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S2 Case 2 - Diarrhoea > Liver System + Disease > Flashcards

Liver System + Disease Flashcards

1
Q

What are the functions of liver?

A

Detoxification
Bile
Cholesterol production
Protein synthesis

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2
Q

What proteins does the liver produce?

A

Albumin
Coagulation

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3
Q

Describe alanine aminotransferase (ALT) liver function test

A

Increased when cells of the liver are inflamed or undergo cell death
Rises dramatically in acute liver damage, such as viral hepatitis

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3
Q

Describe aspartate aminotransferase (AST) liver function test

A

Raised in acute liver damage; less specific for liver disease

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4
Q

Describe alkaline phosphatase (ALP) liver function test

A

Raised in biliary tract damage and inflammation

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5
Q

Describe gamma-glutamyl transferase (GGT) liver function test

A

Produced by the bile duct (sensitive marker for cholestatic damage)
Raised in alcohol toxicity

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6
Q

Describe bilirubin liver function test

A

Plasma total and direct (=conjugated);
Urine urobilinogen and bilirubin

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7
Q

What is jaundice?

A

Symptom of underlying disease
Elevation of serum bilirubin

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8
Q

What are the 3 types of jaundice?

A

Haemolytic
Hepatocellular
Posthepatic

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9
Q

What is the cause of haemolytic?

A

RBC haemolysis

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10
Q

What are the causes of hepatocellular?

A

Infection
Drug
Genetic error
Autoimmune
Neonatal

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11
Q

What are the causes of posthepatic?

A

Intrahepatic bile ducts
Extrahepatic bile ducts

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12
Q

What happens in bilirubin metabolism in circulation?

A

Erythrocytes broken down + haemoglobin released
Globin metabolised
Haem converted to bilirubin
Bound to albumin

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13
Q

What happens to bilirubin metabolism in liver?

A

Dissociates from albumin
Enters hepatocytes
Conjugated with 2 glucuronic acids
Conjugated secreted by hepatocytes
into bile
Bile secreted
Intestinal bacteria degrade bilirubin to urobilinogen
80% oxidised + secreted in faeces
20% secreted in urine

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14
Q

What is neonatal jaundice?

A

Bilirubin transferase low at birth
Unconjugated bilirubin increased in blood

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15
Q

How is natal jaundice treated?

A

Exposure of blue florescent light to skin
= converts bilirubin to H2O soluble isomers

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16
Q

What is haemolytic jaundice?

A

Excessive RBC lysis
= bilirubin produced faster than rate of conjugation by liver

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17
Q

What does haemolytic jaundice look like in blood?

A

Increased unconjugated bilirubin

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18
Q

What does haemolytic jaundice look like in urine?

A

Urobilinogen increased
No bilirubin in urine
Urine normal colour

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19
Q

What is hepatocellular jaundice?

A

Liver damage by hepatitis
= low conjugation efficiency = bilirubin not secreted into bile

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20
Q

What does hepatocellular jaundice look like in the blood?

A

Increased BOTH unconjugated (indirect) &
conjugated (direct) bilirubin.
ALT & AST levels are markedly elevated = HEPATIC DAMAGE

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21
Q

What does hepatocellular jaundice look like in the urine?

A

Bilirubin is present in urine
= urine colour is yellowish brown

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22
Q

What does hepatocellular jaundice look like in the stool?

A

Normal to pale

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23
Q

What is obstructive (post-hepatic) jaundice?

A

Bile duct obstruction
= conjugated bilirubin prevented from passing to intestine
= passes to blood

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24
Q

What does obstructive jaundice look like in the blood?

A

Increased conjugated (direct) bilirubin.
γGT & ALP are markedly elevated = BILIARY SYSTEM DAMAGED

25
Q

What does obstructive jaundice look like in the urine?

A

Bilirubin in urine.
Urobilinogen reduced.
Complete obstruction, urobilinogen absent
Urine yellowish brown colour

26
Q

What does obstructive jaundice look like in the stool?

A

Pale

27
Q

What is hepatitis?

A

Inflammation of liver

28
Q

Describe acute hepatitis

A

Develops quickly
Last short period of time
Patient recovers normally

29
Q

Describe chronic hepatitis

A

Develop over number of years
Leads to fibrosis + cirrhosis

30
Q

Describe viral hepatitis

A

Acute/chronic liver injury

31
Q

How is hepatitis A spread?

A

Faecal-oral spread

32
Q

Describe hepatitis A

A

Short incubation period
Acute
Asymptomatic
Mild illness
RNA virus

33
Q

How is hepatitis A treated?

A

No specific treatment
Prophylactic anti-HAV immunisation - eg. travellers

34
Q

Describe hepatitis E

A

Acute
More severe liver damage than HepA

35
Q

How is HepE treated?

A

No treatment
In extreme conditions = antiviral ribavirin

36
Q

How is HepB spread?

A

Blood
Blood products
Sexually

37
Q

Describe HepB

A

DNA virus
Long incubation
Liver damage by antiviral immune response

38
Q

What is the treatment for HepB?

A

Interferon alpha
Nucleoside analogues

39
Q

How is HepC spread?

A

Blood
Blood products

40
Q

Describe HepC

A

RNA virus
Short incubation
Asymptomatic

41
Q

What is the treatment for HepC?

A

Treatment depends on strain + stage
Lats 24-48 weeks

42
Q

How does sofosbuvir treat HepC?

A

Uridine nucleotide analogue inhibits HCV polymerase
= prevents viral replication

43
Q

What is autoimmune hepatitis?

A

Autoantibodies against hepatocytes

44
Q

What does autoimmune hepatitis present as?

A

Jaundice
RUQ pain

45
Q

How do you investigate autoimmune Hep?

A

Type 1 = smooth muscle Abs (80%), anti-nuclear Abs (10%)
Type 2 (children) = anti-liver microsomal type 1 Abs

46
Q

How do you treat autoimmune Hep?

A

Immunosuppressants

47
Q

What is alcohol-induced hepatocellular steatosis?

A

Fatty change
= increased lipid biosynthesis
= impaired secretion of lipoproteins
= increased catabolism of fat

48
Q

Is hepatic steatosis reversible?

A

YES
= if abstention to alcohol

49
Q

What are the clinical features of alcoholic hepatitis?

A

Hepatocyte swelling = accumulation of fat + H2O
Cellular necrosis
Fibrosis
Increase in serum bilirubin + ALP

50
Q

What are the clinical features of hepatic steatosis?

A

Mild increase in serum bilirubin + ALP
Asymptomatic

51
Q

What does cirrhosis do?

A

Hepatocytes replaced by non-functional connective tissue
Portal vein hypertension + shunting blood around liver

52
Q

What does cirrhosis not do?

A

Increase susceptibility to idiosyncratic reactions
Increase likelihood of autoimmune-mediated drug reactions

53
Q

What causes cirrhosis?

A

Alcohol = most common
Drugs
Chronic viral hepatitis
Autoimmune hepatitis

54
Q

What does alcohol-mediated hepatic cirrhosis look like?

A

Initially liver yellow, large + fatty = reversible stage
Brown, shrunken + non-fatty

55
Q

What are the signs of cirrhosis?

A

Fluid retention + oedema in legs
Gallstones
Coagulation defects
Reduced mental functions
Jaundice

56
Q

How is oedema treated?

A

Salt restriction + treatment with diuretic

57
Q

What are the 3 hepatocyte zones?

A

Centrilobular = lowest oxygenation
Mid-zone
Periportal = highest oxygenation

58
Q

What is periportal most susceptible to?

A

Viral hepatitis

59
Q

What is centrilobular most susceptible to?

A

Ischaemia

60
Q

Describe paracetamol toxicity

A

Alcohol induces CYP2E1 expression
Accelerates paracetamol hepatoxicity

S2 Case 2 - Diarrhoea (12 decks)

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