Liver Lecture 1 Flashcards
What is the composition of bile?
- Bile acids
-cholic acid
-chenodeoxycholic acid
(derivatives of cholesterol) - Phospholipids
- Cholesterol
- Bile pigments
-bilirubin
interface hepatitis
autoimmune hepatitis
What of liver function?
Prothrombin time
Albumin
AST
ALT
LDH
AST-mito, muscle intestine, brain, kidney, pancreas, RBC
ALT-hepatocytes
LDH-elevated in shock liver
Most liver disease ALT> AST what are some exceptions?
Flipped
- Alcoholic liver disease–> 2:1 ratio
- Wilson’s Disease
- accompanying hemolytic anemia - Advanced fibrosis
- so in Hep C when fibrosis gets really
When do you see markedly elevated aminotransferase levels?
- Drug/toxin induced injury
- Acetaminophen
- NOT Alcohol alone - Acute viral hepatitis
- shock liver
- autoimmune hepatitis
- common bile duct stone
What are markers of cholestasis?
- Alkaline phosphatase
- seen in infiltrative diseases (sarcoid, tb, fungal, amyloidosis, heme malignancy) - Gamma glutamyl transferase
- induced by alcohol, meds - 5’ nucleotidase
- specific to liver - bilirubin
Causes of acute liver failure? Definition of acute liver
- drugs, viral hepatitis, autoimmune hepatitis
- 50% from suicide acetaminophen - sudden loss of hepatic function
- no underlying liver disease - massive hepatic necrosis
Definition
1. INR> 1.5 and Hepatic Encephalopathy
Both occurring within 24 weeks of first onset of symptoms without underlying disease
(exceptions-if disease has only be recognized for
Cause of chronic liver disease?
cirrhosis
Acute liver injury
hepatic dysfunction without encephalopathy
What is the definition of cirrhosis?
a diffuse process characterized by fibrosis and conversion of normal architecture into structurally abnormal nodules
What are symptoms with cirrhosis?
asymptomatic non specific: anorexia, loss of muscle mass, weakness, fatigue advanced cirrhosis: -lower extremity edema -abdominal distension (ascites) -GI bleeding -confusion (hepatic encephalopathy) -muscle wasting and loss of muscle mass -muscle cramping -gynecomastia
Why does cirrhosis lead to portal hypertension?
- increased vascular resistance
a. distortion of vascular architecture
b. increase in vascular tone
- contraction of myofibroblasts around hepatic sinusoids
- increased production of vasoconstrictors (endothelin-1)
- reduced release of vasodilators - increased portal inflow
- splanchnic vasodilation
- increased NO production
- angiogenesis
What leads into the portal vein?
Splenic and SMV
- 75% of blood to liver
- within liver portal vein divides into R and L branches
What are complications of cirrhosis?
related to portal hypertension 1. ascites 2. variceal bleeding 3. hepatic encephalopathy 4. hepatorenal syndrome unrelated to portal HTN -hepatocellular carcinoma
