Liver pathophysiology Flashcards
What is the liver’s position in the body?
Upper right side of the abdomen
Approximately how much does the liver weigh in adults?
Three pounds
Which of the liver lobes is the largest? Into how many lobes is the liver divided?
Right
4
What are the four lobes of the liver?
Right, left, quadrate and caudate
To which structures is the liver connected? Which vessel carries blood into the liver? Which vessel carries blood away from the liver?
Diaphragm and abdominal walls
Portal vein
Hepatic vein
What is the main function of bile ducts? What is the function of the gallbladder?
Carry bile throughout the liver and gallbladder
Stores, concentrates, and releases bile
What fluid is produced by liver cells?
Bile
What type of cells are Kuppfer cells? What are the three types of cells found in liver microscopy?
Phagocyte
Kuppfer, fat storing and sinusoids
What are the three main functions of the liver?
Metabolic, secretory, and vascular
Which function of the liver involves the excretion of wastes and toxins from the blood into the bile? What is a key metabolic function of the liver?
Secretory function
Regulation of blood glucose levels
Name a key metabolic function of the liver
Metabolism of proteins and fats
What does the liver do with ammonia?
Ammonia (nitrogen) conversion
What is one of the vascular functions of the liver?
Produces proteins for blood clotting
What is a vascular function of the liver besides producing blood clotting proteins?
Breaks down old and damaged blood cells
From what is bilirubin formed? How does the liver modify bilirubin to facilitate its excretion?
Breakdown of RBC haem
Produces a glucuronide (conjugated bilirubin)
Why is conjugated bilirubin water-soluble? What happens when conjugated bilirubin levels are high due to liver disorder?
To be excreted in the bile
Excess is excreted in the urine
Why is unconjugated bilirubin not excreted in the urine? What is the primary physiological role of bilirubin?
It is not water-soluble
Cellular antioxidant
What is hepatitis? What are possible causes of hepatitis?
Inflammation of the liver
Drugs, alcohol, toxins, physical damage, infection
Which types of infections can cause hepatitis? Name viral infections that causes hepatitis
Viral, parasite or bacterial
Hepatitis A, B, C, D, or E
What diagnostic test is used in cases of hepatitis? Which liver enzymes are commonly tested for diagnosis of hepatitis?
Nucleic acid testing
ALT, AST, CK, LDH
How is Hepatitis A typically treated? How is acute hepatitis B typically treated? How is chronic hepatitis B treated?
Treatment to relieve symptoms
Treatment to relieve symptoms
Keep the virus under control
What does Peginterferon alfa 2-a do to treat chronic hepatitis B?
Stimulates the immune system
How does emergency treatment for hepatitis work?
Stops infection development
What type of therapy is used to treat Hepatitis C?
Combination therapy
What type of drug is Riba-virin? What is the mechanism of action of Riba-virin?
Antiviral
Stops virus production
What does NAFLD stand for? What two worldwide epidemics are linked to NAFLD? What other liver diseases is NAFLD linked to?
Non-Alcohol Fatty Liver Disease
Obesity and type 2 diabetes
Hepatitis C and alcohol-related
Which types of hepatitis have a vaccine for prevention?
Hepatitis A and B
What is a risk factor for NAFLD? What percentage of the population does NAFLD affect?
Obesity
20-30%
What co-morbidities are a risk factor for NAFLD? What is a risk factor for NAFLD? What type of hepatitis is a risk factor for NAFLD?
Insulin resistance, hypertension, polycystic ovaries
Poor diet or exercise
Hepatitis B or C
What are symptoms of NAFLD?
Jaundice
Dark urine
Ascites
Haematemesis
Encephalopathy
Pruritis
What tools can be used to diagnose NAFLD?
LFTs, ultrasound
How is NAFLD treated if overweight? How are associated conditions of NAFLD treated?
Lifestyle change and weight loss
Obesity, diabetes, HTN, cholesterol
What is liver cirrhosis? What process occurs in liver cirrhosis that changes liver structure?
Chronic disease causing hepatocyte destruction
Fibrosis
What vascular consequence can arise from liver cirrhosis? What are other consequences of liver cirrhosis?
HTN in portal vein
Water retention, bleeding oesophagus, encephalopathy
What are the three forms of cirrhosis? Which form of cirrhosis is most common?
Alcohol-induced, post-necrotic, biliary
Alcohol-induced
Where does fibrosis mainly occur in alcohol-induced cirrhosis? What is also responsible in alcohol-induced cirrhosis?
Central veins and portal areas
Malnutrition and chronic alcoholism
From what does scar tissue result in post-necrotic cirrhosis? What does biliary cirrhosis result from?
Acute viral hepatitis or drug-induced necrosis
Chronic biliary obstruction
Define pathogenesis
Chain of events leading to disease
What are some causes of liver cirrhosis?
Alcohol, infections, hepatitis B and C, fats
Breakdown of bile ducts
Build-up of iron
Poorly formed bile ducts
Cystic fibrosis
Autoimmune hepatitis
Galactosemia (inherited disorder)
Glycogen storage disease (inherited disorder)
Copper accumulation
What are symptoms of liver cirrhosis?
Weight loss
Nausea
Pain in stomach
Breast enlargement in men
Bleeding gums
Body inflammation
Clay-coloured stools
Oedema
How can liver cirrhosis be diagnosed?
Blood tests, urine tests, liver/spleen scan, physical exam, CT scan, biopsy, ultrasound
What causes alcohol induced liver cirrhosis? What happens to healthy cells in alcohol induced liver cirrhosis?
Heavy drinking
Replaced by scar tissue
What happens to smooth tissue in alcohol induced liver cirrhosis? What can drinking high amounts of alcohol lead to?
Becomes hard and nodular
Alcoholic hepatitis
Is alcohol induced liver cirrhosis reversible?
Reversible if drinking stopped
What is the term for the buildup of iron that can cause liver cirrhosis?
Haemochromatosis
Wilson’s disease involves the accumulation of which mineral in the liver?
Copper
What are the two classifications of alcohol-induced liver cirrhosis?
Compensated or decompensated
In compensated cirrhosis, how does the liver cope with damage? What happens in decompensated cirrhosis?
By enlargement
Liver cannot cope and function
What is ascites?
Protein-containing fluid build-up in abdomen
What is peri-tonitis?
Inflammation of the peritoneum
What percentage of decompensated cirrhosis patients die within one year?
20%
What should happen when a patient is diagnosed with a cirrhosis-related complication?
Transplant evaluation
What is another name for blood vessel dilation?
Varices
What type of diseases are the most leading cause of liver transplantation?
Chronic liver diseases
What kind of hepatitis is a specific chronic disease that can lead to cirrhosis?
Chronic viral hepatitis
What type of liver disease is primary biliary cirrhosis?
Cholestatic
Alpha-1-anti-trypsin deficiency is what type of disorder?
Metabolic
Can cirrhosis be cured? Where does treatment for liver cirrhosis typically occur? What is a key aspect of treating liver cirrhosis?
No but symptoms managed
Hepatology unit
Treat underlying causes
What type of medication might be used to treat viral hepatitis? What medication is used to reduce ammonia levels in liver cirrhosis patients? Besides medication, what else is important in treating liver cirrhosis?
Antiviral medication
Neomycin
Healthy lifestyle (avoiding alcohol, losing weight)
Why is malnutrition common in cirrhosis patients? Why are vaccinations important for liver cirrhosis patients? What type of diet should cirrhosis patients follow? What type of foods should cirrhosis patients avoid?
Due to liver damage
To reduce infection
Balanced diet
Salty foods
Why does liver damage lead to muscle weakness? Why do liver cirrhosis patients need extra calories and protein? What can be used to reduce itching in liver cirrhosis patients?
Body consumes muscle tissue
To combat muscle weakness
Creams
What type of medical attention is necessary for bleeding oesophageal varices? What medication reduces the risk of bleeding in oesophageal varices? What medication can help with peripheral oedema in liver cirrhosis patients?
Urgent medical attention
Beta-blocker
Diuretic tablets
What can be used regularly to prevent infections in the fluids around the stomach? What can be used to drain fluid out of the abdomen in severe ascites?
Antibiotics
Tubes
What is the name for problems with brain function caused by liver cirrhosis?
Encephalopathy
What syrup acts as a laxative to clear bowels and remove toxins in encephalopathy? Why does liver cirrhosis cause encephalopathy?
Lactulose syrup
Liver does not clear toxins
Why can liver failure cause bleeding problems? What can be given to treat bleeding due to liver failure?
Fail to make blood clot
Vitamin K
Liver cirrhosis increases the risk of developing what cancer? What is the most common cause of this cancer in the USA?
HCC
Hepatitis C and cirrhosis
What is the most recommended treatment option for HCC and compensated cirrhosis? Why do many HCC patients have recurrence within 5 years of treatment?
Hepatic re-section
Loco regional therapy (radio-frequency and chemotherapy)
What can have high rates of early recurrence and limited survival for HCC patients?
Transplantation
Autoimmune hepatitis is a cause of what liver condition? Cystic fibrosis can lead to what liver condition? Glycogen storage disease is a cause of what liver condition?
Liver cirrhosis
Liver cirrhosis
Liver cirrhosis
What is hepatitis A (HAV)?
HAV is a virus that causes inflammation of the liver. It does not lead to chronic disease.
What is Hepatitis B (HBV)?
HBV is a virus that can cause lifelong infection. It can lead to liver damage, cirrhosis, and cancer
What is Hepatitis C (HCV)?
HCV is a virus that causes inflammation of the liver. It can lead to liver damage, cirrhosis, and cancer
What is the incubation period for Hepatitis A? What is the incubation period for Hepatitis B? What is the incubation period for Hepatitis C?
2 to 7 weeks, with an average of 4 weeks
6-23 weeks, with an average of 17 weeks.
6-7 weeks
How is Hepatitis A spread? What are the symptoms of Hepatitis A?
Transmitted by faecal-oral route, close person-to-person contact, and contaminated food/water
Children may have none; adults usually experience fatigue, nausea, abdominal pain, jaundice, and dark urine
How is Hepatitis B spread? What are the symptoms of Hepatitis B?
Through blood, semen, vaginal secretions, contaminated needles, and from mother to child at birth
Many have none, but some may experience jaundice, fatigue, dark urine, and nausea.
How is Hepatitis C spread? What are the symptoms of Hepatitis C?
Through infected blood, IV drug needles, body piercing tools, tattooing, and sharing items like razors or toothbrushes
Many have none, but some may experience jaundice, fatigue, dark urine, and nausea.
What is the treatment for chronic Hepatitis A? What is the treatment for chronic Hepatitis B?
What is the treatment for chronic Hepatitis C?
Not applicable; Hepatitis A does not cause chronic disease
Regular evaluation and antiviral drugs to reduce liver damage.
Regular evaluation with varying success in treatment.
Is there a vaccine for Hepatitis A? Is there a vaccine for Hepatitis B? Is there a vaccine for Hepatitis C?
Yes, 2 doses for anyone >1 year
Yes, 3 doses for all age groups
No vaccine
Who is at risk for Hepatitis A? Who is at risk for Hepatitis B? Who is at risk for Hepatitis C?
Those in areas with poor sanitation, travellers, and those exposed to contaminated food or water.
Infants of infected mothers, sexual partners of infected persons, healthcare workers, IV drug users, and those receiving transfusions
IV drug users, those with multiple sex partners, and people exposed to infected blood.
How can Hepatitis A be prevented? How can Hepatitis B be prevented? How can Hepatitis C be prevented?
Vaccination, good hygiene, washing hands, and proper sanitation.
Vaccination, avoiding shared needles, using condoms, and proper handling of blood.
Avoiding shared needles, blood exposure, and unsafe sex.
What are the three main causes of cirrhosis?
- Alcohol abuse & malnutrition → Laennec’s Cirrhosis
- Infection & drugs → Postnecrotic Cirrhosis
- Biliary obstruction → Biliary Cirrhosis
What is the initial step in the pathogenesis of cirrhosis?
Destruction of hepatocytes (liver cells)
What happens after hepatocyte destruction in cirrhosis? What additional effect does fatty infiltration have in cirrhosis?
Fibrosis and scarring of liver tissue
It contributes to fibrosis and scarring, worsening liver damage
How does fibrosis and scarring affect blood flow?
It leads to obstruction of blood flow and increased pressure in venous and sinusoidal channels.
What is the final major consequence of cirrhosis progression?
Portal hypertension (increased BP in portal vein)
What is the functional unit of the liver? What are the main components of this?
Hepatic lobule
- Hepatocytes (liver cells)
- Central vein
- Hepatic sinusoids
- Portal triad (hepatic artery, portal vein, bile duct)
- Bile canaliculi
What is the function of hepatocytes?
They perform metabolic functions, detoxification, and bile production.
What structures make up the portal triad?
- Branch of the hepatic portal vein – Brings nutrient-rich blood from the intestines.
- Branch of the hepatic artery – Supplies oxygenated blood.
- Bile duct – Carries bile from the hepatocytes to the gallbladder and intestines.
What is the function of hepatic sinusoids? What is the role of the central vein in the liver lobule?
They are capillary-like vessels that allow nutrient and oxygen exchange between the blood and hepatocytes.
It collects blood from the hepatic sinusoids and drains it into the hepatic vein.
What are bile canaliculi, and what is their function?
They are small ducts between hepatocytes that transport bile to the bile duct.
How does blood flow through the liver lobule?
Blood flows from the portal triad (hepatic artery and portal vein) → hepatic sinusoids → central vein → hepatic vein → inferior vena cava.
How does bile flow in the liver lobule?
Bile flows from hepatocytes → bile canaliculi → bile ducts → gallbladder or small intestine.
