Liver disease CPC Flashcards
What is this
and explain the rest of the architecture in terms of bile, blood, epithelium and sinusoids
Liver
- central vein on the LHS
- Portal triad on RHS (portal vein at top, then below hepatic artery, then bile duct)
bile going from central vein -> portal triad
blood going from portal triad -> sinusoid -> central vein
Sinusoids have a discontinuous epithelium meaning that blood can pass into the space of Disse to interact with hepatocytes
Tell me the difference between the cells in these zones
3 - most metabollically active
also most likely to be affected by reduced blood supply as they recieve oxygen last
What is direct bilirubin?
conjugated bilirubin
indirect bilirubin?
unconjugated
Complete bilirubin?
Total conjugated + unconj
What test do you do if bilirubin does not settle in a newborn?
DAT test or coombs and unconjugated bilirubin
to test for haemolysis
raised bilirubin with all other normal blood tests? (incl blood film and ALP)
Gilbert’s
inheritence of gilberts?
autosomal recessive
how many people carry the gilberts gene and how many of the population have it
50%, thus 6% of population has it
is gilberts common
yes really common - 1 in 20
how to diagnose gilberts
worsened by fasting
pathophysiology of gilberts
UDP glucuronyl transferase activity reduced to 30%
this enzyme usually conjugates bilirubin
so increased unconjugated bilirubin but do not have bilirubinaemia (as this is tightly bound to albumin)
is urobilinogen in urine normal
yes
What test is most representative of liver function?
Prothrombin time (INR)
Sky high ALT - cause of liver failure?
paracaetamol
What indicates need for a liver transplant in paracetamol overdose?
If the PT is higher in seconds since the hours they took the overdose
if not they will be fine
Hepatic
AST and ALT are very high - which means it is hepatic
ALP is up but not really high (<120 is normal). Would be really really high in obstructive (more than the AST and ALT)
ViraL»_space;> ALT would be higher (L - L)
AST:ALT ratio of 2:1»_space;> Alcoholic hepatitis or cirrhosis
Do serology for the viruses +/- biopsy
Prognosis of hepatitis A?
good - you get it and cured or dead
i.e. if you survive (which most do in the UK) you get IgG forever and are cured
buzzwords for alcoholic hepatitis
ballooning and mallory denks
scarring and fibrosis in cirrhosis - by collagen
What is caused by vitamin B1 deficiency? And what is vitamin B1?
B1 - thiamine
Beri-beri!
why do you get gynaecomastia w liver failure?
liver cannot break down oestrodiol
Chronic stable liver disease not liver failure
three signs of portal hypertension?
Caput medusae
and SPLENOMEGALY
(NOT hepatomegaly)
and ASCITES (shifting dullness)
not telangiectasia
What does a flapping tremor show, why?
Liver failure because liver cannot remove toxins thus toxins (?ammonia) are poisoning the brain
micronodular cirrhosis - cause?
alcoholic cirrhosis
what causes itching in jaundice
bile salts/acids
obstructive jaundice
what is courvoisier’s law?
in the prescence of jaundice, if the gall bladder is palpable, the cause is unlikely to be gall stones
this is because the gall bladder with stones is usually small and fibrotic
therefore could be pancreatic cancer…
pancreatic ca is painless
gallstones are painful
