Liver Disease And Metabolism Flashcards
Chronic liver disease causes
Alcohol
Fat
Metabolic syndrome
Viral hepatitis
Biliary disease
Autoimmune disease
What are the 4 steps of liver disease progression
Primary injury
Inflammation
Liver cell injury/death
Fibrosis
Why may the liver not be able to regenerate after damage
Damage too advanced
Damage too extensive
Regenerative capacity exhausted
What happens when the liver cannot regenerate after injury
Fibrotic nodules/scar tissue laid down
What factors drive the progression of liver disease
Degree/ number of injuries
Genetics
Micro biome
Environment
Diet
Drugs + toxins
Is cirrhosis reversible
Yes
Liver functions
Protein synthesis and metabolism
Bile production
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function
What substances is the liver involved in metabolism of
Protein
Carbohydrates
Lipids
Hormones
Drugs
Chronic liver disease symptoms
Weight loss
Tiredness
Pruritis
Pale stools
Dark urine
Complications of underlying disease
Pruritis
Severe itching skin
What does the audit C score assess
Alcohol use
Why are travel and illicit drug use important in taking a history for liver disease
Travel to places where hep C is prevalent
Hep C from needles
Signs of liver disease on examination
Nail clubbing
Palmar erythema
Spider naevi
Gynaecomastia
Hair loss
Proximal wasting
Scratch marks
Xanthelasma
How can chronic liver cause xanthelasma
Cholesterol deposits are associated with primary biliary cholangitis
Which tests can be used to asses liver function
Albumin
INR/prothrombin time
Which tests can be used to assess stage of liver disease
Platelet count
ALT/AST
ALT/AST
the ratio between the concentrations of the enzymes aspartate transaminase (AST) and alanine transaminase
What substances can be measured in the blood to assess the liver
Bilirubin
AST
ALT
alkaline phosphate
Gamma glutamyl transpeptidase
What do high AST and ALT in the blood indicate
Liver cell damage
Is AST or ALT more liver specific
ALT
Does high alkaline phosphatase and GGT suggest a hepatic or cholestatic issue
Cholectatic
If AST is higher than ALT is liver damage likely due to alcohol or viruses
Alcohol - unless liver has significant fibrosis
If ALT is higher than AST is liver damage likely die to alcohol or viruses
Viruses - unless liver has significant fibrosis
What is the maximum ALT concentration alcohol can cause
500
What imaging is used in liver disease
Ultrasound
CT
MRI
ERCT/MRCP
What can be viewed using ultrasound in liver disease
Biliary tree
Liver lesions
Ascites
Spleen
Veins
Complications of chronic liver disease
Portal hypertension
Liver failure
malignancy
Why does chronic liver disease cause portal hypertension
Cirrhosis
How much of the livers blood supply if from the portal circulation
75%
What signs and symptoms are caused by portal hypertension
Caput Medusa
Ascites
Splenomegaly
How does liver fibrosis cause portal hypertension
Blood doesn’t flow as easily from portal veins into liver so pressure in portal vein incr
What effect of chronic liver disease causes ascites
Portal hypertension
How does portal hypertension cause ascites
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
How does the RAAS cause a viscous cycle in patients with ascites
Ascites -> decr circ volume -> RAAS activation -> more H2O reabsorbed
What does back flow of blood into the spleen due to portal hypertension cause
Splenomegaly
How does portal hypertension cause hepatorenal syndrome
RAAS causes renal vasoconstriction and hypoperfusion of the kidney
Ascites treatment
Low salt diet
Diuretics
TIPPS
TIPPS
small stent between portal and systemic vasculature
Why does why does portal hypertension cause varicella bleeding in the eosophagus
Blood seeks alternative channels
Varicella bleeding treatment
Resuscitation
Terlepressin
Antibiotics
Banding
Injection sclerotherapy
TIPPS
How can variceal bleeding due to portal hypertension be prevented
Beta blocker - Propranolol/Carvedilol
Banding
When does hepatic decompensation occur
Liver no longer completes life preserving functions
What can occur when the liver stops removing toxins from the blood due to Decompensation
Encephalopathy
Hepatic encephalopathy causes
Sepsis
Bleeding
Drugs
Deteriorating liver function
Hepatic encephalopathy
Confusional state precipitated by liver disease
Hepatic encephalopathy treatment
Lactulose
Transplant
How is ammonia produced in the GI tract
Glutamine broken down to glutamate + ammonia
What usually happens to ammonia produced in the GI tract
Converted to urea in the liver and excreted by the kidneys, or combined with glutamate in the muscles to form glutamine
What type of liver disease is shown by a class A child-Pugh score
Compensated
What type of liver disease is shown by a class B or C Child-Pugh score
Decompensated
What type of cancer may be caused by liver disease
Hepatocellular carcinoma
Hepatocellular carcinoma risk factors
Hepatitis
Cirrhosis
Male
African or Asian ethnicity
Smoking
Family history
Hepatocellular carcinoma treatment
Radiofreq ablation
Transarterial chemoembolisation
Drugs
Surgical resection
Liver transplant
What percentage of hepatocytes containing fat is increased
5-10%
