LIVER DISEASE Flashcards
Where in the cell is aspartate aminotransferase (AST) located?
Where in the cell is alanine aminotransferase (ALT) located?
► use this information to explain why alcohol causes an increase in one of these enzymes more than the other
- AST: Mitochondria
- ALT: Cytoplasm
♦ alcohol is a mitochondrial toxin and therefore increases AST levels more than ALT
In obstructed bile flow (cholestasis) there is an increase in a certain enzyme, what is the enzyme and which cells synthesise it?
Alkaline phosphatase (ALP)
Synthesised by bile duct epithelium
If ALP is raised, which liver enzyme can help differentiate the cause?
Check GGT
If raised indicates hepatobiliary cause, if not indicates skeletal cause
A more accurate way to describe LFTs would be as liver dysfunction tests. Describe 3 tests that are more indicative of liver functioning. Which tests will become abnormal first?
- Albumin: falls in dysfunction
- PT/PTT: rises in dysfunction
- Glucose: falls in dysfunction (less glycogen breakdown + gluconeogenesis)
These tests indicate liver is beginning to fail, LFTs will become abnormal first
List the three liver conditions alcohol causes in chronological order
- Deposition of fat → alcoholic fatty liver disease
- Acute hepatitis
- Cirrhosis
How can alcoholic fatty liver disease be reversed?
Cessation of drinking
Most liver pathology, including alcoholic fatty liver disease and cirrhosis, affect which zone first? What is an exception to this rule?
Zone 3
Viral hepatitis affects zone 1 first
Which type of liver disease may improve with weight loss? What are the symptoms of this disease and LFTs?
► how can the disease progress?
Non-alcoholic fatty liver disease (NAFLD)
Often asymptomatic
Abnormal LFTs, ALT raised more than AST
► can progress to NASH (non-alcoholic steatohepatitis → fat + inflammation) and cirrhosis
What is the triad of symptoms in alcoholic hepatitis? What is the classic presentation history? What causes the hepatitis?
- RUQ pain
- Fever
- Jaundice
Classically occurs after heavy binge drinking on top of long history of alcohol consumption
Toxic effects of acetaldehyde build up
What is shown?
Mallory body: classic finding in alcoholic hepatitis
Which thrombotic condition can cause abdominal pain, ascites and hepatomegaly?
Budd-Chiari syndrome: caused by occlusion of hepatic veins that drain liver.
► commonly associated with myeloproliferative disorders
Which condition classically causes a “nutmeg liver”? Explain what this is caused by
“Cardiac cirrhosis” secondary to right-sided heart failure
also seen in Budd-Chiari syndrome
Chronic liver oedema ⇒ Cirrhosis
A child with flu is given aspirin and goes on to develop liver failure and encephalopathy. What does this child have? Symptoms?
Reye’s syndrome
Causes mitochondrial damage and fatty changes in the liver
Vomiting, coma, death
► aspirin contraindicated in children except in Kawasaki’s disease
Alpha-1 antitrypsin deficiency is associated with early onset COPD. What is another potential problem that can be caused by this deficiency?
Liver cirrhosis caused by abnormal buildup of alpha-1 in the liver endoplasmic reticulum
NOTE → high yield damage
What is a classic bacteria to cause a liver abscess by entering through the intestines / biliary tree?
Klebsiella
Anti-smooth-muscle antibodies are present in up to 70% of people with which condition? How is this condition typically treated?
Autoimmune hepatitis
Steroids and immunosuppression
Briefly explain why N-acetylcysteine is given in paracetamol overdose
Converted into glutathione which can then metabolise NAPQI into non-toxic metabolite
ITU patients with shock are at increased risk of which type of liver damage? Which zone specifically is affected? Prognosis?
Shock liver (ischaemic hepatitis)
Diffuse liver injury from hypoperfusion, zone 3 necrosis
Self limiting
