Liver Disease

Question 1

Liver functions

Answer 1

Metabolism and digestion
Imunity
Detoxification
Energy/nutrient storage
Protein production

Question 2

Bile function

Answer 2

Neutralise stomach acid
Fatty acid transport and metabolism
Increasing solubilty in the GIT

Question 3

Liver disease symptoms

Answer 3

Jaundice
Ascites
Puritis
Change in colour of excretions
Irregular bood clots

Question 4

Liver function tests

Answer 4

Enzymes - ALT,AST,GGT,ALP - raised in liver disease
Proteins- Bilirubin - total raised, conjugated reduced
-Albumin - lowered as synthesised in liver
Clotting factors - Prothrombin time- longer(vitK,lack of
clotting factors)
- INR

Question 5

Liver disease classification

Answer 5

Acute - self limiting, 6 months, permanent structural damage
Cholestatic - Obstruction to bile flow (ALP,GGT,bili.,chol.)
hepatocellular - Hepatocyte damage (ALT,AST)

Question 6

Liver disease progression

Answer 6

Normal ->inflammatory damage (fibrosis) ->disrupted structure & loss of function (cirrhosis) -> failure

Question 7

Encephalopathy

Answer 7

Neuropyscological
Sudden deterioration during end stage failure
Change in behavious

Question 8

Alcoholic liver disease

Answer 8

Stage 1: Alcoholic fatty liver disease
Reversible if alcohol stopped. Asymptomatic
Stage 2: Alcoholic hepatitis
Progress halted by alcohol reduction
Stage 3:cirrhosis
Unlikely to survive past 5yrs unless permanent
alcohol stop
Management: Stop alcohol, treat withdrawal (diazepam)
IV thiamine for definciency

Question 9

Non-alcoholic fatty liver disease

Answer 9

Stage 1: Fatty liver, asymptomatic
Stage 2: Nonalcoholic steatohepatitis
               fibrotic tissue between hepatocytes, pain
Stage 3:fibrosis
Stage 4:Cirrhosis
Obesity linked, treat underlying cause

Question 10

Heapatitis

Answer 10

A - Faecal-oral transmission, self limiting, vaccine available.
Nausea, vom., diarrhoea, malaises, jaundice, pale stools

B- Blood/sex transmission. Self limiting, vaccine available
Symptoms as A

C - Blood transmission. No vaccine, antibiotics required
Hep C blood tests for diagnosis

Question 11

Paracetamol toxicity

Answer 11

Normally metabolised by CYP450 into NAPQ1. High NAPQ1, glutathionone can’t conjugate all into safe product -> toxic effects
Urgent IV acetylcysteine

Question 12

Hyponatraemia

Answer 12

Increased free drugs in the plasma.
Increased sensitivity to anticoags. due to less cloting factors
increased fluid retention