Liver Function And Pathology Flashcards
What are the 3 main functions of the liver?
Storage
Synthesis
Metabolism
What are is the liver an important storage organ for?
Glycogen
Vitamins
Iron
Copper
What is the livers synthetic function?
Glucose
Lipids/cholesterol
Bile production
Clotting factors
Albumin (main plasma protein)
What are the livers metabolic functions?
Bilirubin (Hb metabolism)
Ammonia metabolism
Drugs
Alcohol
Carbohydrate + Lipid metabolism
How is the liver important in maintain blood sugar levels?
Acts as a store of glycogen which can be broken down into glucose
What vitamins does the liver store?
B12
Fat soluble vitamins (A,D,E and K)
What anabolic metabolic process is carried out by the liver and is important in maintaining blood glucose levels?
Gluconeogensis
What are some vague non specific symptoms of liver disease?
Nausea
Vomiting
Loss of appetite
Abdominal pain
Fatigue
What conditions do all forms of chronic liver disease lead to?
Liver cirrhosis
What are some specific symptoms of liver disease?
Jaundice
Oedema/ascites
Bleeding (easy bruising)
Confusion
What is jaundice/what causes it?
Yellowing of skin and eyes due to buildup of bilirubin in the body
Since the liver is unable to metabolise it effectively
What is ascites?
Build up of fluid in the peritoneal cavity
Why can liver dysfunction/disease lead to ascites/oedema?
Liver able to produce less albumin
Blood has reduced oncotic pressure
Less water drawn back in from the interstitium into the blood (Hydrostatic > oncotic)
More water in the tissues = oedema/ascites
Why are individuals with liver dysfunction prone to bleeding/bruising?
Liver cant produce sufficient clotting factors
More likely to easily bleed/bruise, have more nosebleeds or prolonged bleeding after minor injuries
Why can a patient with liver dysfunction develop confusion?
What is this condition called?
Metabolic dysfunction means less detoxification can occur, toxins like ammonia build up and go to brain
HEPATIC ENCEPHALOPATHY
What are the characteristic presentations of hepatic encephalopathy?
Altered mental state
Confusion
Coma
What is acute liver failure?
Sudden onset of the liver disease specific symptoms with no previous underlying history of symtoms/disease
What are some examples of things that can cause acute liver failure?
Acute excess alcohol intake
Paracetamol OD
Viral infection (EBV, CMV, acute hepatitis)
Mediations like aspirin
Why do we avoid giving aspirin to children?
Can cause liver failure
What is liver cirrhosis?
Permanent irreversible damage to the liver that results in impairment of liver function that damages the architecture of the liver
Happens due to chronic inflammation of the liver
Describe the process that changes the liver in liver cirrhosis:
Chronic I inflammation —> fibrosis and necrosis of hepatocytes -> nodules form
What are the 5 main categories of causes of Liver Cirrhosis/chronic inflammation of the liver?
Drugs
Infection
Deposition
Autoimmune
Other
What drugs that are given to patients can affect the liver causing cirrhosis?
Iatrogenic (aspirin)
Alcoholic liver disease (the most common)
What are the changes that occur in alcoholic liver disease?
Fatty changes leading to hepatomegaly (weeks)
Alcoholic hepatitis (years)
What is occurring in the fatty changes stage of Alcoholic liver disease?
Excess alcohol metabolism occurring
Excess Glucose -> TAGs
Makes liver larger
This stage occurs over weeks and is reversible
What occurs in the alcoholic hepatitis stage of Alcoholic liver disease?
Inflammatory cells with fatty change
More sever symptoms (jaundice, RUQ pain, Hepatomegaly possibly Ascites, confusion)
This still can be reversed before liver cirrhosis stage is met
How do you treat alcoholic liver disease?
Reduce alcohol intake
Treat symtoms
What are some viral infections that can cause chronic liver disease/cirrhosis?
Hepatitis B
Hepatitis C
What is the more common Hepatitis virus in Europe?
Hep C
Since transmitted blood borne via IV lines
Does Hep B have a cure and a vaccine?
Vaccine
No cure
Does Hep C have a cure and a vaccine?
Cure
No vaccine
Since Hep B and Hep C cause chronic inflammation which can lead to liver cirrhosis, what can it also lead to//a big increase in risk in developing?
Hepatocellular carcinoma
Anything causing chronic inflammation increases risk of Hepatocellularcarinoma/malignancy
What are some deposition causes of chronic livier disease/cirrhosis?
Fatty liver disease/Non Alcoholic Fatty Liver Disease (NAFLD)
What is the cause of Non Alcholic Fatty Liver Disease? (NAFLD)
Insulin resistance leads to glucose levels in liver being high
Glucose -> TAGs
Fatty liver disease
If enough fat builds up causing inflammation condition is called NASH (Non alcoholic Steatohepatitis)
What is Non Alcoholic Steatohepatitis (NASH)?
Chronic inflammation of the liver due to the build up of a fatty liver that has nothing to do with alcohol intake (Non Alcoholic Fatty Liver Disease/NAFLD)
Why is NASH becoming more prevalent?
Obesity
Metabolic syndromes
All more prelavent so more NAFLD
What are the 2 other deposition causes of chronic liver disease/Cirrhosis ?
Hereditary Haemochromatosis
Wilsons disease
What is hereditary Haemochromatosis?
How can it lead to liver cirrhosis?
What other dangerous condition can it increase the risk of developing?
How is it treated?
Autosomal recessive mutation of HFE gene
Leads to over absorption of Iron
Increased deposition of iron in liver
This causes liver damage
Increases risk of Hepatocellular carcinoma
Venesection = treatment (removing blood from patient to reduce iron levels)
What is Wilsons disease?
What protein transports copper?
Genetic disorder of issue with Cu metabolism
Decreased secretion of Cu from Billary system into circulation to be removed
This leads to it building up in tissues like the liver
Ceruloplasmin transports copper
How is Wilsons disease treated?
Drugs for symptoms
Ultimately liver transplant
What are some autoimmune immune causes of autoimmune hepatitis that directly attack the hepatocytes?
ASMA
ANA
What are 2 autoimmune conditions which affect the bile ducts leading to liver cirrhosis/chronic inflammation?
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
What is primary biliary cirrhosis?
Progressive autoimmune destruction of bile ducts can lead to cirrhosis
What is primary sclerosing cholangitis?
Autoimmune cause of inflammation and scarring of bile ducts leavening to liver damage and cirrhosis
What disease is Primary Sclerosing cholangitis closely linked to?
Inflammatory bowel disease like ulcerative colitis
What are some rare condition causing liver cirrhosis?
Alpha 1 antitrypsin deficiency
Glycogen storage disorders
Budd-chiari syndrome
What is budd-chairi syndrome?
When hepatic veins get blocked
