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Metabolism CC > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

3 Major causes of liver disease

A

Obesity
Undiagnosed infection
Harmful drinking

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2
Q

Liver shrinks if it has..

A

Cirrhosis

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3
Q

Cirrhosis causes

A 
Alcohol
Fat/Metabolic syndrome
Viral hepatitis - HBV/HCV
Biliary disease
Autoimmune
Metabolic- Wilsons, A1At deficiency
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4
Q

Liver disease progression

A

Primary injury –> inflammation –> liver cell injury/death

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5
Q

If injury overwhelms regenerative potential of liver

A

Fibrosis

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6
Q

Ishak stage

A

Incremental increase in severity of fibrosis

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7
Q

What drives progression of cirrhosis

A 
Degree/no. of insults
Genetics- FLD
Microbiome
Environment
Drugs- methotrexate + NAFLD
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8
Q

Liver Function

A 
Protein synthesis + metabolism - clotting factors, urea breakdown
Bile production
Bilirubin elimination
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function
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9
Q

Chronic liver disease- Systemic symptoms

A

Weight loss
Tiredness
Fatigue

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10
Q

Chronic liver disease- cholestatic symptoms

A

Associated with bile ducts
Pruritis (bile is irritant)
If bile flow interrupted –> pale stools + dark urine

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11
Q

Chronic liver disease- complications of underlying disease

A

Viral hepatitis- immunological symptoms from infection

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12
Q

Chronic liver disease Symptoms

A 
Palmar erythema
Spider naevi
Hair loss
Gynaecomastia
Leuchonychia/Clubbing
Proximal wasting
Scratch marks
Xanthelasma
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13
Q

Indicators of CLD/Cirrhosis

A

Albumin
INR
Platelet count

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14
Q

Aetiology CLD

A

Viral markers
Autoantibodies + immunoglobins
Metabolic- ferritin, HbA1c, Alpha 1 antitrypsin, alphafetoprotein

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15
Q

Bilirubin test

A

Unconjugates vs conjugated

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16
Q

Aspartate aminotransferase (AST)

A

Mitochondrial enzyme
Heart/muscle/kidney
Hepatitis

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17
Q

Alanine aminotransferase (ALT)

A

Liver specific

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18
Q

Alkaline phosphatase

A

Bile canalicular + sinusoidal membranes
Bone/placenta
Cholestasis

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19
Q

Gamma glutamyl transpeptidase (GGT)

A

Hepatocellular
Cholestasis
Alcohol

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20
Q

AST > ALT

A

alcohol

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21
Q

ALT> AST

A

e.g. viruses / NAFLD

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22
Q

Pattern of liver tests

A

ALT/AST= hepatic

Alk Phos/gamma GT= cholestatic

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23
Q

ALT

A

Alcohol doesn’t put ALT >500
500-1500- autoimmune hepatitis
>1500- hepatitis virus/drugs/ischaemia

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24
Q

Blood supply

A

75% is portal

Portal system drains spleen + gut

25
Complications of CLD
Portal Hypertension Splenomegaly Liver Failure
26
Portal Hypertension
Blood from portal vein doesn't flow through as easily as cirrhotic --> increase in hydrostatic pressure within portal veins
27
Portal hypertension- albumin
Not synthesised | --> low oncotic pressure
28
Portal hypertension- Hormones + vasoactive peptide
Not synthesised - -> relaxed endothelium, leaky vessels - -> reduced barrier function - -> drives water out of tissues - -> oedema - -> ascites
29
Splenomegaly
• Spleen starts to consume lots of platelets as it gets larger
30
5 Factors for considering liver function
``` Livers ability to clear bilirubin Ability to make albumin Ability to make clotting factors (PTT) Clearance of ammonia based products- hepatic encephalopathy Ascites ```
31
5-6 Child-Pugh score
Compensated disease | Still performing life preserving functions
32
7-15 Child-Pugh score
Decompensated Cirrhosis Liver no longer functioning At significant death risk- 20-50% within year Transplant
33
Hepatic Encephalopathy
Mild confusion to coma | Result of liver failure
34
Hepatic Encephalopathy precipitated by
Sepsis Bleeding Drugs Deteriorating liver function
35
Hepatic Encephalopathy Diagnosis
Hepatic flap- slow flapping tremor Clinical EEG/MRI changes
36
Hepatic Encephalopathy gut derived toxins
Ammonia
37
Hepatic Encephalopathy treatment
Lactulose- empty out bowel to clear ammonia | Transplant
38
Ammonia production
Deamination of AA's | Liver --> urea cycle --> excretion through kidneys
39
Ammonia reduction purpose
Reduce amount of bacteria in gut- non-absorbable antibiotics | L-orthenine L-arginine to shuttle ammonia away
40
Portal hypertension
Blood needs to find escape route- leave portal system + go back into systemic Happens at porto-systemic anastomoses- Umbilibus, upper oesophagus, rectum and retroperitoneum
41
Oesophageal varices
``` Baggy veins in lumen of oesophagus Thin walled Veins can pop Can stop bleeding by banding Significant mortality --> medical emergency ```
42
Oesophageal varices treatment
R Resuscitation Terlipressin + antibiotics Banding TIPSS- shunt between hepatic + portal vein to reduce portal hypertension
43
Ascites
Kidneys respond to oedema by maintaining circulation BC Kidneys respond to hypovolaemia via RAAS --> compounds starlings forces --> can go into renal failure
44
Ascites treatment
Diuretic - spironolactone to inhibit RAAS Low salt diet Transplant 50% 2 year mortality
45
5 causes of renal decompensation
``` Sepsis Bleeding Drugs Venous occlusion Hepatocellular carcinoma ```
46
Hepatocellular carcinoma
RFs- hepatitis, cirrhosis, male, smoking, fam history, African + Asian Screening every 6 months cirrhotic patients
47
NAFLD
Hepatic steatosis on histology or imaging
48
Normal liver fat
2-3%
49
Increased hepatic fat
5-10%
50
insulin resistance
Drives Fatty liver disease
51
Nutritional deficiency ALD
Poor oral intake refeeding risk Thiamine + vitamin deficiencies Need to replace thiamine --> Wericke's or Korsakoff's encephatlopathy
52
Hepatitis B
DNA blood-borne virus Immune response causes damage Inflammation --> fibrosis --> cirrhosis --> liver failure --> cancer
53
Hep B HBV antigens
HBsAg- infected HBeAg- viral replication HBcAg- not in blood
54
Hep B treatment
Pegylated interferon Nucleoside + nucleotide analogues --> cirrhosis can be halted, v effective
55
Haemochromatosis
Iron overload C282T mutation of HFE gene (Chr 6) Serum iron >30 Venesection treatment
56
Autoimmune hepatitis
Treatment- prednisolone + azathioprine
57
Primary Sclerosing Cholangitis
Increase risk of cholangiocarcinoma + hepatocellular carcinoma
58
Wilson's disease
``` Increase copper accumulation Liver- cirrhosis Basal ganglia- neuropsychiatric Kidneys- Fanconi's syndrome Eyes- Keyser-Fleischer rings ```

Metabolism CC (29 decks)

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