Patho of Liver Disease

Question 1

Functions of the Liver

Answer 1

1) Digestive
2) Endocrine
3) Hematological
4) Excretory

Question 2

Digestive function

Answer 2

-Processing/storing fats, carbs, proteins, vitamins, and minerals

Question 3

Endocrine function

Answer 3

• Metabolism of
  1) glucocorticoids
  2) mineralocorticoids
  3) sex hormones

Question 4

Hematological function

Answer 4

• Temporary storage of blood -Synthesis of bilirubin from hemoglobin
• Synthesis of clotting factors

Question 5

Excretory function

Answer 5

• Excretion of bile and cholesterol

- Synthesis of urea

Question 6

Stages of Liver disease

Answer 6

1) Hepatitis
2) Fibrosis
3) Cirrhosis

Question 7

Hepatitis

Answer 7

• General term for inflamed liver

- Can be caused by; alcohol, Hep A,B,C, autoimmune disease, fat, drugs, medications

Question 8

Fibrosis

Answer 8

• 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

Question 9

Cirrhosis

Answer 9

• Advanced fibrosis
• Leads to portal hypertension, impairment of all functions
• Risk of developing HCC

Question 10

Compensated Cirrhosis

Answer 10

• Liver retains functionality despite damage
• Lab values will change (decreased albumin and platelets)
• No symptoms though
• Can go undiagnosed for a long time

Question 11

Decompensated cirrhosis

Answer 11

• Lab values will change
• Signs and symptoms will be present too
• Key clinical events: ascites, encephalopathy, jaundice
• Late event: Hepatocellular carcinoma (HCC- liver cancer)

Question 12

Signs and symptoms of liver disease

Answer 12

• Upper right quadrant pain
• Hepatosplenomegaly
• Jaundice
• Angiomata
• Edema
• Ascites
• Loss of body hair

Question 13

Synthetic function of the liver

Answer 13

• 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)

Question 14

Liver enzymes

Answer 14

• AST: also found in other organs
• ALT: liver specific
• ALP: also found in the bone

Question 15

Other clues of liver damage

Answer 15

• 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

Question 16

Portal Hypertension

Answer 16

-Blood cannot get through cirrhotic liver so pressure in portal veins increase

Question 17

Varices

Answer 17

-Impede blood flow
-Alternate pathways are made
which swell and enlarge
-High risk of bleeds/rebleeds
-Keep patient in the hospital

Question 18

Circulatory abnormalities

Answer 18

• Portal pressure increases
• Leads to increased systemic pressure
• Salt and water get retained
• Cardiac output increases

Question 19

Ascites

Answer 19

• Accumulation of lymph fluid within peritoneal cavity due to
• Hypoalbuminemia
• Portal hypertension

Question 20

Hepatic encephalopathy

Answer 20

• Neurological impairment ranging from confusion to coma

- Ammonia do not correlate

Question 21

Hepatorenal syndrome

Answer 21

• Kidneys compensate for liver dysfunction

- Increased load on kidneys leads to kidney damage

Question 22

Infections

Answer 22

• Liver plays an important role innate (non-specific) and adaptive immunity
• Compromised due to decreased blood flow

Question 23

MELD Score

Answer 23

• Model for end stage liver disease

- Assesses the 3 month mortality risk

Question 24

APRI or FIB-4

Answer 24

• To assess the likelihood of fibrosis and cirrhosis

- Imaging such as ultrasound, CT and MRI