Liver Disease Flashcards
what are the main functions of the liver
metabolism digestion immunity detoxification storage energy / nutrients production of proteins
what is the largest organ in the body
liver and has the largest surface area
how much of the cardiac output does the liver receive
25%
what are the symptoms of liver disease
jaundice
ascites
puritis
change in faeces or urine colour
fat in faeces
blood clotting irregularity
cutaneous signs
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.
what is ascites
condition in which fluid collects in spaces within your abdomen. If severe, ascites may be painful
what is puritis
Pruritus is the medical term for itchy skin.
what does lft stand for
liver function tests
what are some examples of LFTs
Generally blood tests
mainly liver enzymes and proteins normal ranges vary
what are 3 further investigations that can be carried out after lfts
imagine
biopsy
further blood tests e.g. for hepatitis
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
What are 4 standard LFTS
ALT alanine transminase
AST aspartate transaminase
ALP alkaline phosphatase
GGT gamma glutamyltransferase
what are amino transferases
they are inflammation indicators
damaged hepatocytes release both into blood stream and this is highest in viral infection.
what does the AST to ALT ratio mean
> 2 indicates an alcoholic liver disease
< 1 indicates non alcoholic liver disease
what is ALT more specific to
liver
what is ALP specific too
bile
what is GGT specific too
liver
what does raised alp and ggt indicate
block of bile ducts
what are 3 protein based LFTs
Bilirubin
Albumin
Prothrombin
what does a high amount of bilirubin cause
it can cause jaundice and high levels can predict liver disease
what is bilirubin a product of
breakdown of haemoglobin
what is albumin synthesized by
the liver
what is albumin responsible for
Oncotic pressure in the blood and transport as well as binding of nutrients and drugs
what can a decrease in albumin cause
fluid retention and indicate liver disease
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
