Liver & Gall Bladder Disease Flashcards
Describe the blood flow between the liver and the heart
Blood goes from the heart: Oxygen rich & Nutrient poor
AORTA –> PROPER HEPATIC ARTERY –> LIVER
Then deoxygenated blood goes from the liver
HEPATIC VEINS –> INFERIOR VENA CAVA –> RIGHT ATRIUM
Where does blood also come to and from the liver?
The Gut:
- Portal Venous System
- Oxygen poor (venous) but Nutrient rich
What is Bile Flow?
- Bile is produced in the liver as bile acids which turn into bile salts
- This fluid is stored in the gall bladder
- When something is eaten (especially fatty) bile enters the duodenum and into the gut where it aids digestion
- Bile salts are then split into primary and secondary bile acids which is reabsorbed at the bottom of the gut
- Takes a lot of energy producing them so good to recycle
What are the functions of the liver
• Detoxification
- filters & cleans blood of waste products
• Immune Functions
- fights infections & diseases
- Synthesis of clotting factors, proteins, enzymes, glycogen & fats
- Production of bile & breakdown of bilirubin
- Energy storage (glycogen & fats)
- Regulation of metabolism
- Ability to regenerate
Presentation of Acute Liver Injury
ACUTE:
- asymptomatic
- abnormal LFTs & coagulopathy
- malaise, nausea, anorexia
- jaundice
- confusion
Presentation of Chronic Liver Injury
CHRONIC:
- abnormal LFTs
- hepatomegaly
- malaise, ab discomfort
- itching
- ascites, oedema
- haematemesis
- easy bruising
- jaundice
- confusion
- anorexia, wasting
Serum “Liver Function Tests” (LFTs)
- Albumin
- ALP (alkaline phosphatase)
- GGT (gamma GT)
- ALT
- AST
- Bilirubin
- Globulin
• Normal LFTs and platelet count do not exclude liver disease
What is Jaundice
- Raised bilirubin (obstruction of bile duct, liver disease, excessive breakdown of red blood cells)
- Yellow eyes, skin
Describe the metabolism and excretion of bilirubin
- Bilirubin is a breakdown product of haemoglobin –> haem –> bilirubin
- Unconjugated bilirubin is then bound to albumin and transported into the liver where it gets conjugated and then gets excreted via intestine (& renal)
- If bilirubin rises and not excreted, the motion turns pale
- In biliary obstruction - the unconjugated bilirubin cannot leave the biliary system which leads to increased bilirubin in bloodstream
What are the causes of Jaundice?
• PRE-HEPATIC:
- haemolysis
• HEPATIC (intrinsic liver disease)
- Cirrhosis
- Infiltration of the liver by tumours
- Acute hepatitis
• POST-HEPATIC (obstruction of biliary flow)
- Gallstones
- External compression: pancreatitis, lymphadenopathy, pancreatic tumour
Causes of Chronic Liver Disease
MOST COMMON:
- Non Alcoholic Steatohepatitis
- Alcohol (common cause of cirrhosis)
- Viral hepatits (B, C)
What are the risk factors for Non-alocholic fatty liver disease
- Diabetes
- Obesity
- Hypertension
- Dyslipidaemia
- LFTs may be normal
Compare Hep B & Hep C
HEP B:
- DNA virus
- Reads in heaptocyte genome
- Persists in liver EVEN if no longer in blood
- Can reactivate
- Transmission - mainly intercourse
- Vaccination available
- Longterm treatment
Hep C
- RNA virus
- Mainly IV transmission (needles)
- Once cleared = cleared
- Reinfection possible - no immunity
- Time limited treatment: 90% cure
- No vaccination
What is the stages of Chronic Liver Disease
• NCPH (non-cirrhotic portal hypertension)
- often due to vascular problems in liver
- Tolerating bleeding well and clotting intact
- RARE
• PRE-CIRRHOTIC:
- No effect on dental work
- May be asymptomatic
•LIVER CIRRHOSIS
Cirrhosis of the Liver
- Result of chronic longstanding damage to the liver (alcohol + fat)
- Scar tissue replaces healthy tissue - disruption of liver architecture
- Increased resistance to blood flow through the liver, leading to portal hypertension
Spotting Liver Cirrhosis
COMPENSATED:
- invisible
- blood can be normal
- risk low (of bleeding)
DEOMPENSATED:
- visible
- abnormal blood tests
- risk high
Child-Pugh score assesses severity of liver disease
Complication of Chronic Liver Disease
ACUTE:
- GI bleeding
- Ascites
• Both leading to portal hypertension
- Jaundice
- Hepatic Encephalopathy
- Renal impairment
- Coagulopathy
- Infection
CHRONIC:
- Malnutrition
- Bone Disease (osteoporosis)
Portal Hypertension
• Decreased platelets (thrombocytopenia) so increased risk of bleeding
Liver Cancer (Hepatocellular Carcinoma)
- Can complicate liver cirrhosis of any cause
* In hepatitis B can occur in pre-cirrhotic liver disease
Signs & Symptoms of Chronic Liver Disease
- Palmer Eryhthema
- Spider Naevi
- Gynaecomastia
• Leuconychia
(white nails - hypoalbuminaemia)
- Finger Clubbing
- Jaundice
- Ascites
Hepatic Encephalopathy (decrease in brain function)
- Feature of decompensation
- Difficult to spot if subtle
- Can present as overt confusion in a patient with CLD
- Often more troublesome for other than patient, but can be disabling
- Indicares underlying problem (bleed, infection, constipation)
- Collateral history
How do you recognise Hepatic Encephalopathy
- Confusion
- Altered behaviour
- Coma
- Collateral history
How do we treat liver disease
SYMPTOMATIC:
- Diuretics
- Nutrition support
- Supplements
- Propranolol
SPECIFIC:
- Antiviral
- Immunosuppression
- Relieving Obstruction
- Venesection
