Revision Week 6 Liver Flashcards
What is Glisson’s capsule?
fibrous protective lining on the liver
What divides the left and larger right lobe?
falciform
What does each segment have?
Own portal vein, artery and bile duct
What does fenestrated endothelium mean?
Liquid has access but blood does not
What are the stages in Phase I of drug metabolism in the liver?
- Oxidation
- reduction
- hydrolysis
What is Phase II of drug metabolism?
Conjugation
How are drugs excreted from body?
- Kidneys
- faeces (bile from liver)
- lungs (water vapour)
- sweat/tears
- milk, saliva
What does Phase 1 do in drug metabolism?
Increases drug polarity
-creates a new chemically reactive group permitting conjugation
What happens in phase 2
further increases polarity
What do LFTs distinguish in liver?
Hepatocellular injury or cholestasis
What are LFTs?
- ALT
- AST
- ALP
- GGT
- Bilirubin
- Albumin
- PT
Why are bilirubin, albumin and pt called true LFTs?
Measures of protein synthesis in liver
ALT
marker for hepatocellular injury
-mainly exists in liver
AST
- also in heart, skeletal muscle,brain, RBC
- may be elevated because of diseases associated with other areas its in
Where can ALP be found?
-present in liver, bile duct, bone and placenta
altered levels raising ALPs?
- biliary obstruction
- liver disease
- bone problems
- hyperthyroidism, hyperparathyroidism
- renal osteodystrophy
- pregnancy
When does ALP synthesis increase?
During cholestasis
In what cells in bone can ALP be found?
osteoblasts
GGT present where?
- liver/bile duct
- kidneys
- pancreas
- gallbladder
- etc. etc.
hepatocellular injury?
ALT increased
AST increased
cholestasis
ALP increased
GGT increased
What is cholestasis?
Blockage of bile duct
If ALP and GGT both increased what does that suggest?
- suggests biliary epithelial damage and bile flow obstruction
- GGT increase confirms that ALP increase is from liver
GGT and alcohol
GGT raised with lots of alcohol
albumin function
maintains intravascular osmotic pressure
bilirubin
breakdown product of haemoglobin, gets conjugated in liver and excreted
What causes darker urine
conjugated bilirubin passes to liver causing darker urine
pre-hepatic jaundice
excessive red blood cell breakdown
hepatocellular jaundice
jfpsf
post-hepatic
liver fine, obstruction biliary drainage but bilirubin still conjugated
pre-hepatic jaundice causes
- Gilbert’s syndrome
- Haemolytic anaemia
hepatocelullar jaundice acute causes
- poisoning e.g. paracetamol
- infection
- liver ischaemia
hepatocellular jaundice chronic causes
- cirrhosis
- etc
obstructive jaundice causes
- gallstones
- strictures
- tumours
- congenital biliary atresia
When is chronic liver disease chronic
longer than 6 months
compensated cirrhosis
asymptomatic stage
LFTs show damage
decompensated cirrhosis
symptomatic:
- ascites
- jaundice
- variceal haemorrhage
- hepatic encephalopahty
what cells are activated in liver when damaged and produce fibrosis
heapptonfn
what is steatosis
fatty acid build up in cells in liver
NASH
steatosis + inflammation and scarring
When is it not reversible
fibrosis
What is mainly responsible for liver disease in alcohol?
acetaldehyde
What are scores for grading cirrhosis
CHild-Pugh
-…
UKELD score for transplant
49
ascites diagnosis
- shifting dullness
- USS
What is treatment for ascites?
- treat underlying disease
- look for infection
- decrease salt intake
- no NSAIDs
- spironolactone first line
- loop diuretics
- paracentesis
- TIPSS or transplant
What is first line medication for ascites?
Spironolactone -mineralocorticoid receptor antagonist
What is hepatorenal syndrome?
Kidney failure seen in those with severe liver damage
What activates RAAS system in kidneys?
decreased perfusion of glomeruli
Treatment for hepatorenal syndrome?
- Transplantation
- TIPSS
Spontaneous bacterial peritonitis?
bacterial infection in the peritoneum, despite the absence of an obvious source of infection
What antibiotics for SBP? (Mild and severe?)
Mild - co-trimaxazole PO
Severe -
What is hepatic encephalopathy?
build up of ammonia -> hyperammonaemia
What is hyperammonaemia toxic to?
CNS - disturbs astroytes
treatment for hepatic encephalopathy?
- lactulose
- antibiotics
What is definition of acute liver failure?
causing encephalopathy and impaired protein synthesis
hep A
igM
hepA and igG
means theyve had vaccination
How is Hepatitis B transmitted? (3 Bs)
- Bone (sex)
- Baby
- Blood
What are children with Hep B more likely to get?
Chronic Hep B
Surface antigens Hep B HBsAg
present in all infectious individuals
HBeAg
marker for how infectious individual is - usually related to acute
Hep B virus DNA
measure response to antiviral therapy
-used for prognosis
