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BDS2 BAMS > Liver Diseases > Flashcards

Liver Diseases Flashcards

1
Q

What is the most common reason why acute liver failure occurs?

A

Tends to happen when there is a sudden insult to the liver and liver function loss is RAPID

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2
Q

What is an example of acute liver failure?

A

paracetamol poisoning

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3
Q

Define ‘paracetamol poisoning’

A

= free radical damage to hepatocytes caused by processing paracetamol through an alternative pathway.
= due to a blockage or overloading of normal pathways

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4
Q

What are hepatocytes?

A

Specialised epithelial cells- make up 80% of liver mass

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5
Q

(Paracetamol poisoning) What are the options for treating this early in the process- which drug can be given if an overdose is detected?

A

= can be assessed by blood sample to determine risk
= liver metabolic pathway for paracetamol follows zero order kinetics ( the rate of reaction does not depend on the reactant concentration)

= acetylcysteine can be given if there is a risk of damage above recommended dose- as this is given to block alternative pathways

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6
Q

What 2 things will happen when there is a sudden loss of liver function?

A

=the liver has both synthetic and metabolic functions: both of these will stop
= the ability to make proteins and clotting factors will be lost and ability to decontaminate the blood from toxic substances will be lost

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7
Q

In acute liver failure: Due to the sudden loss of liver function when and what can cause rapid death?

A

= within 5-7 days
= bleeding risk (most likely to lead to death)
= encephalopathy - impairment of brain function cause by high levels of toxins in the blood

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8
Q

Does the liver usually recover after acute liver failure?

A

Yes- given time

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9
Q

What is often the only option for patients suffering from acute liver failure?

A

liver transplant (within a few days)- often not possible

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10
Q

What may happen if a patient suffering from acute liver failure is kept alive for a period of time ?

A

Their own liver may come back into function

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11
Q

What are 3 examples of chronic liver failure?

A

= Cirrhosis
= primary liver cancer
= secondary liver cancer

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12
Q

What is Cirrhosis? (simple definition)

A

= disordered architecture of the liver

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13
Q

How can primary liver cancer occur?

A

= can follow on from cirrhosis
= or can happen due to hepatitis virus infection

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14
Q

How might secondary liver cancer occur?

A

Can be metastatic (development of secondary malignant growths at a distance from the site of primary cancer)
= particularity from bowel tumours where cells from cancer can be washed through portal system and embedded themselves in liver where they grow

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15
Q

Cirrhosis is a mixed picture of……… , ……… , …… of liver structure ?

A

= damage
= fibrosis
= regeneration

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16
Q

Describe Cirrhosis in more detail?

A

= damage to hepatocytes
= once damage stopped the liver regenerates (happens when insufficient damage to cause ALF but enough that a proportion of the liver is gradually lost each recovery
= when the liver is regenerated (although cells can regenerate) the liver architecture often cannot (standard portal triad may not be regenerated properly)

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17
Q

Describe the multi-factorial aetiology of cirrhosis: (6 points)

A

= alcohol
= primary biliary cirrhosis (autoimmune disease)
= viral disease (hep b&c (chronic active hepatitis) virus is never controlled or cleared continues to replicate)
=autoimmune chronic hepatitis
= heamachromatosis (iron levels build up slowly)
= cystic fibrosis

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18
Q

Give an example of a patient who may be at a higher risk of cirrhosis?

A

if a patient had a tendency towards haemochromatosis and also was a heavy drinker

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19
Q

What are the key signs and symptoms of Cirrhosis?

A

= NONE
= Acute bleed- portal hypertension
= ascites and oedema
= jaundice
= spider naevi/ palmar erythema
= encephalophathy

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20
Q

(Cirrhosis) Why might an acute bleed be a symptom of Cirrhosis?

A

= portal hypertension, elevated pressure in portal venous system, the portal vein is a major vein which leads to the liver, blood vessels around oesophagus to swell (oesophageal varices)

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21
Q

Why might jaundice by a symptom of Cirrhosis?

A

= related to the livers ability to produce bilirubin
= if fewer liver cells are able to correctly process bilirubin, conjugated and pass it to the biliary tree. chances of jaundice are higher

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22
Q

Why might ascites be a sign of cirrhosis?

A

= when lack of synthetic-ability of liver to produce normal plasma proteins there will be a loss of plasma oncotic pressure (the osmotic pressure generated by large molecules (especially proteins) in solution ) which holds fluid within the blood vessels
=as this reduces as the protein pressure falls, fluid will more easily move into the tissues
= in particular, from the portal vein into the peritoneum where it will accumulate (ASCITES)

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23
Q

Why might encephalopathy be a sign/symptom of Cirrhosis?

A

= brain impairment due to toxic materials within the blood, will happen as the liver function fails to remove these (leads to death)

24
Q

What are spider naevi and palmar erythema a result of?

A
  • high oestrogen levels are seen because oestrogen metabolism is not taking place
25
Q

How does spider naevi present?

A

= small prominent arterioles which develop near the skin
= become enlarges and produce a central arteriole with lots of feeder vessels coming away from there

26
Q

How does Palma Erythema present?

A

= no known aetiology
= pale palm surrounded by erythema around the margins of the hand

27
Q

What is ascites? (simple definition)

A

= fluid accumulating in the peritoneal area, around the bowel

28
Q

Why does ascites occur?

A

=lower plasma protein synthesis and lower oncotic pressure within blood vessels
= fluid easily moves from blood vessels out into the tissues (in this case peritoneum) where is accumulates as liquid

29
Q

Describe the pressure caused in ascites?

A

High Portal venous pressure

30
Q

How can ascites be fixed?

A

fluid drained manually to release the pressure that it is placing on the thorax

31
Q

What are oesophageal varices?

A

= dilations of the little veins at the bottom end of the oesophagus

32
Q

What 2 types of function can be lost in liver failure?

A

= synthetic
= metabolic

33
Q

What 2 main things are included in the loss of synthetic function in liver failure?

A

= plasma proteins synthesis will lead to ascites and oedema
= loss of clotting factors

34
Q

What is meant by the loss of clotting factors in liver failure?

A

= loss of synthetic function
= if patient develops oesophageal varices which then rupture there is little ability for the blood to be able to clot itself (often terminal event)

35
Q

Describe loss of metabolic function (liver failure)? (3)

A

=medicines will be unpredictable
= detoxification
=failure of conjugation of bilirubin will lead to the characteristic jaundice

36
Q

Describe detoxification in the loss of metabolic function in liver failure?

A

= products of metabolism which are harmful to the brain will not be removed and therefore will pass to cause encephalopathy, potential toxicity

37
Q

What does the failure of conjugation of bilirubin lead to?

A

Jaundice

38
Q

How is red blood cell haemoglobin broken down and how does it become bilirubin?

A

=haemoglobin is broken into heme and globin
= heme breaks down into iron and biliverdin (green pigment)
= biliverdin is then transformed into bilirubin (orange pigment)

39
Q

What do liver function tests measure?

A

the degree of liver inflammation

40
Q

What do liver function tests usually look at?

A

= the ability of the liver enzymes to escape from the cell like ALT (alkaline transaminase) and GGT (Gamme-glutamyl)- these enzymes will escape the liver cells if they are damaged or inflamed more easily than if they are healthy

40
Q

What do liver function tests usually look at?

A

= the ability of the liver enzymes to escape from the cell like ALT (alkaline transaminase) and GGT (Gamme-glutamyl)- these enzymes will escape the liver cells if they are damaged or inflamed more easily than if they are healthy

41
Q

What is the most useful test for determining liver function?

A

= INR

42
Q

Why is the INR the most useful test for liver function?

A

= based upon synthesis of clotting factors and therefore is synthesis is impaired as liver function is impaired then the INR will change

43
Q

What scenario may there be a raised liver function test result however nothing is wrong with the patient

A

= enlarged liver producing normal amount of enzymes

44
Q

what scenario might there be a normal liver function test result however the liver is damaged?

A

= small fibrosed liver which is producing a lot of hepatic enzymes- fewer cells producing a higher amount of enzymes

45
Q

What does the INR measure?

A

= measured prothrombin time against a control (lab worker/volunteer)
= prothrombin -> thrombin

46
Q

What is a normal value of INR/

A

1.0

47
Q

Normal value of INR if patient is on warfarin?

A
  • therapeutic range is 2-4
48
Q

What does it mean if the INR is not 1?

A

significant liver synthetic dysfunction (not enough clotting factors)

49
Q

Give 2 examples of fluid retention?

A

=ascites
= ankle oedema

50
Q

Why might a patient suffering from liver failure have a raised INR?

A

the liver is no longer synthesising clotting factors effectively- prolonged bleeding

51
Q

Why is portal hypertension a result of liver failure?

A
  • blood is unable to leave portal veins and enter hepatic vein, escapes at edge pf embryological gut and lower oesophagus to form these thin-walled oesophageal varices
  • inability of GI blood to re-enter the vena cava
  • leads to oesophageal vein dilation
52
Q

In liver failure- what can the inability to remove waste lead to?

A

encephalopathy

53
Q

What can build-up of haembreakdown products lead to ?

A

jaundice (unconjugated bilirubin)

54
Q

How can liver failure be treated?

A

= identify patients at risk of developing liver failure
= reduce rate at which damage is happening
= supportive
= transplantation

BDS2 BAMS (8 decks)

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