Main functions of the liver Flashcards
what are the role of the liver
production of the clooting factors
bile acids
carohyrades production, gluconugesi
protein synstes
lipdis
hormones
how does the liver detodxy
removal of urea
detoxifciation of drugs
bilirubin metabolism
breakdown of insulin and hormones
what is the immune function of liver
clearning blood of particel and infectiosn including bacteria
nutrilsing and destroying all drugs and toxins
what does hte liver store
vid d, a, b12 and k
what type of bilirubin is bond to albumin
unconjugated
is unconfugae soluble in water
no
can unconjuaged bilirubi pass through brain barrier
yes
what are amniotransferases
enzymes present in the hepatocytes
which is mroe speici, alt or ast
alt
what chemical sratin piotns toward ald
ast, alt
what is alkaline phosphatas
enzyme presnet in bile duct with is elvetated in liver obstion or infaiton,
where can alkaline phosphatise be found
bile ducts, obstuaiotn and livver infaltion, bones, placent and intestines
what does radiwd gamma gt mean
alchol use or drug suc as nsaids
what does low levels of albumin mena
kidney disoroer or chronci liver diseaes
what is a low prothorbin time indicitiv off
liver dysfuctoin
what does creatine mean
determes surfial from liver deia nad need for transplant
what can a low platelte count indicate
hyperslenism
what is the platlet count an indirect mraker of
portal hypertension
symptoms of liver failure
jaundice
ascites
variceal bleed
hepatic encephalopathy
causes of preheaptic jandice
increased quantity of bilirubin
imparied transprot
hepatic causes of jaundice
defectvie uptake of bilirubin
defective conjugation
defective excretion
post hepatic jaundice cause
defective tranport of bilirubin by th biliary ducts
what are the cues on hisrotyr for pre hepatic jaundice
anemica
acholuri jaundice
clues on history for hepatic jaundice
risk foactr for liver diesea e.g. ivdu
decompresation - acidtes, varicela bleed, encephalopahty
clues on history for post hepatic jaundice
abdomial pain
cholestatis - pale stool, high colured urine, prutitus
what is seen on clical examination for pre hepatic jaundice
pallor, splenomegaly
what is seen on clincial examion for hepatic jaundice
stigmata of cld,
ascites
asterixis
what is seen on clinal examintion for post hepatic jaundice
palpable gall bladder
what blood investigation can be done for jandice
hep b and c serology
auto antibody porife
caerulopasmin and copper
ferritin and transferrin saturation
alph 1 antitrypsin
fasting glucose adn lipid profile
what can be seen for ultra sound in jaundice patins
see where the obstion is and wherther it is extraphatic or intra hepatic
delinetas site of obstuciotn
cause of obstruction
portal hypertension
see cancer spread
main benift of ct/mri over sultrat
higher senityite, betteer for pancrease
what is ercp
uses endoscpoe and x ray to diagnose paites
what is mrcp
a scan using mri and contrast maerks, no die is added
what is endoscopic retrograde cholangiopancreatography
placing an endocpy in paitent and using radiation to highlight areas of issues
uses markers
how can ercp be usedd therpatuily
dilate bialry tree
acute gaoll stones
stenting of ulary tract obsiton
complicaton of ercp
sedation
pancratis,
cholangistis
sphincteromeoty
what is choleecocholithiaiss
gall sotnses in common bile duct
what is the role of the percutaneous transhepathic cholangiogarm
when ercp not possible due to duodeal obstuoi fo previous serve
hilar stengin
injects die into skin tgehn use ct to look at it
what is main differece in ercp and ptc
ercp more invaise, it uses a dye injected into liver through skin, does not require endosocpty
does mrcp use contrast
no
what is endoscopic ultrasound
a tiney proe is enter into the skin and used for biypys
what can endoscopic biopsy be used for
characterin pancreatic masses, stadging of tumours, fine needle aspiarto of tumor and cysts, excluding biliar mcirocalculi
what can be found with a liver biopsy
certain conditions sucha s autoimmune hepatitis
confirm diagnos e.g. pbc, drug induced liver injury
important for staing of severity e.g. alcholich hepatis, nafld
what is chornic liver diese
liver diase that lasts more than 6 months
what are the causes of cirrhosis
alchol
autoimmune - primary biliary cholangitis, primary schlerosis cholangitis
haemochromatosi
chronci viral hepatisis b,c
non alcholic fatty liver disease
drugs - amiodarne
cysitic fibrosis, a1 antipyin difice, wilsons disese
vascualr probls - portal hypertion
cyrpotgenic
sacodois
amyloid
schistomiasis
what pathological change is seen in liver as a result of cirrhosis
infilataiton of lymphocytes
apotopic heapcyts (enlagemnet and change in nucli)
kupffer cel acited
suinoi lumne with increased resistance to blood flow
what are the presentaion of componseaeted chronic liver diseae
screening tests
abnomal liver funcion tests
what are the presenation of decompansted liver disese
hepatorenal syndome
ascites
varicela bleeding
hepatic encephalopahty
what are acites
fluid in the free space in abdomen
how to confirm ascites
ultrasound
what are the periphal signs of ascites
spiders neivie, palmar erythema, abdomial veins, fetor hepaticus, umilical nodule
jvp
flank haematoma
what tests are needed for new onset asciteis
proetin and albumin concentation
cell count and differentials
sagg - serum
cell count
what does 1.1g /dl cut of mean
if hte serum asice graide is great than 1.1g/ dl it is proal hyptension related
if less than 1.1. it is non portla hyperaion related
causes of ascities
portal hypertension
Low serum albumin causing reduced plasma oncotic pressure
Hypoperfusion of the kidneys leading to activation of the renin-angiotensin system leading to salt and water retention
what extra tests could be done for asciti fludi
tb culture
cytolgy
triglueride
bilirubuin
cause of sagg above 1.1.
portal hypertoisn
chf
constrictive pericarditis
budd chiarri
myxedema
massive liver metates
what cause sagg below 1.1
malignancy, tb, chylous asciteis, pancretic, biliary ascietes, nephrotic syndrome, serositis
what are the treatment options for ascites
diuretics
large volume paracenties
tips
aquareetics
liver transplations
what is heptarenoal sydrome
artiers in kidney deteriorate due to increase in rass, and the heart increase contagion due to tachycardia
what cuawes heptaroenal syndoem
sever liver cirrhosis
what is the treamte for heptaorenla syneom
vasosuppersi, liver transoalt , voluem exspantoin of albium
what cuase viceral heamorages
portal hyperension
where are portaoysmpysci astomsie
skin - caput medusa
oesophagel and gastric
rectal
posterial abdomal wall
stomal
what are the varices with portal hyptension
caput medusae, rectal varices, oesophagel varcies
whis the treatmen for varcies hemoargese
recussitiaon, iv treatnem, endocopy band ligation, teripressin for contoal, sengestilblakemore tube , tipss for rebleed after banding
what is hepatic encephalopathy
confusion due to liver disease, due to toxin buildup
what is seen with hepatic encoepy symptions
gi bleed, infection, constipation, dehydration,
Asterixis - flapping tremor
foetoer hepatics - choronci bad breath
what is the terament for hepatic encephaly
underliing cause traament
antiboitix including neopycin and broad spectrino
laxatives - phsphe enemas nd lactulse
what is the most common liver cancer
hepatoceluar carcinoma
presenationof hepatcelluar carcinoma
abdmoial mass
abdomial pain
weight loss
bleeding form tumouur
what ar the radiolical tests for hepatocellular carcinoma
ultrasound, ct, mri
what are the turmor markers for heptacolluar carcinoma
afp
treatment for hepaceluar carcinoma
hepatic rection
liver transpland
chemotharpy - local or systematic
alcohol injection
radioterhfatoin ablation
tki inhitoar
hormonal therapy
ways to deliver local chaimrey
trasncatherter arterlial chemoa embolization
tki infoar for hepacelluar carciaons
sorafenib
hormone therapy for hepacelluar cancer
tamoxifen
what is used to stop bleeding of oepsygal vercies
terrepressin
