Liver Disease Flashcards by Jamie Sanderson

what are the main functions of the liver

metabolism 
digestion
immunity
detoxification
storage energy / nutrients
production of proteins

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what is the largest organ in the body

liver and has the largest surface area

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how much of the cardiac output does the liver receive

25%

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what are the symptoms of liver disease

jaundice

ascites

puritis

change in faeces or urine colour

fat in faeces

blood clotting irregularity

cutaneous signs

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what is jaundice

a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment.

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what is ascites

condition in which fluid collects in spaces within your abdomen. If severe, ascites may be painful

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what is puritis

Pruritus is the medical term for itchy skin.

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what does lft stand for

liver function tests

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what are some examples of LFTs

Generally blood tests

mainly liver enzymes and proteins normal ranges vary

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what are 3 further investigations that can be carried out after lfts

imagine
biopsy
further blood tests e.g. for hepatitis

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what is biopsy

biopsy is a medical procedure that involves taking a small sample of body tissue so it can be examined under a microscope

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What are 4 standard LFTS

ALT alanine transminase
AST aspartate transaminase
ALP alkaline phosphatase
GGT gamma glutamyltransferase

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what are amino transferases

they are inflammation indicators

damaged hepatocytes release both into blood stream and this is highest in viral infection.

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what does the AST to ALT ratio mean

> 2 indicates an alcoholic liver disease

< 1 indicates non alcoholic liver disease

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what is ALT more specific to

liver

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what is ALP specific too

bile

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what is GGT specific too

liver

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what does raised alp and ggt indicate

block of bile ducts

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what are 3 protein based LFTs

Bilirubin

Albumin

Prothrombin

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what does a high amount of bilirubin cause

it can cause jaundice and high levels can predict liver disease

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what is bilirubin a product of

breakdown of haemoglobin

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what is albumin synthesized by

the liver

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what is albumin responsible for

Oncotic pressure in the blood and transport as well as binding of nutrients and drugs

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what can a decrease in albumin cause

fluid retention and indicate liver disease

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what can severe deficit of albumin be due to

malnutrition

What are two clotting factors

prothrombin and prothrombin time

what is prothrombin time

time taken for blood to clot following sample

what does a longer pt time indicate

reduction in clotting factors produced by liver

how is clotting factors expressed

international normalised ratio (INR)

what is the target international normalised ratio

2-3 and higher levels will indicate clotting

state some different types of liver condition

``` acute liver damage chronic liver disorders alcoholic hepatitis cirrhosis bile duct obstruction cancer autoimmune ```

How can liver disease be defined

by time course

what are the two main catagory of liver disease

acute and chronic

what is acute liver disease

a self limiting episode with a history of disease being less than 6 months

what is chronic liver disease

long term damage to the liver with longer than 6 month history

what does chronic liver disease have the potential to change

it has potential for permanent structural changes ``` alchohlic cirrhosis non alcoholic fatty liver disease non alcoholic steatohepatitis viral infection hereditary conditions ```

what does the term acute on chronic mean

sudden deterioration in stable chronic patient

what can liver disease also be classified by

classified by damage

what are two types of damage by which livers can be classified

Cholestatic | hepatocellular

what is cholestatic in reference too

bile flow is reduced or blocked/impaired | elevated ALP, GGT, Bilirubin, Bile acids and Choleserol build

what is hepatocellular in referennce too

damage to hepatocytes ALT and AST release by damaged cells Serum levels may be elevated

what can both hepatocellular and cholestatic damage cause

fibrosis

what symptoms are often associated with severe liver disease

Fluid retention Ascites Portal hypertension Jaundice

what is hepatic encephalopathy

neuropsychological syndrome seen in 70% of patients with cirrhosis

what % of patients will develop sever hepatic encephalopathy

30 - 45%

what is the most common cause of cirrhosis

alcoholic liver disease

what causes the damge in alcoholic liver disease

inflammation PM3A causes the damage

what are the 3 stages of alcoholic liver disease

stage 1 - alcoholic fatty liver disease stage 2 - alcoholic hepatitis stage 3 - cirrhosis

describe the stage 1 of alcoholic liver disease

alcoholic fatty liver disease is caused asymptomaticly and is normaly reversibly by taking a break from drinking

describe the 2nd stage of alcoholic liver disease

alcoholic hepatitis is mainly due to the chronic alcohol use over a long period of time and again progression can be halted by stopping drinking

describe the 3rd stage of alcoholic liver disease

cirrhosis means that if they continue they will die within 5 years

what are the main ways to manage alcoholic liver disease

prevention of use of alcohol

how can we treat alcohol withdrawal

delirium tremens - diazepam

what are the 4 stages of non alcoholic fatty liver disease

stage 1 fatty liver asymptomatic and may be detected by LFTS stage 2 NASH (non alcoholic steatohepatitis stage 3 fibrosis stage 4 cirrhosis

who is at risk of non alcoholic fatty liver disease

Diabetes Type II, Obese, Hypertension, Hypercholesterolemia, smokers, over 50

what is hpatitis

inflamation to the liver

what are the 5 types of viral hepatitis

common A B C Rare D E

What are A and E viral hepatitis caused by

contaminated food and water

What are B - D viral hepatitis caused by

caused by infected body fluids and blood products

What are the initial symptoms of hepatitis a

``` nausea vomiting diarrhoea malaise abdominal discomfort mild fever ```

what other symptoms might they experience if they have hepatitis a

``` jaundice liver enlargement skin rash pale stoole ```

is hepatitis a acute or chronic

acute

how long does hepatitis b take to present

1 to 3 months