liver disease causes Flashcards
the 12 functions of the liver
- remove toxins
- drug detox CYP450
- breakdown blood cells into bilirubin
- processes of nutrients from food
- produces bile
- stores sugar
- production of cholesterol
- processing and storage of vitamins
- maintaining nutrients in blood
- protein synthesis of albumin
- manufacture hormones
- clotting factors
which clotting factors does the liver make
all except 8
which vitamins does the liver store
b12, d, iron and cooper
risk factors for liver disease
-alcohol obesity -viral hepatitis -paracetamol overdose -psc -pbc -autoimmune hepatitis -haemochromatosis -alpha 1 antitrypsin deficiency -Budd chiari -wilsons
how many alcoholics get liver disease
1 in 5
3 major pathways of alcohol metabolism
- catalase (need h20)
- alcohol and acetaldehyde dehydrogenase-> NADH
- CYP450
non hepatic presentations of alcohol abuse
intoxification/withdrawal injury eg burns,# epileptic fits neuropathy haematemesis hypertension cardiomyopathy pancreatitis infections eg TB
4 major alcoholic liver disease presentations
alcoholic steatosis alcoholic hepatitis cirrhosis alcoholic cholestasis
what is alcoholic steatosis
inflammation of the liver with fat cells
- often symptomless
- tender hepatomegaly
lfts of alcoholic steatosis
ggtp and mcv increased
mild increase ALT and ALP
prognosis of alcoholic steatosis
increased risk of cirrhosis over 10 yrs
2x mortality rate versus normal population
alcoholic hepatitis symptoms
anorexia vomiting RUQ pain jaundice tender hepatomegaly bruising malnutrition encephalopathy ascites
treatment of alcoholic hepatitis 4
nutritional support
alcohol withdrawal
steroids
pentoxifylline: tnf alpha blocker
what is alcoholic cholestasis
decrease bile flow due to obstruction
- rare
- assoc. to hepatitis stage
alcoholic cirrhosis transplantation abstinence period length
6 months
genetic link for ALD and NALFD
PNPLA3
Transplant contraindications
alcohol abuse IV drug abuse extra hepatic malignancy advanced cardiopulmonary disease alcoholic hepatitis
prophylaxis for ascetic infections
cotrimoxazole
the NAFLD pathway and with years
normal
steatosis 8-13 years
steatohepatitis 8-13 years
fibrosis and cirrhosis 10 years
metabolic syndrome boundaries 5
waist >102 cm or 88cm m:f fasting glucose>6.1 BP >130 or 85 diastolic fasting trig >1.71 HDL cholesterol <1 or 1.3 men and women
risks of obesity
osteoarthritis pulmonary disease stroke cancer gout endocrine heart liver
NAFLD lab findings 4
- mild elevation of ALT most common
- GGT, alk PHOS in 1/3
- ferritin in1/2
- transferrin increased
patients at risk to develop NASH with fibrosis 3
> 45 years
BMI >31
dm
treatment NAFLD 5
-lifestyle
-weight loss meds
exenatide
-phenoxyfyline TNF-A
-thiazolidenoides on adiponectin
-metformin on trig
