Liver and Friends Flashcards
What are the normal Functions of the Liver?
Protein Synthesis - albumin
Glucose and Fat metabolism
Detoxification and Excretion - drugs, hormones, bilirubin
Defense against infection - complement factors, clotting factors
Bile synthesis
What can chronic liver disease lead to?
Liver cirrhosis
Subsequent Liver failure
What does Acute Liver disease lead to?
Recovery - ability to regenerate
Acute Liver Failure
What is Acute Liver injury?
severe acute liver injury from a primary liver aetiology. It is characterised by liver damage (i.e. elevated transaminases) and impaired liver function (e.g. jaundice and coagulopathy with INR > 1.5). Hepatic encephalopathy is absent.
What are some causes of acute liver injury?
Viral A, B, EBV
Drugs - Paracetamol
Alcohol
Vascular – ischaemia (Budd Chiari Syndrome)
Obstruction – usually bile
Congestion – from heart failure
What are some causes of chronic liver disease?
Alcohol
Viral infection - Hepatitis (B/C)
Autoimmune liver disease
Metabolic dysfunction - iron/copper overload
NAFLD
What is a typical presentation of acute liver injury?
Non-specific signs:
Malaise
Nausea
Anorexia
Jaundice
GI Upset
Jaundice
Hepatomegaly
What are some common presentations of chronic liver disease?
Ascites
Oedema
Haematemesis (varices) – vomiting blood
Malaise
Anorexia
Wasting
Easy bruising
Itching
Erythema nodosum
Spider naevi
Hepatomegaly
Abnormal LFTs
Jaundice (rarer)
Confusion rarer)
What are the key liver function tests?
Serum Albumin - decreases in injury
Serum Bilirubin - increases in injury
Prothrombin time - increases in injury
Serum Liver Enzymes:
Hepatocellular - Transaminases (AST, ALT)
Cholestatic - Alkaline, Phosphatase Gamma GT
What LFT markers assess the livers synthetic function?
(what would happen to these markers in disease?)
Bilirubin (increase)
Albumin (decrease)
Prothrombin Time (increase)
What LFT markers would be raised in hepatocellular injury?
ALT
AST
What would the Ratio of AST/ALT suggest?
ALT>AST - chronic liver disease
AST>ALT - cirrhosis or acute alcoholic hepatitis
What LFT makers would be raised in cholestatic injury?
Alkaline Phosphatase (ALP/AP)
Gamma-glutamyltransferase (GGT)
What causes the yellow colour in jaundice?
The accumulation of bilirubin in the blood
What are the different classifications of jaundice?
Pre-hepatic - haemolysis, gilberts
Hepatic - liver damage/disease
Post hepatic - obstruction/biliary
What would be the colour/changes to urine and stools in pre hepatic jaundice?
Urine - Normal
Stools - Normal
Itching - None
Liver Tests - Normal
What would be the colour/changes to urine and stools in Intra hepatic/ Post Hepatic jaundice?
Urine - Dark
Stools - May be pale
Itching - Maybe
Liver Tests - Abnormal
What should be considered asking when a Px presents with Jaundice?
- Dark urine/ Pale stools, Itching
- Symptoms - Biliary pain, Rigors, abdo swelling, weight loss
- PHx - biliary disease, malignancy, HF, Autoimmune
- Drug Hx
- Social Hx - alcohol, Recent travel, IVDU
- FHx
What Tests would be wanted in a Px with Jaundice?
Liver enzymes - Very high AST/ALT suggests liver disease
Ultrasound - dilation of hepatic bile ducts in biliary obstruction
CT, MRCP, ERCP
What are MRCP/ERCPs?
Magnetic Resonance cholangiogram
Endoscopic Retrograde Cholangiogram
Where do Gallstones most commonly form?
In the gall bladder
What are the components of Gallstones?
70% cholesterol
30% pigment +/- Calcium
What are the risk factors for gallstones development?
4Fs
Female,
Fat
Fertile
Forty
(but can affect anyone)
What is the presentation of a Px with Gallstones?
Biliary Pain
Obstructive jaundice