Liver Function And Pathology Flashcards
What are 3 main functions of the liver
- Storage (Fe, Cu, Glycogen, Vitamins)
- Synthetic (Glucose/lipids, Cholesterol, Bile, Clotting factors, Albumin)
Metabolic (Bilirubin, NH3, Drugs, Alcohol, Carohydrates and lipids)
Name the 2 main protein made by liver
Albumin
Clotting factors
What are 4 specific symptoms of Liver disease?
- Jaundice
- Oedema/ Ascites
- Bleeding/ easy bruising
- Confusion
- Relate the metabolic function of the liver to jaundice
2. Relate the synthetic function of the liver to Oedema/ Ascites
- Increase in Bilirubin in blood
2. Reduced function to make albumin which exerts oncotic pressure in blood
- Relate the synthetic function of the liver to Bleeding
2. Relate the metabolic function of the liver to Confusion
- Reduced ability to make clotting factors
2. Reduced ability to detoxify NH3
List 4 causes of Acute Liver failure
- Alcohol
- Paracetamol
- Viral
- Medications (Aspirin in children)
All causes of liver disease lead to Cirrhosis
What is Cirrhosis?
What does it develop in response to?
What does it lead to?
Permanent damage to liver, resulting in impairment of liver function and distortion of architecture of liver
Develops in response to any chronic inflammation-> Fibrosis and hepatocyte necrosis-> Nodules
What are 5 groups causes of Chronic Inflammation leading to Cirrhosis?
- Drugs
- Infection
- Deposition
- Autoimmune
- Other
List ways that Drugs can cause chronic inflammation leading to Cirrhosis
- Iatrogenic causes (unintentional damage)
- Alcoholic liver disease;
- Fatty change/ Steatosis (in weeks, usually reversible)-> Hepatomegaly
- Alcoholic hepatitis (Usually over years)->RUQ pain, Hepatomegaly, Jaundice
List ways that Infection can cause chronic inflammation leading to Cirrhosis
- Hep B: Vaccine, no cure, Symptomatic
- Hep C: (IV Drug use) Cure, no vaccine, mostly Asymptomatic
(These can also cause hepatocelluar carcinoma)
List ways that Deposition can cause chronic inflammation leading to Cirrhosis
- Non Alcoholic Fatty Liver Disease (NAFLD);
- Insulin resistance, Triglyceride accumulation in hepatocytes
- Called Non Alcoholic Steatohepatitis (NASH) if inflammation present - Hereditary Haemochromatosis; (Autosomal recessive)
- Increased Fe absorption-> Increased Ferritin
- Risk of hepatocellular carcinoma - Wilson’s Disease;
- Reduced Cu secretion from biliary system
- Reduced Ceruloplasmin (carries Cu in blood)
- Can affects CNS
List ways that Autoimmune abnormalities can cause chronic inflammation leading to Cirrhosis
Autoimmune hepatitis;
- Autoantibodies against hepatocytes (E.g ASMA, ANA)
- PBC (Primary Biliary Cirrhosis, AMA +ve)
- PSC (Primary Sclerosing Cholanitis, AMA-ve)
(PSC associated with IBD, especially Ulcerative Colitis)
List ways other than Drugs/ Infection/ Deposition/ Autoimmune that can cause chronic inflammation leading to Cirrhosis
- Budd Chiari
- Glycogen Storage Disorders
- Alpha1 Antitrypsin deficiency
What are the 3 main veins of the Portal Circulation
- Inferior Mesenteric Vein (Descending colon)
- Superior Mesenteric Vein (Ascending Colon mainly)
- Splenic Vein
Describe the Portal Circulation
- IMV drains into Splenic vein
- Move to the right side, and combine with SMV
- This makes the Portal Vein->Hepatic vein-> IVC
Why does Cirrhosis lead to Portal Hypertension?
Cirrhosis of liver-> Fibrosis, reducing expansive capability and compressing Portal Vein-> Hypertension
What are 4 consequences of Portal Hypertension?
- Ascites (Increased hydrostatic pressure and reduced albumin production)
- Splenomegaly (Pressure buildup in Splenic circulation)
- Varices (Blood shunts from Portal-> Systemic circulation via anastomoses not normally in use, leading to distension of veins at anastomoses)
- Hepatorenal Syndrome
What are 3 common sites where Varices can occur?
- Oesophageal Varices (Can lead to Haematemesis)
- Ano Rectal Varices (Typically painless, rarely bleed)
- Umbilical Varices (‘Caput medusa’ is the clinical sign)
Describe and explain Hepatorenal Syndrome (A consequence of portal hypertension)
Acute, rapidly declining kidney function
- Hypertension affects arterial/ Splanchnic circulation causing Vasodilator release
- Perceived drop in circulatory volume> RAAS activation
- Leads to Renal Artery vasoconstriction-> Reduced perfusion
Outline how the Biliary System and how bile enters the duodenum
- Bile Canaliculi in Liver form R and L Hepatic Ducts, which combine-> Common Hepatic Duct
- Cystic duct from Gallbladder joins CHD-> Common Bile Duct
- Pancreatic duct joins CBD to later enter Duodenum at Ampulla of Vater
- Sphincter of Oddi controls rate of entry of bile and secretions into Duodenum
Gallstones form in the Gallbladder are quite common
What are they made of?
What are 4 risk factors
- Cholesterol/ Bile Pigments/ A mixture (Not normally visible on X Ray)
- Diet and lifestyle
- Female
- 40s
- Pregnancy
Gallstones don’t often have any complications. Name 4
- Biliary Colic
- Acute Cholecystitis
- Ascending/ Acute Cholangitis
- Acute Pancreatitis
Describe Biliary Colic and it’s presentation
- Sudden onset RUQ pain that lasts for a while, as CCK makes GB contract and GSs pushed up against neck of GB (typically after a fatty meal)
- No inflammation
Describe Acute Cholecystitis and it’s presentation
- RUQ pain as Cystic Duct is obstructed by Gallstones
- Inflammation present
- +ve Murphy’s sign (Put hand on right side, breathe in, Gallbladder hits hand + pain)
(Treat: Pain relief, Cholecystectomy)
Describe Acute/ Ascending Cholangitis and it’s presentation
- Caused by infection
- Gallstone reaches and obstructs CBD
Present with Charcot’s Triad;
- RUQ pain
- Jaundice
- Evidence of inflammation
Describe Acute Pancreatitis and it’s presentation
- Gallstone in CB at/ after the point at which the Pancreatic Duct joins the CBD
- Autodigestion of pancreas
- Epigastric pain, which radiates to back
- Vomiting
- Cullens and Grey Turners’ signs
- Raised pancreatic Amylase and Lipase in blood
