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THE PATIENT > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What are the functions of the liver?

A 
Metabolism
Synthesis
Immunological
Storage
Homeostasis
Bile production
Clearance

MISSHBC

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2
Q

What does the liver metabolise?

A 
Carbohydrate
Protein
Fat
Steroid hormone
Insulin
Aldosterone
Bilirubin
Drugs

FABPICSD

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3
Q

What does the liver synthesise?

A 
Proteins
Clotting factors
Fibrinogen
Cholesterol
25 OH vitamin D
Glucose from fat and protein
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4
Q

What cells does the immunological function of the liver involve?

A

Kupffer cells

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5
Q

What does the liver store?

A

Fat sol vits A, D, K, B12

Folic acid

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6
Q

What molecule does homeostasis of liver include?

A

Glucose

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7
Q

What is involved in the clearance of the liver?

A

Bilirubin
Drugs
Toxins

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8
Q

What are the causes of liver disease?

A 
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
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9
Q

What 2 parameters are used to classify liver disease?

A

pattern of damage

time course of the damage

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10
Q

Describe the 2 patterns of damage?

A

Cholestatic
Bile flow disrupted
Bile stagnant in bile duct

Hepatocellular
Hepatocyte injured
Fatty infiltration= steatosis
Inflammation= hepatitis

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11
Q

Describe the 2 time courses of damage?

A

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

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12
Q

What diagnostic blood tests are used to diagnose liver disease?

A 
Bilirubin
Transaminase
Prothrombin time and INR ratio
Alkaline phosphatase
Y-glutamyl transferase
Albumin
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13
Q

Describe the results of the bilirubin test?

A 
Normal range= 5-20umol/L
Increased levels= 
	1. Haemolysis
	2. Hepatocellular damage
	3. Cholestasis
>50umol/L= clinical jaundice
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14
Q

What is bilirubin?

A

Produced after RBC breakdown
Transported to liver attached to albumin in serum
Turns into water sol conjugate
Excreted in bile into intestine

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15
Q

Where is Aspartate transferase found?

A

Heart, liver, skeletal muscle, pancreas, kidney RBC

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16
Q

What is the normal level of Aspartate transferase?

A

0-40iu/L

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17
Q

Where is Alanine transferase found?

A

Liver

18
Q

What are the 2 transaminases used in diagnosis?

A

Alanine transferase

aspartate transferase

19
Q

Describe the results of the transaminase test?

A

Increased levels=
Hepatitis
Due to drugs
Sepsis

20
Q

What is PT?

A

blood clotting time= <16 secs

21
Q

What is INR?

A

lab measurement on blood clotting time= <1.2

22
Q

Where is the clotting factor produced and synthesized?

A

Liver

23
Q

Describe the results of the PT/INR ratio?

A

Increased PT/INR =
Acute liver disease
Chronic liver disease

24
Q

What are the normal levels of Alkaline phosphatase?

A

30-120iu/L

25
Q

Where is Alkaline phosphatase found?

A

Liver, bone, intestine, placenta

26
Q

Describe the results of the Alkaline phosphatase test?

A

Increased levels=
Cholestasis
Biliary tree damage

27
Q

What are the normal levels of Y-glutamyl transferase?

A

5-55iu/L

28
Q

Where is Y-glutamyl transferase found?

A

Liver, biliary epithelial cell, pancreas, kidney, prostate, intestine

29
Q

Describe the results of the Y-glutamyl transferase test?

A

Increased levels=

1. Enzyme inducers- alcohol
2. Cholestasis
3. Pancreas carcinoma
4. GIT carcinoma
30
Q

What are the normal levels of albumin?

A

35-50g/dL

31
Q

What is albumin?

A

Protein

32
Q

Where is albumin synthesised?

A

Liver

33
Q

What is the half life of albumin?

A

20-26 days

34
Q

Describe the results of albumin test?

A

Oedema

Chronic liver disease

35
Q

What indicates liver dysfunction?

A

2 tests will be abnormal

2 x upper limit of the range

36
Q

What can Damage of hepatocyte that is persistent and extensive lead to?

A

Fibrosis

Cirrhosis

37
Q

What is Fibrosis?

A

active deposition of collagen formation of scar tissue

38
Q

What is Cirrhosis?

A

erratic regeneration and nodules form

39
Q

How is Cirrhosis classified?

A

Pugh point scoring system

40
Q

What parameters are in the Pugh point scoring system?

A 
Encephalopathy presence
Ascites presence 
bilirubin
albumin
INR

THE PATIENT (8 decks)

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