Liver COPY Flashcards
Give some functions of the liver. Name what diseases can occur if these go wrong.
- Detoxification (clears ammonia, for example) - hepatic encephalopathy
- Albumin production - hypoalbuminaemia = oedema = ascites, leukonychia
- Clotting factor production (except 8) - easy bruising and easy bleeding
- Immunity (Kupffer cells in reticuloendothelial system) - spontanoeus peritonitis can occur
- Metabolises carbohydrates - hypoglycaemia
- Bilirubin regulation - jaundice (stool and urine changes), pruritis
- Oestrogen regulation - gynecomastia (men), spider naevi (normal but pathological if > 5, caused by vasodilation), palmar erythema
- Unknown - Dupuytren’s contracture, clubbing
Give 2 possible outcomes of acute liver disease.
2 possible outcomes: recovery or liver failure
Give 5 causes of acute liver disease.
- Viral hepatitis
- Drug induced hepatitis
- Paracetamol DILI
- Vascular
- Obstruction
What are the signs and symptoms of acute liver disease/injury?
- Malaise
- Nausea
- Anorexia
- Jaundice
- Rare:
- Confusion
- Bleeding
- Pain
- Hypoglycaemia

Give 2 possible outcomes of chronic liver disease.
- Recovery
- Cirrhosis - then liver failure
What are the signs and symptoms of chronic liver disease/injury?
- Ascites
- Oedema
- Dupuytren’s contracture
- Malaise
- Anorexia
- Pruritus
- Clubbing
- Palmar erythema
- Xanthelasma
- Spider naevi
- Hepatomegaly
- Bleeding
- Haematemesis
- Easy bruising
Give 6 causes of chronic liver disease.
- Alcohol
- NAFLD
- Viral hepatitis (B, C, E)
- Autoimmune diseases
- Metabolic, e.g. haemochromatosis
- Vascular, e.g. Budd-Chiari
Describe the progression from a chronic liver condition to chronic liver failure.
Chronic liver condition, e.g. NAFLD, Hep B - Liver damage - Liver symptoms - Liver cirrhosis if prolonged - Liver failure ultimately and high risk of hepatocellular carcinoma

In terms of LFTs, which ones give you an idea of how the liver was working?
- Serum bilirubin
- Serum albumin
- Prothrombin time - INR
What do the liver hepatic enzymes indicate? What do the levels of some enzymes tell us?
- They DO NOT tell us how well the liver is working but indicate liver damage
- AST and ALT (aminotransferases) = raised in hepatocyte damage. ALT is more specific in hepatocellular disease
- ALP (alkaline phosphate) = raised in intra/extrahepatic disease of any cause, e.g. gallstones, primary biliary cirrhosis. Marker for damage to the biliary tree. NOTE: also raised in bone resorption
- GGT (gamma-glutamyl transferase) = raised in alcoholic liver disease
What is the definition of liver failure? What are the causes of liver failure?
- Liver failure = liver loses its ability to repair and regenerate leading to decompensation (characterised by: abnormal bleeding, ascites, hepatic encephalopathy, jaundice). Acute (< 26 weeks) or chronic
- Infection – viral hepatitis
- Metabolic – Wilson’s/Alpha 1 antitrypsin
- Autoimmune:
- PBC – interlobular ducts
- PSC – intra and extra hepatic
- Neoplastic:
- HCC
- Metastatic disease
- Vascular:
- Budd Chiari – occlusion of hepatic veins
- Ischaemia
- Toxins:
- Paracetamol
- Alcohol
What are the symptoms of liver failure?
- Same as acute presentation:
- Malaise
- Nausea
- Anorexia
- Jaundice
What are the signs of liver failure?
- Coagulopathy (increased prothrombin time/INR)
- Hepatic encephalopathy:
- Altered mood/dyspraxia
- Liver flap/asterixis
- Fetor hepaticus:
- Sweet and musty breath / urine
What are the investigations for liver failure?
- Clinical examination = jaundice, liver flap, confused, change in personality (for example, from family member)
- Bloods:
- Increased PT
- Increased AST / ALT
- Toxicology screen - to look for alchol etc.
- FBC (as alcohol can cause macrocytic anaemia), U&E
- If ascites present:
- Peritoneal tap with microscopy and culture
How do we treat liver failure?
- Conservative:
- Fluids
- Analgesia
- Medical = treat complications:
- Ascites - diuretics
- Cerebral oedema - Mannitol = decreases intercranial pressure
- Bleeding - Vitamin K but if actively bleeding, e.g. haematemesis, give FFP
- Encephalopathy - lactulose (increases ammonia absorption in bowels = excretion)
- Sepsis - sepsis 6 (BUFALO = blood cultures, urine output, fluids, antibiotic, lactate, oxygen), antibiotics
- Hypoglycaemia - dextrose
- Surgical:
- Transplant
What happens to alcohol in the liver (excessive)?
- Acted upon by one of 3 enzymes: cytochrome P450 2E1, alcohol dehydrogenase, or catalase
- All 3 pathways lead to the conversion of alcohol to acetaldehyde
- Once alcohol dehydrogenase converts alcohol, NAD+ is needed which is converted into NADH. Higher NADH levels = more fatty acids, low NAD+ levels = less fatty acid oxidation. Combined = more fat production in the liver
- ROS also produced and react with components of hepatocytes, e.g. proteins = serious damage
- Acetaldehyde can bind to macromolecules + inhibit them - recognised as foreign and destroyed by the immune system - leads to inflammation and eventual cirrhosis

What are the 3 stages of alcoholic liver disease?
- Fatty liver (steatosis)
- Alcohol hepatitis (presence of Mallory bodies)
- Alcohol cirrhosis - destruction of liver architecture and fibrosis

What are the signs and symptoms of alcoholic liver disease?
- Fatty liver = vague abdominal signs, e.g. nausea, diarrhoea
- Alcoholic hepatitis = jaundice, ascites, clubbing, hepatosplenomegaly
What might be seen histologically that indicates a diagnosis of alcoholic liver disease?
Neutrophils and fat accumulation within hepatocytes
What are the investigations for alcoholic liver disease?
- GGT very raised; AST and ALT mildly raised. This is because of leakage due to damage to hepatocytes
- FBC - Macrocytic anaemia
What blood test might show that someone has alcoholic liver disease?
Serum GGT (gamma-glutamyl transferase) will be elevated
What distinctive feature is often seen on biopsy in people suffering from alcoholic liver disease?
Mallory bodies
What are the complications of alcoholic liver disease?
- Wernicke-Korsakoff encephalopathy:
- Presents with ataxia, confusion, nystagmus, memory impairment
- Treat with IV thiamine
- Acute/chronic pancreatitis
- Mallory-Weiss tear
What is the treatment for alcoholic liver disease?
- Alcohol abstinence
- Treat malnutrition with good diet and thiamine






















