Patho of Liver Disease Flashcards
Functions of the Liver
1) Digestive
2) Endocrine
3) Hematological
4) Excretory
Digestive function
-Processing/storing fats, carbs, proteins, vitamins, and minerals
Endocrine function
- Metabolism of
1) glucocorticoids
2) mineralocorticoids
3) sex hormones
Hematological function
- Temporary storage of blood -Synthesis of bilirubin from hemoglobin
- Synthesis of clotting factors
Excretory function
- Excretion of bile and cholesterol
- Synthesis of urea
Stages of Liver disease
1) Hepatitis
2) Fibrosis
3) Cirrhosis
Hepatitis
- General term for inflamed liver
- Can be caused by; alcohol, Hep A,B,C, autoimmune disease, fat, drugs, medications
Fibrosis
- Ongoing inflammation
- The liver tries to heal itself with scar tissue (doesn’t function the same)
- Development of collage within the liver: damaged tissue is encapsulated or replaced by collagen
- Fibrolytic changes: affects blood flow through liver and functions of liver
Cirrhosis
- Advanced fibrosis
- Leads to portal hypertension, impairment of all functions
- Risk of developing HCC
Compensated Cirrhosis
- Liver retains functionality despite damage
- Lab values will change (decreased albumin and platelets)
- No symptoms though
- Can go undiagnosed for a long time
Decompensated cirrhosis
- Lab values will change
- Signs and symptoms will be present too
- Key clinical events: ascites, encephalopathy, jaundice
- Late event: Hepatocellular carcinoma (HCC- liver cancer)
Signs and symptoms of liver disease
- Upper right quadrant pain
- Hepatosplenomegaly
- Jaundice
- Angiomata
- Edema
- Ascites
- Loss of body hair
Synthetic function of the liver
- Albumin: maintains osmotic pressure
- INR: will increase due to decreased coagulation factors
- Bilirubin: by product of hemoglobin degradation
- Enzymes: markers of liver inflammation (acute-snapshot)
Liver enzymes
- AST: also found in other organs
- ALT: liver specific
- ALP: also found in the bone
Other clues of liver damage
- Decreased hemoglobin
- Thrombocytopenia
- Portal hypertension: platelets back up into the spleen, they also get damaged due to the increased pressure
- Platelet count <150,000 = liver damage
- Angiomata
- Jaundice
- Palmar erythema
Portal Hypertension
-Blood cannot get through cirrhotic liver so pressure in portal veins increase
Varices
-Impede blood flow
-Alternate pathways are made
which swell and enlarge
-High risk of bleeds/rebleeds
-Keep patient in the hospital
Circulatory abnormalities
- Portal pressure increases
- Leads to increased systemic pressure
- Salt and water get retained
- Cardiac output increases
Ascites
- Accumulation of lymph fluid within peritoneal cavity due to
- Hypoalbuminemia
- Portal hypertension
Hepatic encephalopathy
- Neurological impairment ranging from confusion to coma
- Ammonia do not correlate
Hepatorenal syndrome
- Kidneys compensate for liver dysfunction
- Increased load on kidneys leads to kidney damage
Infections
- Liver plays an important role innate (non-specific) and adaptive immunity
- Compromised due to decreased blood flow
MELD Score
- Model for end stage liver disease
- Assesses the 3 month mortality risk
APRI or FIB-4
- To assess the likelihood of fibrosis and cirrhosis
- Imaging such as ultrasound, CT and MRI
