Liver anatomy function tests Flashcards
4 functions of the liver
- delivers bile to duodenum
- carbs -> glycogen
- lipids?
- makes albumin/clotting factors
2 vessels supplying blood to liver
- portal vein
- hepatic artery
which zone has most rich blood supply in liver lobule
- zone 1 near the portal triad
what is the direction of flow in the liver (vessels?)
- from portal vein and artery to central vein
when do you start experiencing symptoms from liver disease
liver at 25% of function
platelets have dropped and INR elevated
severe hepatitis when ALT/AST is
> 15x ULN or > 600
Ddx for severe hepatitis with AST, ALT elevations higher than ALP GGT
- Viral
- Autoimmune
- cocaine
- acute obstruction
Diffuse nodular transformations with fibrosis suggests
CIRRHOSIS
In acute viral (a/e) hepatitis, which enzyme goes up first
ALT
Incubation period of HEV
- ~ 1 mo
causes of chronic hepatitis
- viral B(D), C
- Drug-induced
- Autoimmune
Classic histology of chronic hepatitis
- portal inflammation
- parenchynal inflammation, necrosis
- fibrosis
progression of fibrotic changes
- first portal-portal
- portal- central
- severe necroinflammatory activity
who is most at risk of chronic hepatitis due to viral infection
- neonate
If HBeAg is present in blood, it indicates
person is infectious
how can you treat a HepB infection
- Immune modulation - interferon alpha
- nucleoside analogs
3 things to order if suspect Hep B infection
- HBsAg - infected
- Anti-HBs - immune -
- Anti- HBc - core - resolved infection
If you’re HBs Ag positive then what is the work up
- rest of HEP B antibodies
- Check LFTs - INR, Bili, Alb, Plt, CBC
In the setting of inactive hep B, and active hepatitis think about
Hep D
how do you screen for a Hep C infection
- Anti-HCV (pos -> PCR, check RNA)
- ALT
- AST
Diagnosing alcoholic hepatitis
- AST>ALT
- management: no alcohol, withdrawal, give steroids if acute
Chronic alcoholic hepatitis lab restults
effects on platelets
INR
elevated MCV
Histological features of alcoholic hepatitis
- fat droplets in hepatocytes
- mallory bodies
ballooning
Differences between steatosis and steatohepatitis
steatosis can resolve -
steatohepatitis - with fibrosis chronic damage
where does fibrosis form in the context of steatohepatitis
- Zone 3 - around central vein
Who is at risk for non alcoholic fatty liver disease - NAFLD
- Metabolic syndrome
Contrary to AFLD, NASH lab tests look like
ALT> AST rather than the opposite
- HIGH ferritin (inflammation)
-
Pathogenesis of NASH
2 hit process
1) inflammation hepatic steatosis
2) oxidative stress - steatohepatitis
- extra FFAs
