Liver and gall disease Flashcards
Summarise the Liver’s Blood Supply in 3 points
Arterial:
(1) [OXYGENATED, NUTRIENT POOR] Proper Hepatic Artery
(2) [NUTRIENT RICH, OXYGEN POOR] Hepatic Portal Vein
(3) [OXYGEN + NUTRIENT POOR] = Hepatic Veins
Bile flow: Produced, Function, Types
In liver as PRIMARY BILE ACIDS + SALTS
metabolism of fats
Primary or Secondary
Functions of liver (5)
(1) Detoxification
-filters and cleans blood of waste products
-drugs, hormones
(2) Immune functions
-fights infections and diseases
-RE system
(3) Involved in synthesis of clotting factors, proteins, enzymes, glycogen and fats
Production of bile and breakdown of bilirubin
(4) Energy storage (glycogen and fats)
(5) Regulation of fat metabolism
Ability to regenerate
Microanatomy
Organised in lobules with central (hepatic vein)
Hexagon - portal triads in the “corner”
Types of liver injury
Acute
–>viral (A,B, EBV), drugs, alcohol, vascular –> liver failure
–> recovery
Chronic
–>recovery
–>cirrhosis –> liver failure (varices, hepatoma)
–> alcohol, viral (B, C), autoimmune, metabolic (iron, copper) –> liver failure (varices, hepatoma)
Presentation of acute liver injury
Asymptomatic abnormal LFTs Malaise, nausea, anorexia Jaundice Confusion - think ALF *rarer*: Bleeding Liver pain
Presentation of chronic liver injury
Ascites, oedema Haematemesis (varices) Malaise, anorexia, wasting Easy bruising Itching Hepatomegaly, Abnormal LFTs *rarer*: Jaundice Confusion
Serum “liver function tests” (LFTs)
Albumin ALP – Alkaline phosphatase GGT – gamma GT ALT – Alanine Aminotransferase AST – Aspartate Aminotransferase Bilirubin Globulin
Prothrombin time (PT)/ INR Platelet count -normal LFTs and normal PT and platelet count do not exclude liver disease/ cirrhosis, but while normal the function is relatively preserved
Albumin
Bilirubin
Prothrombin time (PT)
Give some index of liver function
- if normal would suggest a “preserved” liver function
- appears normal
ALP – Alkaline phosphatase
GGT – gamma GT
AST – Alanine Aminotransferase
ALT – Aspartate Aminotransferase
Give no index of liver function
Jaundice causes: (pre, hepatic, post)
Pre-hepatic
-haemolysis
Hepatic
-cirrhosis
-acute hepatitis (viral, alcoholic, autoimmune, drug-induced)
-infiltration of the liver by tumours
Post-hepatic (obstruction of biliary outflow)
-gallstones
-external compression: pancreatitis, lymphadenopathy, pancreatic tumour, ampullary tumour
Bilirubin: what? metabolism? and excretion? what happens if in XS?
Breakdown product of haemoglobin
Metabolised in liver
Excreted via intestine (and renally)
If bilirubin rises and is not excreted the motion turns pale
Bilirubin metabolism can be interrupted at various points
What is meant by Liver Cirrhosis?
What is it as a result of?
Which tissue is dominant and what is the overall result?
What is the implication of blood flow here?
SCARRING of the liver
Result of chronic LONGSTANDING DAMAGE to the liver where SCAR TISSUE replaces healthy tissue (exceed healing capacity of liver) –> leading to disruption of LIVER ARCHITECTURE
= resistance to blood flow through the liver, leading to PORTAL HYPERTENSION and its complication(s)
Causes of chronic liver disease: most common
Alcohol
Non Alcoholic Steatohepatitis (NASH)
Viral hepatitis (B, C)
Jaundice: First Sign + Cause
Scleral jaundice usually first noted
Due to > bilirubin
Less common causes of chronic liver disease (4)
(1) Immune
- autoimmune hepatitis
- primary biliary cirrhosis
- primary sclerosing cholangitis
(2) Metabolic
- haemochromatosis
- Wilson’s
- alpha 1 antitrypsin deficiency…
(3) Vascular
- Budd-Chiari
(4) Drugs
- amiodarone
Weekly safe limits
14 units
Harmful drinking
15-28 units
Hazardous drinking (very heavy)
> 28 units
Binge drinker
Men = >10 units in one session Women = >7 units in one session
Taking an alcohol history
1 unit = 8g EtOH
= half pint normal beer/ lager
= small glass of wine
= pub measure of spirits
Hepatitis B
Type of virus, Transmissions, Immunity and effectiveness of Tx
DNA virus Reads in hepatocyte genome Persists in liver even if no longer in blood Can reactivate Mainly transmitted via intercourse/ vertically Early infection: chronicity Vaccination available Longterm treatment
Hepatitis C
Type of Virus, Transmissions, Immunity and effectiveness of Tx
RNA virus
Mainly transmitted through IVDA; needles blood products
Once cleared = cleared
Reinfection possible - no immunity
Time limited treatment - well tolerated, 90% cure
No vaccination
Non-alcoholic fatty liver disease: Risk Factors, LFT signs, Epidemiology
On the rise; often unrecognised Risk factors -diabetes -obesity -hypertension -dyslipidaemia = metabolic syndrome LFTs may be normal; even in advanced disease Affecting 20% of Western population
