LOBs

Question 1

What is in the liver lobule?

Answer 1

At the centre is the central vein and portal triads around the outside

Question 2

what are zones of the liver?

Answer 2

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

Question 3

what liver lobule zone is most likely to be damaged by poisoning?

Answer 3

Zone three

Question 4

what is the metabolism of bilirubin?

Answer 4

enters the liver unconjugated

becomes conjugated in UDP glucuronyl transferase

conjugated bilirubin eaves the liver.

Question 5

what is the O’grady criteria?

Answer 5

indicates poor prognosis

1. acidaemia below 7.3
2. renal impairment shown by creatinine above 300
3. hepatic encephalopathy grade 3 or 4
4. INR>6.5
5. factor V level<10%

Question 6

what are poor prognostic factors for paracetomal overdose?

Answer 6

underlying hepatic impairment
microsomal enzyme induction through phenytoin, alcohol, rifampicin, starvation

acute glutathione depletion states through acute illness HIV, alcoholism

Question 7

what are the key components to assess suicide risk?

Answer 7

Ideation
Intent
Plan
Access to leathal means
History o suicide attempts

Question 8

why does liver disease affect clotting?

Answer 8

The liver produces some clotting factors and also leads to a decrease in Vit K due to decreased bile salts

Question 9

what are contraindications for percutaneous liver biopsy?

Answer 9

Ascites
Clotting levels
Tape Worms

Question 10

what are examples of crystalloids?

Answer 10

Sodium chloride
Glucose
Hartmanns

Question 11

what are complications of liver disease?

Answer 11

Increased bleeding
Oedema
Ascites
Portal hypertension (oesophageal varices)
hepato renal syndrome
hepatic encephalopathy
liver cancer

Question 12

what is the west haven criteria?

Answer 12

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

Question 13

what causes hepatic encephalopathy?

Answer 13

Raised concentrations of ammonia and increased GABA inhibitory transmission. The ammonia is due to glutamine and decreased hepatic excretion

Question 14

what is the criteria for needing a coroner?

Answer 14

• unknown cause of death
• violent or unnatural death
• sudden and unexplained
• no medical certificate is available
• deaths in prison/ police custody

Question 15

what are the three parts to a death certificate?

Answer 15

A/B/C/

1a. the disease/condition
b. other cause/ conditions that lead to a
c. things that lead to b

2. other significant conditions contributing to death but not related to the disease causing it.

Question 16

what are the three types of jaundice?

Answer 16

Pre hepatic
Hepatic
Post hepatic

Question 17

What is prehepatic jaundice?

Answer 17

where excess unconjugated billirubn goes to the liver

Question 18

what is hepatic jaundice?

Answer 18

where there is abnormal conjugation or secretion by the liver cell causing an increase in both conjugated an unconjugated billirubin

Question 19

what is post hepatic jaundice?

Answer 19

impaired excretion due to obstruction of bile flow causing an increase in conjugated billirubin

Question 20

what is a cause of prehepatic jaundice?

Answer 20

haemolytic anamia

Question 21

how does urine and stool etc change in prehepatic jaundice?

Answer 21

normal and no pruritis

Question 22

what are causes of hepatic jaundice?

Answer 22

hepatitis, cirrhosis, Dublin Johnson syndrome

Question 23

how does urine, stools etc change in hepatic jaundice?

Answer 23

Dark urine, normal stools

Question 24

what are causes of post hepatic jaundice?

Answer 24

gallstones
malignancy
inflammation

Question 25

how does urine, stool etc change with post hepatic jaundice?

Answer 25

dark urine
acholic stool
pruritis

Question 26

what liver test is mainly associated with obstructive causes?

Answer 26

ALP

Question 27

what liver test is mainly associated with hepatic cause?

Answer 27

ALT

Question 28

what is the breakdown of ethanol?

Answer 28

Ethanol –> acetaldehyde via alcohol dehydrogenase –> acetate via aldehyde dehydrogenase

Question 29

what are the two pathways to get from ethanol to acetaldehyde?

Answer 29

1. microsomal ethanol oxidising system and this pathway is increased in alcoholics
   Ethanol + oxygen –> Acetaldehyde and water
2. Catalase
   ethanol + hydrogen peroxide –> acetaldehyde and water

Question 30

why can you get ethanol induced hypoglycaemia?

Answer 30

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

Question 31

what do you give for ethanol induced hypoglycaemia?

Answer 31

200ml 20% glucose

Question 32

In ethanol breakdown there is increased NADH how is this removed?

Answer 32

DHAP–> glycerol 3 phosphate

but this is a precursor for TG synthesis

Question 33

what happens 24-48 hours after paracetomal overdose?

Answer 33

nausea/vomiting

RUQ pain

Question 34

what happens 48-96 hours after paracetomal overdose?

Answer 34

hepatic failure
jaundice
coagulopathy