LOBs Flashcards
What is in the liver lobule?
At the centre is the central vein and portal triads around the outside
what are zones of the liver?
Zone one: around the portal triads where oxygenated blood enters from the hepatic arteries
zone two: in the middle
zone three: around the central vein. highest conc of p450 here
what liver lobule zone is most likely to be damaged by poisoning?
Zone three
what is the metabolism of bilirubin?
enters the liver unconjugated
becomes conjugated in UDP glucuronyl transferase
conjugated bilirubin eaves the liver.
what is the O’grady criteria?
indicates poor prognosis
- acidaemia below 7.3
- renal impairment shown by creatinine above 300
- hepatic encephalopathy grade 3 or 4
- INR>6.5
- factor V level<10%
what are poor prognostic factors for paracetomal overdose?
underlying hepatic impairment
microsomal enzyme induction through phenytoin, alcohol, rifampicin, starvation
acute glutathione depletion states through acute illness HIV, alcoholism
what are the key components to assess suicide risk?
Ideation Intent Plan Access to leathal means History o suicide attempts
why does liver disease affect clotting?
The liver produces some clotting factors and also leads to a decrease in Vit K due to decreased bile salts
what are contraindications for percutaneous liver biopsy?
Ascites
Clotting levels
Tape Worms
what are examples of crystalloids?
Sodium chloride
Glucose
Hartmanns
what are complications of liver disease?
Increased bleeding Oedema Ascites Portal hypertension (oesophageal varices) hepato renal syndrome hepatic encephalopathy liver cancer
what is the west haven criteria?
For grading hepatic encephalopathy
Grade zero: reduced attention, memory disturbance, personality change
Grade One: psychiatric and behavioural changes. Mild confusion, decreased attention, slurred speech and irritability
Grade Two: Drowsiness and lethargy, gross deficits in abilities to perform mental tasks, obvious personality changes, inappropriate behaviour and lack of sphincter control. Liver flap starts
Grade Three: Somnolent but rousable, unable to perform mental tasks, amnesia, incoherent speech and more pronounced confusion. Panaroia and anger
Grade Four: Coma
what causes hepatic encephalopathy?
Raised concentrations of ammonia and increased GABA inhibitory transmission. The ammonia is due to glutamine and decreased hepatic excretion
what is the criteria for needing a coroner?
- unknown cause of death
- violent or unnatural death
- sudden and unexplained
- no medical certificate is available
- deaths in prison/ police custody
what are the three parts to a death certificate?
A/B/C/
1a. the disease/condition
b. other cause/ conditions that lead to a
c. things that lead to b
- other significant conditions contributing to death but not related to the disease causing it.
what are the three types of jaundice?
Pre hepatic
Hepatic
Post hepatic
What is prehepatic jaundice?
where excess unconjugated billirubn goes to the liver
what is hepatic jaundice?
where there is abnormal conjugation or secretion by the liver cell causing an increase in both conjugated an unconjugated billirubin
what is post hepatic jaundice?
impaired excretion due to obstruction of bile flow causing an increase in conjugated billirubin
what is a cause of prehepatic jaundice?
haemolytic anamia
how does urine and stool etc change in prehepatic jaundice?
normal and no pruritis
what are causes of hepatic jaundice?
hepatitis, cirrhosis, Dublin Johnson syndrome
how does urine, stools etc change in hepatic jaundice?
Dark urine, normal stools
what are causes of post hepatic jaundice?
gallstones
malignancy
inflammation
how does urine, stool etc change with post hepatic jaundice?
dark urine
acholic stool
pruritis
what liver test is mainly associated with obstructive causes?
ALP
what liver test is mainly associated with hepatic cause?
ALT
what is the breakdown of ethanol?
Ethanol –> acetaldehyde via alcohol dehydrogenase –> acetate via aldehyde dehydrogenase
what are the two pathways to get from ethanol to acetaldehyde?
- microsomal ethanol oxidising system and this pathway is increased in alcoholics
Ethanol + oxygen –> Acetaldehyde and water - Catalase
ethanol + hydrogen peroxide –> acetaldehyde and water
why can you get ethanol induced hypoglycaemia?
Increased ethanol breakdown means increase NADH formation due to it being a bi-product of the breakdown.
NADH depletes pyruvate and this means increased lactate
NADH depletes oxaloacetate meaning increased malate
what do you give for ethanol induced hypoglycaemia?
200ml 20% glucose
In ethanol breakdown there is increased NADH how is this removed?
DHAP–> glycerol 3 phosphate
but this is a precursor for TG synthesis
what happens 24-48 hours after paracetomal overdose?
nausea/vomiting
RUQ pain
what happens 48-96 hours after paracetomal overdose?
hepatic failure
jaundice
coagulopathy
