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214.201 > Liver disorders > Flashcards

Liver disorders Flashcards

1
Q

Function units of the liver?

A

Thousands of lobules which form the four lobes. Lobules are hexagonal structures composed of hepatocytes

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2
Q

True or False - the liver can regenerate

A

True

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3
Q

What proportion of cells can the liver lose before it stops functioning?

A

3/4

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4
Q

What are the blood supply’s to the liver?

A

Two sources;

  • oxygenated blood via hepatic artery
  • venous blood via hepatic portal vein (carries nutrients and toxins)
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5
Q

What are sinusoids?

A

Vascular channels allowing exchange between blood and hepatocytes

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6
Q

Where is bile produced and flow to?

A

Produced in hepatocytes, drains into canaliculi

  • Exits lobules via bile ducts
  • Exits liver via hepatic duct
  • Enters duodenum via common bile duct
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7
Q

What are the liver functions

A
  • Synthesis of plasma proteins and clotting factors
  • Storage of minerals and vitamins
  • Metabolism of carbohydrates, fats, proteins
  • Elimination of bilirubin
  • Metabolism of steroid hormones
  • Metabolism of alcohol
  • Metabolism of drugs
  • Production of bile salts
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8
Q

How is bilirubin conjugated?

A

1) Reticulo endothelial system - RBC become heme which become bilirubin. Transported to hepatic portal vein bound to albumin
2) Liver: Bilirubin is conjugated (water soluble), excreted via common bile duct
3) GI tract: Brown colour of feaces

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9
Q

How to diagnose liver disorders?

A
  • Pt history
  • Pt signs & symptoms
  • Physical exam
  • Laboratory tests
  • Other: liver biopsy, abdomen ultrasound, CT scan, MRI
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10
Q

What are the categories for impaired liver function?

A
  • Hepatocellular injury
  • Cholestasis
  • Liver failure
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11
Q

What is a hepatocellular injury?

A
  • Injury to hepatocytes leads to cell necrosis
  • Causes decreased synthetic/metabolic activity of the liver and the release of intracellular contents
  • Causes hyperbilirubinemia, high levels of bilirubin in the blood, causing jaundice
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12
Q

What are the likely causes of a hepatocellular injury?

A
  • Non-alcoholic fatty liver disease
  • Viral hepatitis
  • Alcohol, drug toxicity
  • Haemochromatosis
  • Autoimmune disease
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13
Q

What is cholestasis?

A
  • Reduction of bile flow
  • Usually obstruction: Maybe intra- or extra- hepatic
  • Causes a build-up in the blood of substances that are normally excreted in the bile
  • Bile accumulates and plugs ducts which rupture and damage liver cells
  • Causes Alk Phos to be released in blood
  • Build up of bile acids cause itching
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14
Q

What are the likely causes of cholestasis?

A
  • Gall stones (cholelithiasis)
  • Abdominal masses/malignancies
  • Some drugs
  • Pregnancy
  • Primary biliary cholangitis
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15
Q

What is liver failure?

A

Massive liver destruction and loss of functional capacity

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16
Q

What are the likely causes of liver failure?

A
  • Sudden e.g. fulminant hepatitis

- Chronic progressive damage e.g. chronic alcoholic cirrhosis

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17
Q

What is jaundice & what does it do?

A
  • Yellow discolouration of the skin and sclera due to abnormally high levels of serum bilirubin accumulating in these tissues
  • Bilirubin is toxic to cells
  • Urine is dark due to high bilirubin
  • Usually first and only sign of liver disease
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18
Q

What is kernicterus?

A
  • High bilirubin in neonates
  • In neonates bilirubin can cross blood brain barrier and damage neurons in the brain causing permanent, fatal brain damage
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19
Q

How does kernicterus occur?

A
  • Premature babies have immature liver function and are unable to form conjugated bilirubin
  • Have immature blood brain barrier
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20
Q

How to treat kernicterus?

A

With blue light therapy

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21
Q

What are the 3 main types of jaundice?

A
  • Pre-hepatic (hemolytic) jaundice
  • Intrahepatic jaundice
  • Posthepatic (obstructive) jaundice
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22
Q

What is pre-hepatic (hemolytic) jaundice?

A
  • Increased rate of breakdown of RBCs
  • Excess unconjugated bilirubin is produced faster than the liver is able to conjugate it for excretion
  • Unconjugated bilirubin is insoluble and is not excreted in the urine
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23
Q

What are causes of pre-hepatic (hemolytic) jaundice?

A
  • Haemolytic anemias
  • Blood transfusion reactions
  • Incompatible Rh factor in neonates
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24
Q

What is intrahepatic jaundice?

A
  • Damage to liver cells (hepatocyte injury) impedes conjugation of bilirubin and/or its secretion
  • Failure to process or secrete bile
  • Reflux of bile between hepatocytes
  • Accumulation of unconjugated bilirubin in bloodstream
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25
Q

What are causes of intrahepatic jaundice?

A
  • Hepatitis
  • Hepatotoxicity
  • Cirrhosis
  • Alcoholic liver disease
  • Primary biliary cholangitis (autoimmune Disease that destroys bile ducts in liver)
  • Neonatal jaundice
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26
Q

What is post-hepatic (obstructive) jaundice?

A
  • Bile flow between liver & intestine is obstructed, impairing bile formation or bile flow
  • Causes a build-up in the blood of bilirubin and bile acids, and the synthesis and release of enzymes from the apical membrane of duct cells
27
Q

What are causes of post-hepatic (obstructive) jaundice?

A
  • Strictures (biliary atresia) of bile duct
  • Obstruction by gallstones
  • Tumours of bile duct or pancreas
28
Q

What is hepatitis?

A
  • Inflammation of the liver

- If inflammation persists it causes fibrosis then cirrhosis

29
Q

What are causes of hepatitis?

A
  • Viral infection (hepatitis virus)

- Alcoholism

30
Q

What is acute hepatitis?

A
  • Hepatitis for less than 6 months
  • Sharp, sudden onset with hepatocyte damage
  • Jaundice
  • Dark urine
31
Q

What is chronic hepatitis?

A
  • Hepatitis for more than 6 months
  • Long term, steady, ongoing hepatocyte damage
  • Jaundice may occur
  • Urine is unaffected
32
Q

What is alcohol induced liver disease?

A

Spectrum of conditions:

  • Fatty liver (steatosis) - Liver cells contain fat deposits; the liver is enlarged
  • Alcoholic hepatitis - Liver inflammation and liver cell necrosis
  • Cirrhosis - Scar tissue partially blocks sinusoids and bile canaliculi
33
Q

What is non-alcoholic fatty liver disease (NAFLD)?

A
  • Absence of alcohol use and hepatitis viral infection
  • Associated with insulin resistance/metabolic syndrome/obesity
  • Ranges from Steatosis, inflammation with steatosis, hepatocyte necrosis, cirrhosis
  • Elevated liver enzymes
34
Q

What is cirrhosis?

A
  • Chronic end-stage liver disease which leads complete liver failure
  • Nodules of regenerated parenchymal cells with widespread fibrosis and often ascites
  • Characterised by portal hypertension (increased vascular resistance in the liver and increased splanchnic/portal blood pressure), often leading to ascites
35
Q

What are caused of cirrhosis?

A
  • Alcohol abuse
  • Viral hepatitis
  • NAFLD
  • Biliary disease
36
Q

What are clinical manifestations of cirrhosis?

A
  • Fibrosis of nodules causing disrupted vascular flow & biliary ducts in liver
  • Leads to portal hypertension and associated complications such as ascites and varices, biliary channel obstruction and bile stasis
  • Results in hepatomegaly, weight loss, cachexia, weakness, anorexia, RUQ pain
37
Q

What is portal hypertension?

A

Increased pressure in hepatic portal system due to cirrhosis

38
Q

What are manifestations of portal hypertension?

A
  • Splenomegaly, spleen engorge with blood, decreasing number of RBCs, WBCs, and platelets
  • Ascites, increase in fluid in peritoneal cavity
  • Collateral channels and shunts develop between portal and systemic blood systems, causing oesophageal varices, haemorrhoids, and paraumbilical veins (caput medusa)
39
Q

What are ascites?

A

Fluid in peritoneal cavity

40
Q

What are causes of ascites?

A
  • Obstruction of lymphatic flow
  • Portal hypertension
  • Lowered albumin levels
  • Impaired liver function causes increase ADH & aldosterone resulting in fluid retention
41
Q

What are oesophageal varices?

A
  • Varices in submucosa & lumen of oesophagus

- Thin walled so may haemorrhage into stomach which causes bleeding varices

42
Q

What is liver failure?

A
  • Most severe stage of liver disease
  • Can result from sudden liver damage (fulminant hepatitis) or chronic liver disease
  • 80-90% liver function lost
43
Q

What is normal production of bile acids & bile salts?

A
  • Liver produces bile acids & salts which are secreted in bile
  • Important for normal fat digestion
  • Bile salts act as emulsifiers & allow efficient action of lipases on triglycerides
44
Q

What is impaired production of bile acids & bile salts?

A
  • Difficulties in digesting fat, indigestion causing fat to be excreted in faeces
  • Causes fat intolerance, steatorrhoea (pale greasy stools)
45
Q

What is normal alcohol & drug metabolism?

A
  • Liver detoxifies drugs and alcohol

- Detoxification reactions use cytochrome p450 enzymes or microsomal enzymes

46
Q

What is impaired alcohol & drug metabolism?

A

Deficient detoxification reactions causing toxic degradation of cells in the body

47
Q

What is normal metabolism of cholesterol & steroid hormones?

A

The liver forms lipoproteins, syntheses cholesterol, and metabolises steroid hormones

48
Q

What does impaired metabolism of cholesterol & steroid hormones cause?

A
  • Lowered serum cholesterol levels
  • Gynecomastia, testicular atrophy in males
  • Amenorrhea in females
49
Q

What is normal metabolism of carbohydrates?

A
  • Glycogenesis during the absorptive state

- Maintains blood glucose during post-absorptive state through glycogenolysis and gluconeogenesis

50
Q

What is impaired metabolism of carbohydrates?

A
  • Impaired carbohydrate metabolism increasing risk of hypoglycaemia
51
Q

How does impaired liver function affect storage of vitamins?

A

Impaired fat absorption and reduced storage of fat-soluble vitamins may lead to deficiencies

52
Q

What is normal metabolism of proteins?

A
  • Liver synthesises plasma proteins (albumin) & some clotting factors (prothrombin, fibrinogen)
  • Liver deaminates proteins & forms urea
53
Q

What is impaired metabolism of proteins?

A
  • Decreased blood albumin and oedema
  • Low albumin contribute to ascites
  • Bleeding tendency
  • Elevated levels of blood ammonia which are highly toxic to cells & may cause hepatic encephalopathy
54
Q

What is normal albumin and body fluid distribution in the liver?

A
  • Albumin maintains normal fluid distribution between interstitial and intravascular compartments
55
Q

What is impaired albumin and body fluid distribution in the liver?

A
  • Long term deficiency in albumin (usually with long- term liver failure)
  • Causes accumulation of fluid in interstitial space (called third spacing)
  • Results in oedema and ascites
56
Q

What is hepatic encephalopathy?

A
  • Result of complete liver failure

- Stages: changes in personality, memory, lethargy- progressing to confusion, stupor, convulsions, coma

57
Q

What leads to a coma in hepatic encephalopathy?

A
  • Hypoglycemia due to failure of normal blood glucose homeostasis by the liver
  • A build up of ammonia causing severe liver impairment, ammonia not converted to urea causing increased blood ammonia which is toxic to tissues especially to the brain (encephalopathy)
58
Q

What are some liver function tests?

A
  • Combination of markers of function with markers of liver damage
  • Raised levels of ALT & AST suggest hepatic process
  • Raised levels of Alk Phos indicate biliary disease
  • Raised levels of GGT indicate hepatitis and cholestasis
59
Q

What is intrahepatic cholestasis?

A

Widespread blockage of small ducts/canaliculi; may be caused by oedema that occurs with hepatitis

60
Q

What is extra-hepatic (post hepatic) cholestasis?

A

Blockage of bile from the gallbladder to the duodenum

61
Q

What is gallstones (cholelithiasis)?

A
  • ~80% crystallised cholesterol

- ~20% calcified stones

62
Q

What are the signs & symptoms of gallstones (cholelithiasis)?

A
  • Localised pain

- Nausea and vomiting after eating a fatty meal

63
Q

How are gallstones (cholelithiasis) diagnosed?

A
  • Ultrasound/imaging

214.201 (17 decks)

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