Liver Problems Flashcards
What is alcoholic hepatitis?
Inflammation of hepatocytes caused by alcohol
How does fatty liver occur?
Alcohol metabolism does NAD+ -> NADH
Increased NADH induces fatty acid synthesis
Decreased NAD+, get decreased fatty acid oxidation, accumulation of fatty acids in the liver
Glycerol -> TAGs
Accumulate -> fatty liver
Pathology of cirrhosis
Liver cell necrosis
Modular regeneration and fibrosis
Increased resistance to blood flow and reduced liver function
Complications of cirrhosis?
Hepatocellular carcinoma Liver failure Encephalopathy Wernicke-Korsakoff syndrome Dementia Epilepsy
Causes of liver cirrhosis?
Alcohol Wilson's disease α-1 antitrypsin deficiency Biliary cirrhosis Haemochromatosis Hep B/C Autoimmune hepatitis
Clinical features of liver cirrhosis?
Liver dysfunction Jaundice Anaemia Bruising Palmar erythema Duputren's contracture
What is Wilson’s disease?
When the body cannot excrete copper effectively in the bile
Copper builds up in hepatocytes, spills into bloodstream and is deposited in other organs, often the brain
Lab results for cirrhosis?
Normal/raised ALT and AST Raised alkaline phosphatase Raised bilirubin Decreased albumin Deranged clotting Decreased sodium
Management of cirrhosis?
Stop drinking
Treat complications
Transplant
What is portal hypertension?
When portal venous pressure is >20 mmHg
What can portal hypertension be caused by?
Obstruction of portal vein
- congenital
- thrombosis
- extrinsic compression
Obstruction of flow within liver
- cirrhosis
- hepatoportal sclerosis
- schistosomiasis
- sarcoidosis
What can portal hypertension lead to?
Ascites
Splenomegaly
Oesophageal varices, haemorrhoids and caput medusae
How does portal hypertension lead to ascites?
High pressure in portal venous system means blood is backed up in abdomen
Increased hydrostatic pressure in the abdomen
Less fluid reabsorbed into blood vessels at the end of the capillary beds
Reduced oncotic pressure in the vessels - lack of plasma proteins
How can portal hypertension lead to splenomegaly?
Increased blood pressure in the spleen
Where are the porto-systemic anastamoses?
Oesophageal branch of left gastric vein and oesophageal tributaries of azygous system
Superior rectal branch of inferior mesenteric vein (portal) and inferior rectal veins
Para umbilical and retroperitoneal veins of posterior abdominal wall or diaphragm
Colic/splenic/portal and retroperitoneal veins of posterior abdominal wall or diaphragm
Risk factors for gall stones?
Female Age Obesity then rapid weight loss Multiparity Diet Developed countries Drugs (the pill) Ileal disease or resection Haemolytic disease
How are bile acids concentrated in the gall bladder?
Sodium and water transport across the gall bladder epithelium
Symptoms of acute pancreatitis?
Oedema Haemorrhage Severe pain Vomiting Dehydration Shock Ecchymosis Ileus Necrosis?
Investigation results of pancreatitis?
Raised blood amylase Glycaemia Raised alkaline phosphatase Raised bilirubin Low calcium
Treatment of pancreatitis?
Just supportive
Causes of acute pancreatitis?
Gall stones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP/iatrogenic Drugs
Pathogenesis of acute pancreatitis?
Duct obstruction causes juice and bile reflux causes acinar damage Enzymes are released -proteases cause tissue destruction -lipases cause fat necrosis -elastase cause blood vessel destruction
What happens in chronic pancreatitis?
A result of chronic inflammation
Causes fibrosis and calcification
Parenchymal destruction and duct stenosis
Signs and symptoms of chronic pancreatitis?
Pain Malabsorption -> Steatorrhoea Albumin Weight loss Jaundice
Causes of chronic pancreatitis?
Chronic alcoholism
Cystic fibrosis
Biliary disease
Genetic
What type of cancer are most pancreatic cancers?
90% are ductal adenocarcinomas
Presentation of pancreatic carcinoma?
Initially no symptoms, then get lots
- obstructive jaundice
- pain
- vomiting
- diabetes
- malabsorption
