> fulminant hepatitis (sudden and intense onset of hepatitis) -> death
Persistent infection -> chronic hepatitis -> cirrhosis (death) -> hepatocellular carcinoma -> death
List oral symptoms of hepatic failure
- Bleeding disorders = impacts procedures and prescription of aspirin
- Foetor hepaticus = halitosis
- Angular cheilitis
- Petechiae/ecchymoses
- Smooth tongue
- Xerostomia
- Bruxism
- Crusted perioral rash
