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MET2 > Liver Disease And Metabolism > Flashcards

Liver Disease And Metabolism Flashcards

1
Q

Chronic liver disease causes

A

Alcohol
Fat
Metabolic syndrome
Viral hepatitis
Biliary disease
Autoimmune disease

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2
Q

What are the 4 steps of liver disease progression

A

Primary injury
Inflammation
Liver cell injury/death
Fibrosis

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3
Q

Why may the liver not be able to regenerate after damage

A

Damage too advanced
Damage too extensive
Regenerative capacity exhausted

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4
Q

What happens when the liver cannot regenerate after injury

A

Fibrotic nodules/scar tissue laid down

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5
Q

What factors drive the progression of liver disease

A

Degree/ number of injuries
Genetics
Micro biome
Environment
Diet
Drugs + toxins

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6
Q

Is cirrhosis reversible

A

Yes

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7
Q

Liver functions

A

Protein synthesis and metabolism
Bile production
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function

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8
Q

What substances is the liver involved in metabolism of

A

Protein
Carbohydrates
Lipids
Hormones
Drugs

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9
Q

Chronic liver disease symptoms

A

Weight loss
Tiredness
Pruritis
Pale stools
Dark urine
Complications of underlying disease

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10
Q

Pruritis

A

Severe itching skin

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11
Q

What does the audit C score assess

A

Alcohol use

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12
Q

Why are travel and illicit drug use important in taking a history for liver disease

A

Travel to places where hep C is prevalent
Hep C from needles

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13
Q

Signs of liver disease on examination

A

Nail clubbing
Palmar erythema
Spider naevi
Gynaecomastia
Hair loss
Proximal wasting
Scratch marks
Xanthelasma

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14
Q

How can chronic liver cause xanthelasma

A

Cholesterol deposits are associated with primary biliary cholangitis

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15
Q

Which tests can be used to asses liver function

A

Albumin
INR/prothrombin time

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16
Q

Which tests can be used to assess stage of liver disease

A

Platelet count
ALT/AST

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17
Q

ALT/AST

A

the ratio between the concentrations of the enzymes aspartate transaminase (AST) and alanine transaminase

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18
Q

What substances can be measured in the blood to assess the liver

A

Bilirubin
AST
ALT
alkaline phosphate
Gamma glutamyl transpeptidase

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19
Q

What do high AST and ALT in the blood indicate

A

Liver cell damage

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20
Q

Is AST or ALT more liver specific

A

ALT

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21
Q

Does high alkaline phosphatase and GGT suggest a hepatic or cholestatic issue

A

Cholectatic

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22
Q

If AST is higher than ALT is liver damage likely due to alcohol or viruses

A

Alcohol - unless liver has significant fibrosis

23
Q

If ALT is higher than AST is liver damage likely die to alcohol or viruses

A

Viruses - unless liver has significant fibrosis

24
Q

What is the maximum ALT concentration alcohol can cause

A

500

25
Q

What imaging is used in liver disease

A

Ultrasound
CT
MRI
ERCT/MRCP

26
Q

What can be viewed using ultrasound in liver disease

A

Biliary tree
Liver lesions
Ascites
Spleen
Veins

27
Q

Complications of chronic liver disease

A

Portal hypertension
Liver failure
malignancy

28
Q

Why does chronic liver disease cause portal hypertension

A

Cirrhosis

29
Q

How much of the livers blood supply if from the portal circulation

A

75%

30
Q

What signs and symptoms are caused by portal hypertension

A

Caput Medusa
Ascites
Splenomegaly

31
Q

How does liver fibrosis cause portal hypertension

A

Blood doesn’t flow as easily from portal veins into liver so pressure in portal vein incr

32
Q

What effect of chronic liver disease causes ascites

A

Portal hypertension

33
Q

How does portal hypertension cause ascites

A

Water pushed from portal vasculature to abdo cavity due to -
Incr pressure in portal veins
Decr oncotic pressure exerted by albumin
Less breakdown of vasodilator peptides

34
Q

How does the RAAS cause a viscous cycle in patients with ascites

A

Ascites -> decr circ volume -> RAAS activation -> more H2O reabsorbed

35
Q

What does back flow of blood into the spleen due to portal hypertension cause

A

Splenomegaly

36
Q

How does portal hypertension cause hepatorenal syndrome

A

RAAS causes renal vasoconstriction and hypoperfusion of the kidney

37
Q

Ascites treatment

A

Low salt diet
Diuretics
TIPPS

38
Q

TIPPS

A

small stent between portal and systemic vasculature

39
Q

Why does why does portal hypertension cause varicella bleeding in the eosophagus

A

Blood seeks alternative channels

40
Q

Varicella bleeding treatment

A

Resuscitation
Terlepressin
Antibiotics
Banding
Injection sclerotherapy
TIPPS

41
Q

How can variceal bleeding due to portal hypertension be prevented

A

Beta blocker - Propranolol/Carvedilol
Banding

42
Q

When does hepatic decompensation occur

A

Liver no longer completes life preserving functions

43
Q

What can occur when the liver stops removing toxins from the blood due to Decompensation

A

Encephalopathy

44
Q

Hepatic encephalopathy causes

A

Sepsis
Bleeding
Drugs
Deteriorating liver function

45
Q

Hepatic encephalopathy

A

Confusional state precipitated by liver disease

46
Q

Hepatic encephalopathy treatment

A

Lactulose
Transplant

47
Q

How is ammonia produced in the GI tract

A

Glutamine broken down to glutamate + ammonia

48
Q

What usually happens to ammonia produced in the GI tract

A

Converted to urea in the liver and excreted by the kidneys, or combined with glutamate in the muscles to form glutamine

49
Q

What type of liver disease is shown by a class A child-Pugh score

A

Compensated

50
Q

What type of liver disease is shown by a class B or C Child-Pugh score

A

Decompensated

51
Q

What type of cancer may be caused by liver disease

A

Hepatocellular carcinoma

52
Q

Hepatocellular carcinoma risk factors

A

Hepatitis
Cirrhosis
Male
African or Asian ethnicity
Smoking
Family history

53
Q

Hepatocellular carcinoma treatment

A

Radiofreq ablation
Transarterial chemoembolisation
Drugs
Surgical resection
Liver transplant

54
Q

What percentage of hepatocytes containing fat is increased

A

5-10%

MET2 (25 decks)

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