Liver disease Flashcards
What are the functions of the liver?
Metabolism Synthesis Immunological Storage Homeostasis Bile production Clearance
MISSHBC
What does the liver metabolise?
Carbohydrate Protein Fat Steroid hormone Insulin Aldosterone Bilirubin Drugs
FABPICSD
What does the liver synthesise?
Proteins Clotting factors Fibrinogen Cholesterol 25 OH vitamin D Glucose from fat and protein
What cells does the immunological function of the liver involve?
Kupffer cells
What does the liver store?
Fat sol vits A, D, K, B12
Folic acid
What molecule does homeostasis of liver include?
Glucose
What is involved in the clearance of the liver?
Bilirubin
Drugs
Toxins
What are the causes of liver disease?
Alcohol Non-alcoholic fatty liver Viral hepatitis Drugs and toxins Metabolic disorder- Wilsons, glycogen storage disease Immune disease- hepatitis, PBC, PSC Vascular abnormality- budd-chiari, veno-occlusive Cancer Biliary tract disorder Infections
What 2 parameters are used to classify liver disease?
pattern of damage
time course of the damage
Describe the 2 patterns of damage?
Cholestatic
Bile flow disrupted
Bile stagnant in bile duct
Hepatocellular
Hepatocyte injured
Fatty infiltration= steatosis
Inflammation= hepatitis
Describe the 2 time courses of damage?
Acute
<6 month symptom onset
Cause= drugs, viral hepatitis
Acute hepatitis= self limiting, spontaneous recovery, leads to acute liver failure or chronic liver disease
Chronic
>6 months symptom onset
Progressive
Permanent structural
There is enough hepatocyte capacity to carry out functions= compensated
Not enough hepatocyte capacity= decompensated
Cause= alcohol, chronic viral hepatitis
What diagnostic blood tests are used to diagnose liver disease?
Bilirubin Transaminase Prothrombin time and INR ratio Alkaline phosphatase Y-glutamyl transferase Albumin
Describe the results of the bilirubin test?
Normal range= 5-20umol/L Increased levels= 1. Haemolysis 2. Hepatocellular damage 3. Cholestasis >50umol/L= clinical jaundice
What is bilirubin?
Produced after RBC breakdown
Transported to liver attached to albumin in serum
Turns into water sol conjugate
Excreted in bile into intestine
Where is Aspartate transferase found?
Heart, liver, skeletal muscle, pancreas, kidney RBC
What is the normal level of Aspartate transferase?
0-40iu/L
Where is Alanine transferase found?
Liver
What are the 2 transaminases used in diagnosis?
Alanine transferase
aspartate transferase
Describe the results of the transaminase test?
Increased levels=
Hepatitis
Due to drugs
Sepsis
What is PT?
blood clotting time= <16 secs
What is INR?
lab measurement on blood clotting time= <1.2
Where is the clotting factor produced and synthesized?
Liver
Describe the results of the PT/INR ratio?
Increased PT/INR =
Acute liver disease
Chronic liver disease
What are the normal levels of Alkaline phosphatase?
30-120iu/L
Where is Alkaline phosphatase found?
Liver, bone, intestine, placenta
Describe the results of the Alkaline phosphatase test?
Increased levels=
Cholestasis
Biliary tree damage
What are the normal levels of Y-glutamyl transferase?
5-55iu/L
Where is Y-glutamyl transferase found?
Liver, biliary epithelial cell, pancreas, kidney, prostate, intestine
Describe the results of the Y-glutamyl transferase test?
Increased levels=
1. Enzyme inducers- alcohol 2. Cholestasis 3. Pancreas carcinoma 4. GIT carcinoma
What are the normal levels of albumin?
35-50g/dL
What is albumin?
Protein
Where is albumin synthesised?
Liver
What is the half life of albumin?
20-26 days
Describe the results of albumin test?
Oedema
Chronic liver disease
What indicates liver dysfunction?
2 tests will be abnormal
2 x upper limit of the range
What can Damage of hepatocyte that is persistent and extensive lead to?
Fibrosis
Cirrhosis
What is Fibrosis?
active deposition of collagen formation of scar tissue
What is Cirrhosis?
erratic regeneration and nodules form
How is Cirrhosis classified?
Pugh point scoring system
What parameters are in the Pugh point scoring system?
Encephalopathy presence Ascites presence bilirubin albumin INR
