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PBCP- Pathophysiology > Pathophysiology of Cirrhosis and Liver function > Flashcards

Pathophysiology of Cirrhosis and Liver function Flashcards

1
Q

What are the liver functions

A 
Protein metabolism 
aminoacid synthesis and breakdown 
carbohydrate metabolism
hormonal control
bile formation
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2
Q

How is bile formed in the liver

A

Bile acid/salt synthesis from Hb and secretion - (enterohepatic recirculation)

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3
Q

What is the immunological function from the liver

A

Kupffer cells - reticuloendothelial disease

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4
Q

What are some of the causes of liver disease

A

Acute chronic hepatits
alcohol
infections
high lipids + obesity

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5
Q

What is end stage liver damage called and what are the causes

A

Cirrhosis - end stage liver damage

necrosis/fibrosis

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6
Q

What are the consequences of liver disease

A

Reduced protein synthesis

  • hypoalbuminaemia
  • clotting factors - prolonged prothrombin time
  • NH3 removal - encepalopathy
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7
Q

When will carb metabolism occur in the liver?

A

Hypoglycaemia

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8
Q

When will lipid metabolism occur in the liver?

A

Raised level of lipids

increase in free cholesterol

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9
Q

When will bile acid/salt processing occur

A

Fat metabolism lead to - steatorrhea

- fat soluble vitamin deficiency (ADEK)

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10
Q

what is steatorrhea

A

White faeces

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11
Q

What will an increase in bile pigments lead to

A

Pre- hepatic jaundice
hepatic jaundice
post-hepatic jaundice

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12
Q

What happens in pre-hepatic jaundice

A

unconjugated bilirubin in the blood

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13
Q

What happens in hepatic jaundice

A

Mix o unconjugated and conjugated

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14
Q

What happens in post-hepatic jaundice

A

extra hepatic colistatic jaundice
dark urine
all conjugated bilirubin

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15
Q

What hormone problems are associated with the liver?

A

Increase in oestrogen levels

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16
Q

What problems are associated with an increase in oestrogen levels

A

gynaecomastia and testicular amenorrhea
increase in drug half life
amenorrhea

17
Q

how can liver failure cause problems with hormones

A

secondary hyperaldosteronism

18
Q

What problems can secondary hyperaldosteronism cause

A

increase in renal secretion of renin and decrease in breakdown

can lead to ascites and oedema

19
Q

associated problems that portal hypertension cause

A

Hepatomegaly and increased resistance
increase in portal venous pressure
splenomegaly (via splenic vein)

creation of portal - systemic anastomoses

20
Q

What problems does an increase in portal venous pressure cause

A

Increase in vasoconstrictor activity

fibrosis

21
Q

what problems does portal hypertension cause directly

A

back pressure into veins

circulation backs up- affects organs downstream

22
Q

why is there a creation of portal - systemic anastomoses

A

since low flow through HPV the flow goes elsewhere

23
Q

Symptoms and signs of portal hypertension

A 
Jaundice
rigth hypochondrial pain 
ascites 
ankle swelling 
haematemesis and melaena 
gynacomastia 
psychiatric rings
24
Q

Investigations for liver problems

A 
LFT
liver biochem
urine testing 
imaging techniques 
liver biopsy
25
Q

What are you looking for in an LFT

A

Albumin levels
prothrombin time
Serum bilirubin ( unconjugated v conjugated)

26
Q

How do we manage chronic liver disease

A

Treat complications

  • GI bleed - control bleeding
  • prothrombin time
  • PPI - improve/patient gastric bleeding
27
Q

What can be done to prevent hepatic encephalopathy

A

restrict protein intake

limit absorption of toxins from GIT

28
Q

What is fulminant liver failure

A

Rapid onset encephalopathy

cerebral oedema and increase in intracranial pressure secondary to high levels

29
Q

What would put patients at an increased risk of septic arthritis

A 
Prosthetic joints 
bacterial infection elsewhere 
IV drug use 
immunosupression 
recent joint injury surgery
30
Q

Symptoms of septic arthritis

A 
Inability to move the limb with the infected joint 
Intense joint pain 
Joint swelling 
Joint redness 
Fever
31
Q

diagnosis of septic arthritis

A

Aspiration of joint fluid for cell count, gram stain and culture

32
Q

Treatment for septic arthritis

A

Flucloxicillin

4-6 weeks antibodies

33
Q

What are bone infections commonly called?

A

Osteomyelitis

34
Q

What is the most common pathogen for bone infections

A

Staph aureus

35
Q

Symptoms of bone infections

A

gowing end of bone will be painful

tender - bone lesion and general febrile illness

36
Q

Diagnosis of Bone infections

A

Blood culture
rare biopsy
Radiologically

37
Q

Treatment of of bone infections

A

Typically flucloxicillin
clindamcin - if penicllin allergic
vancomycin for MRSA

PBCP- Pathophysiology (11 decks)

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