Pathophysiology of Cirrhosis and Liver function

Question 1

What are the liver functions

Answer 1

Protein metabolism 
aminoacid synthesis and breakdown 
carbohydrate metabolism
hormonal control
bile formation

Question 2

How is bile formed in the liver

Answer 2

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

Question 3

What is the immunological function from the liver

Answer 3

Kupffer cells - reticuloendothelial disease

Question 4

What are some of the causes of liver disease

Answer 4

Acute chronic hepatits
alcohol
infections
high lipids + obesity

Question 5

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

Answer 5

Cirrhosis - end stage liver damage

necrosis/fibrosis

Question 6

What are the consequences of liver disease

Answer 6

Reduced protein synthesis

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

Question 7

When will carb metabolism occur in the liver?

Answer 7

Hypoglycaemia

Question 8

When will lipid metabolism occur in the liver?

Answer 8

Raised level of lipids

increase in free cholesterol

Question 9

When will bile acid/salt processing occur

Answer 9

Fat metabolism lead to - steatorrhea

- fat soluble vitamin deficiency (ADEK)

Question 10

what is steatorrhea

Answer 10

White faeces

Question 11

What will an increase in bile pigments lead to

Answer 11

Pre- hepatic jaundice
hepatic jaundice
post-hepatic jaundice

Question 12

What happens in pre-hepatic jaundice

Answer 12

unconjugated bilirubin in the blood

Question 13

What happens in hepatic jaundice

Answer 13

Mix o unconjugated and conjugated

Question 14

What happens in post-hepatic jaundice

Answer 14

extra hepatic colistatic jaundice
dark urine
all conjugated bilirubin

Question 15

What hormone problems are associated with the liver?

Answer 15

Increase in oestrogen levels

Question 16

What problems are associated with an increase in oestrogen levels

Answer 16

gynaecomastia and testicular amenorrhea
increase in drug half life
amenorrhea

Question 17

how can liver failure cause problems with hormones

Answer 17

secondary hyperaldosteronism

Question 18

What problems can secondary hyperaldosteronism cause

Answer 18

increase in renal secretion of renin and decrease in breakdown

can lead to ascites and oedema

Question 19

associated problems that portal hypertension cause

Answer 19

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

creation of portal - systemic anastomoses

Question 20

What problems does an increase in portal venous pressure cause

Answer 20

Increase in vasoconstrictor activity

fibrosis

Question 21

what problems does portal hypertension cause directly

Answer 21

back pressure into veins

circulation backs up- affects organs downstream

Question 22

why is there a creation of portal - systemic anastomoses

Answer 22

since low flow through HPV the flow goes elsewhere

Question 23

Symptoms and signs of portal hypertension

Answer 23

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

Question 24

Investigations for liver problems

Answer 24

LFT
liver biochem
urine testing 
imaging techniques 
liver biopsy

Question 25

What are you looking for in an LFT

Answer 25

Albumin levels prothrombin time Serum bilirubin ( unconjugated v conjugated)

Question 26

How do we manage chronic liver disease

Answer 26

Treat complications - GI bleed - control bleeding - prothrombin time - PPI - improve/patient gastric bleeding

Question 27

What can be done to prevent hepatic encephalopathy

Answer 27

restrict protein intake | limit absorption of toxins from GIT

Question 28

What is fulminant liver failure

Answer 28

Rapid onset encephalopathy | cerebral oedema and increase in intracranial pressure secondary to high levels

Question 29

What would put patients at an increased risk of septic arthritis

Answer 29

``` Prosthetic joints bacterial infection elsewhere IV drug use immunosupression recent joint injury surgery ```

Question 30

Symptoms of septic arthritis

Answer 30

``` Inability to move the limb with the infected joint Intense joint pain Joint swelling Joint redness Fever ```

Question 31

diagnosis of septic arthritis

Answer 31

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

Question 32

Treatment for septic arthritis

Answer 32

Flucloxicillin | 4-6 weeks antibodies

Question 33

What are bone infections commonly called?

Answer 33

Osteomyelitis

Question 34

What is the most common pathogen for bone infections

Answer 34

Staph aureus

Question 35

Symptoms of bone infections

Answer 35

gowing end of bone will be painful | tender - bone lesion and general febrile illness

Question 36

Diagnosis of Bone infections

Answer 36

Blood culture rare biopsy Radiologically

Question 37

Treatment of of bone infections

Answer 37

Typically flucloxicillin clindamcin - if penicllin allergic vancomycin for MRSA