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YR 3 - Illness and Wellbeing > Liver Disorders > Flashcards

Liver Disorders Flashcards

1
Q

what are the basic functions of the liver? (7)

A

protein metabolism
- produces circulating proteins - clotting factors and albumin

nitrogen excretion
- amino acids break down into ammonia
- pass out into urine

carbohydrate metabolism
- glucose homeostasis

lipid metabolism

bile production

bilirubin metabolism
- breakdown product of RBC

hormone/drug inactivation
- broken down by the liver

immunological functions
- manages bacteria from the GIT

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2
Q

what is the function of albumin

A

maintaining osmotic pressure

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3
Q

what percent of innate immune proteins are produced by the liver?

A

80-90%

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4
Q

where is the liver?

A

upper right quadrant of abdominal cavity

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5
Q

what is the weight of the liver?

A

usually 1.5kg in adults

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6
Q

what are liver cells called?

A

hepatocytes

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7
Q

describe the blood supply of the liver.

A

70% comes from portal vein - from intestines and spleen

30% from hepatic arteries from branch of aorta called coeliac axis

  • blood enters via portal tracts, travels through liver through the sinusoids (gaps between hepatocytes)
  • blood leaves via hepatic vein in the centre of the lobule
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8
Q

describe bile in the liver

A

produced by the liver
- leaves the liver via bile duct out of the portal tract
- travels against the blood flow

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9
Q

describe the organisation of the liver.

A

comprised mostly of hepatocytes
- arranged in rows

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10
Q

what are the potential implications if the liver fails?

A

protein metabolism
- impaired clotting
- reduced albumin - leads to oedema and ascites

nitrogen exretion
- excess ammonia in blood
- mimic neurotransmitters
= impaire cognitive function

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11
Q

what is ascites?

A

when fluid collects in spaces within the abdomen

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12
Q

what is bilirubin?

A

a breakdown product of red blood cells

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13
Q

describe the pathway of bilirubin from the blood and being passed out.

A
  • not water soluble
  • must be bound with albumin to travel in the blood = unconjugated
  • becomes conjugated in the liver = water soluble
  • bilirubin travel via bile duct into gut

in the gut
- bilirubin converted into:
- urobilinogen - travel out in urine or enterohepatic circulation - back through the liver
- or stercobilinogen - travel out in faeces
- some absorbed back into the blood

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14
Q

what is jaundice?

A

excess bilirubin in the blood

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15
Q

what are the 3 types of Jaundice? describe them.

A
  1. Pre-Hepatic
    - the liver is fine
    - too much bilirubin is produced
    - seen in haemolytic anaemia
  2. Hepatic
    - acute diffuse liver cell injury from end stage chronic liver disease or metabolic disorders
    - = too few functioning liver cells
    - unable to process bilirubin normally
  3. Post-Hepatic
    - the liver is fine
    - bile duct obstruction
    - stones, strictures, tumours
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16
Q

how much bilirubin accumulates in the blood to become visible for jaundice?

A

more than 40 micromol/litre

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17
Q

how can liver disease be detected? (5)

A
  • detect liver enzymes
  • albumin levels
  • clotting
  • ultra-sounds
  • biopsies
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18
Q

what two places can liver enzymes leak from, showing indications for liver disease?

A
  • from damaged hepatocytes
  • from damaged bile duct cells
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19
Q

which 2 liver enzymes leaking from damaged hepatocytes can indicate liver disease?

A

ALT - alanine aminotransferase
AST - aspartate aminotransferase

  • mild, slow, progressive increase = chronic liver disease
  • rapid, large increase = severe acute liver disease
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20
Q

which liver enzyme leaking from damaged bile duct cells can indicate liver disease?

A

ALP - alkaline phosphatase

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21
Q

how can albumin levels indicate liver disease?

A
  • synthesised by the liver
  • have a long half life
  • if the levels drop = chronic liver disease
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22
Q

how can clotting indicate liver disease?

A
  • look at how well the blood is clotting
  • clotting factors produced by the liver
    = short half life
  • can indicate acute and chronic
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23
Q

how can ultrasounds be used to detect liver disease?

A
  • check for dilated bile ducts
  • if dilation = obstruction
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24
Q

when would biopsies be taken to investigate liver disease? what is the most common case found when undergoing this investigation

A

after ultrasound
- if bile ducts aren’t dilated = no obstruction
- best to visualise the abnormalities within the liver

= most cases are due to acute hepatitis

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25
Q

what is hepatitis? what are the 2 types

A

inflammation of the liver, defined by raised liver enzymes
- describes any liver disease which isnt neoplastic

acute and chronic

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26
Q

what are the causes of acute and chronic hepatitis?

A

viral
alcohol
obesity
drugs
inherited conditions
autoimmune conditions

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27
Q

describe acute hepatitis

A
  • caused by something that goes away
  • short-lived
  • resolves by itself
  • no signs
  • often only noticed by blood tests
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28
Q

give 6 conditions arising from acute hepatitis, in increasing order of rarity and severity

A
  1. asymptomatic
  2. malaise - general feeling of discomfort
  3. jaundice - high bilirubin levels
  4. coagulopathy - affected blood clotting
  5. encephalopathy - brain function affected
  6. death
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29
Q

give 3 inherited disorders which can cause hepatitis.

A

Haemochromatosis - iron accumulation

Wilson’s disease - copper accumulation

Alpha-1-antrypsin deficiency

30
Q

describe chronic hepatitis

A
  • caused by persistent liver injury
  • persistent cycle of damage and repair
    = long term liver damage
31
Q

what does chronic hepatitis progress to?

A

cirrhosis

32
Q

what is a big cause of chronic hepatitis?

A

non alcoholic fatty liver disease
NAFLD

33
Q

what 2 things does the severity of acute hepatitis depend on?

A
  • how many hepatocytes are damaged as a result
  • how well the liver is able to regenerate the lost cells
34
Q

what is cirrhosis?

A

a irreversible change in the liver due to chronic liver disease

35
Q

describe the pathology of chronic liver disease/cirrhosis

A
  • hepatocytes injured and repaired continuously
  • causes scarring
  • scar tissue links vascular structures - portal tract and hepatic vein = bridging fibrosis
  • liver tissue becomes into separated nodules
  • end stage = cirrhosis
36
Q

cirrhosis is clinically silent, what does this in turn mean?

A

means that you find out when the liver function fails (decompensation) and leading to liver failure and portal hypertension

37
Q

what are the 4 complications of cirrhosis?

A

liver failure
portal hypertension
infection
hepatocellular carcinoma

38
Q

is cirrhosis a disease?

A

NO

cirrhosis is the end point of all chronic liver diseases

39
Q

what effect can alcohol gradually have on the liver?

A

fatty changes

alcohol induced liver inflammation
= alcoholic steatohepatitis

cirrhosis

40
Q

what does alcohol liver injury depend on?

A

dosage and susceptibility

41
Q

how does steatohepatits appear under the microscope?

A

fatty changes
ballooned hepatocytes with mallory body - pink things
inflammatory cells

42
Q

what condition is regarded as the most common cause of liver disease?

A

non alcoholic fatty liver disease

43
Q

describe the pathogenesis of NAFLD.

A
  • fat accumulation = steatosis
  • steatohepatitis
  • cirrhosis
  • hepatocellular carcinoma
44
Q

how is NAFLD treated?

A

need to address the metabolic syndrome
- obesity
- diabetes
- hyperlipidaemia

45
Q

what are the 5 hepatitis virus’ and which other 3 viruses can cause hepatitis?

A

A
B
C
D - only found in people with B
E - faecal-oral transmission via infected water

EBV - epstein-barr virus
CMV - cytomegaloblastic virus
HSV - herpes

46
Q

define hepatotoxic

A

toxins which cause injury to the liver

47
Q

what are the two types of hepatotoxic drugs? describe them.

A

intrinsic
- when excessive doses are administered
- liver injury is predictable

idiosyncratic
- liver injury is rare and unpredictable
- happens from metabolic and immunological response variability

48
Q

can drug-induced liver injury be reversed?

A

yes can stop taking the drugs

time of onset for injury is variable and can be months

49
Q

what is the most common symptom of drug induced liver injury?

A

jaundice

50
Q

describe paracetamol overdose

A
  • 2-3 days massive hepatocellular necrosis - liver looks all pink
  • no inflammation - just around the central vein
  • death if no transplant
51
Q

describe Haemochromatosis - the pathogenesis and treatment

A
  • inherited disorder of iron metabolism
    of the HFE gene
  • increase iron absorption in the gut
  • iron deposited in various organs
  • pancreas - can cause diabetes
  • skin - pigmentation
  • heart - cardiomyopathy
  • liver - chronic hepatocellular injury - cirrhosis
  • increase risk of HCC hepatocellular carcinoma

treatment
- venesection - reduce 1 unit of RBC per week

52
Q

describe a Haemochromatosis biopsy

A

use Perl’s Stain
- highlights iron in the tissues = blue

53
Q

describe Wilson’s Disease and the treatment

A
  • rare
  • autosomal recessive
  • mutation of ATP7B gene
  • impairs the excretion of copper
  • copper accumulates
  • in liver - chronic liver injury - cirrhosis
  • in eye - Kaiser-Fleisher ring
  • in brain - psychiatric

treated by removing the copper
- using penicillamine

54
Q

describe Alpha-1-Antitrypsin deficiency and another condition which it causes, relating to the lungs.

A

A-1-A = protein in blood
- inactivates neutrophil elastases
= digestive enzyme produced by neutrophils in the liver

  • deficiency
  • process impaired
  • A-1-A not secreted
  • accumulates in blood
  • lots of PAS+ globules in liver
  • chronic liver injury - cirrhosis

also causes emphysema in the lungs
- neutrophil elastase damages lung tissues
- lose ability to recoil
- traps air in lungs
= emphysema

55
Q

describe how liver diseases can occur from autoimmunity.

A
  • normal immune regulation disturbed
  • self-antigens are recognised
  • manifest destruction of hepatocytes = autoimmune hepatitis
    or
  • damage to bile ducts = autoimmune biliary diseases
  • primary sclerosing cholangitis
  • primary biliary cirrhosis
56
Q

autoimmune hepatitis - describe the diagnosis, biopsy and treatment.

A

diagnosis
- autoantibodies
- raised IgG, ALT

biopsy
- interface hepatitis
- lots of plasma cells

treatment
- immunosuppression to avoid progression to cirrhosis

57
Q

what are the 2 autoimmune biliary diseases? describe them

A

primary biliary cholangitis
- anti-mitochrondial antibodies
- increased IgM, ALP
- bile duct granulomas
- progresses to cirrhosis

primary scelorising cholangitis
- associated with ulcerative colitis
- pANCA antibodies
- diagnose with imaging
- periductal onion skin fibrosis around bile duct
- progresses to cirrhosis

58
Q

what is acute liver failure?

A

when there is sudden and severe liver damage

59
Q

why would some people with cirrhosis not know they have it?

A

the liver can compensate
- have some residual function

60
Q

what is decompensated liver?

A

liver loses all function
= liver failure

61
Q

give 4 features related to impaired liver function due to cirrhosis

A

hypoalbuminemia/clotting factor deficiencies
- bruising and bleeding

ascites
- low albumin
- aldosterone disturbances

encephalopathy
- due to impaired breakdown of nitrogen substances

gynaecomastia
- due to impaired oestrogen breakdown

62
Q

describe portal hypertension as a result of cirrhosis, what does it cause? (3)

A
  • liver is structurally abnormal
  • blood flow is impaired
  • pressure build up
  • back pressure build up in portal vein
  • blood can’t get through the liver
  • causes ascites and splenomegaly
  • due to pressures
  • porto-systemic shunts
63
Q

what are porto-systemic shunts? (cirrhosis portal hypertension), how does this happen (3) and what do they lead to (2)?

A

blood attempts to bypass the liver

  • oesophageal varices
  • haemorrhoids
  • caput medusae
  • patient becomes prone to bleeding and ruptures - due to weak vessels and paths
  • bypasses the liver function
64
Q

what cells in the liver act to fight infection?

A

Kuppfer cells

65
Q

what is a malignant tumour of hepatocytes called?

A

Hepatocellular Carcinoma

66
Q

give 4 other benign liver tumours

A

haemangioma
bile duct adenoma
focal nodular hyperplasia
hepatocellular adenoma

67
Q

give 3 malignant liver tumours

A

hepatocellular carncoma
cholangiocarcinoma
metastatic tumours

68
Q

what other tumour is metastasis of the liver observed?

A

colorectal cancer

69
Q

how does liver disease affect dental treatment?

A
  • coagulopathies
  • may be carrying infections - hepatitis
  • drug-toxicity can be different due to lower metabolisms
70
Q
A

YR 3 - Illness and Wellbeing (31 decks)

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