Liver Disease Flashcards
4 main liver functions
Digestive
Endocrine
Hematologic
Excretory
Also: Detox, drains bile, glucose regulation, synthesizes and stores AA/proteins/vitamins.
Gall bladder function
Storage of bile
Pancreas functions (2)
Digestive, endocrine.
5 types of liver injury
- Toxic - ETOH, meds like acetaminophen
- Infectious
- Neoplastic- secondary is more common
- Metabolic- non alcoholic fatty liver disease
- Circulatory
4 stages of progressive liver disease
Normal liver can lead to hepatitis or steatosis by severe exposure.
Hepatitis- cell necrosis, inflammation
Steatosis- Accumulative adaptation. Fatty change.
Repeated attacks or continued exposure can lead to:
Cirrhosis- fibrosis, nodules
Two forms of liver degeneration
Hydrophobic (watery) due to toxins
Fatty due to alcohol, obesity, type 2 DM
Liver injury can result in:
Inflammation, degeneration (watery or fatty), necrosis, fibrosis.
How does fibrosis affect liver?
Scarring causes architectural change and reduces function.
Prehepatic jaundice vs hepatic jaundice vs posthepatic jaundice
Pre: Liver is fine. Excess production of bilirubin. Maybe hemolytic event.
Hepatic: Defective liver function due to hepatitis, drugs or cirrhosis.
post: Biliary obstruction, gallstones, pancreatic cancer.
Steatosis
- Reversible?
- Accumulation of what
- Risk factors?
- Increase risk of what
Reversible
Accumulation of triglycerides in liver cells
Risk factors: Alcohol, diabetes, obesity, high fat.
increase risk of hepatocellular carcinoma.
Fulminant hepatic failure
- What is it
- 2 main causes
Rapidly progresses to hepatic failure and encephalopathy in weeks. due to acetaminophen overdose (46%) or hepatitis (10%)
Cirrhosis
Endpoint of liver disease.
Fibrosis of entire liver
Irreversible
Side effects: portal hypertension
Main causes of cirrhosis
Hepatitis C virus
Alcohol
Cryptogenic cirrhosis- at least 1 risk factor for NAFLD.
Portal HTN
- causes
- symptoms
Due to slow hepatic blood flow or enlarged spleen.
Anorexia, varices, ascites.
Most common complication of cirrhosis
Ascites
Increased hydrostatic pressure.
50% 2 year survival rate.
Kidney will activate RAAS when fluid in veins decrease because all the fluid is in the abdomen. This causes BP to increase = more HTN. Bad cycle.
results in widespread bleeding since coagulation cascade proteins are made in liver.
Main cause of acute liver failure
Acetaminophen
How does hepatic failure affect men and women
Due to failure to metabolize estrogen and ammonia.
Men: Excess estrogen leading to gynecomastia, impotence, testicular atrophy, female hair distribution.
Women: Irregular periods, reddening of plasma, spider telangiectasia.
How can hepatic failure cause multiple organ failure?
Due to portal hypertension.
Liver function tests look at
enzymes, bilirubin, proteins, coagulation tests, hepatitis antigens, autoimmune antibodies
Main 4 things to look for in blood panel if kidney failure
Calcium Glucose Creatinine Albumin Blood urea nitrogen (BUN)
What occurs during each of these stages and is recovery possible?
Fatty liver
Liver fibrosis
Cirrhosis
Fatty liver- deposits of fat causes liver enlargement. Strict abstinence= full recovery
Liver fibrosis- Scar tissue forms. Recovery possible, but scar tissue will remain.
Cirrhosis- Growth of connective tissue destroys liver cells and this is irreversible.
#1 cause of acute hepatitis #1 cause of chronic hepatitis #2 cause of chronic hepatitis
Viral
Viral
Alcohol
After having viral hepatitis, you could become a carrier. Which type is most common for this to occur
Hep C > Hep B
Can usually clear A
How to catch hep A, B, and C
A: oral fecal
B and C: needle, sexually
Reyes syndrome
- What is it
- Due to what
- Findings/main cause of death
- __% mortality rate
Fatty liver + encephalopathy
Due to viral infection + aspirin. Which is why you never give someone under 15 aspirin. !!!!!!
Hypoglycemia is main cause of death
Prognosis poor 50% death
Hepatocellular carcinoma
- Risk factors
- What protein is elevated in 70% of cases?
Risk- hepatitis B and C, aflatoxins from mods.
Elevated alpha fetoprotein that correlates with tumor.
Hepatolenticular degeneration.
- another name
- What is it?
- May see what in eye
Wilsons
- Impaired excretion of copper= accumulation = toxic
- Kayser Fleischer rings in K
Gallbladder is stimulated by
Fat in the duodenum
How are gallstones produced
-Risk factors
Supersaturated bile prob due to excess cholesterol.
Risk factors- elevated estrogen, obesity, age, cirrhosis.
Exocrine and endocrine pancreas functions
Exocrine: Empties into duodenum. Produces zymogens (proteases) that are not activated until in intestine. Lipases, amylase, and protease inhibitors that prevent premature activation so they can’t act inside pancreas.
Endocrine: Produce insulin and glucagon
Pancreatic diseases are usually related to what functions
Exocrine function- emptying into duodenum.
Ex: Premature activation of protease enzymes, obstruction of common bile duct, pancreatic malignancies- 80% mortality.
Pancreatic cancers cause __% of cancer deaths
7%. Hard to treat.
Acute pancreatitis. 50% are related to
Gallstones.
Short lived, usually resolves.
May cause organ failure due to shock or duodenal obstruction.
Chronic pancreatitis. 60% related to
Alcoholism.
Does not resolve by self, progressive destruction.
May cause jaundice or intestinal malabsorption.
Metabolic liver disease #1 example
NAFLD non alcoholic fatty liver disease.
Progressively gets worse.
1 cause of drug induced liver damage
acetaminophen, ibuprofen
Most common manifestations of NAFLD
Diabetes, obesity, high triglycerides.
First presents as steatosis- accumulation of fat. Reversible.
How can NAFLD progress to cirrhosis
1/3 of adults have NAFLD (fat in liver. Reversible)
2% progress to NASH- non alcoholic steatosis hepatitis. (fat + inflammation)
10% convert to cirrhosis. Chronic inflammation and scarring.
**NAFLD is a big contributor to Cirrhosis.
1 and #2 causes of cirrhosis
Hep C (26%) Alcoholic liver disease (21%)
