S6 L1 Liver Function, Jaundice, LFTs Flashcards
Liver functions (3 main)
Liver:
- Vague symptoms
- Specific symptoms
- Examples of acute liver disease causes
Liver Cirrhosis
- Damage type?
- Permanent?
- Develops due too..
Causes of chronic inflammation, list 5…
Drugs, Infection, Deposition, Autoimmune
Causes of Chronic Inflammation - explain in more detail…
- Drugs, also what 3 changes can be seen in the liver…
Causes of Chronic Inflammation - explain in more detail… name some conditions associated with both of these…
- Infection (list 2 diseases associated)
- Deposition (list 4 diseases associated)
Causes of Chronic Inflammation - explain in more detail… name some conditions associated with both of these…
- Autoimmune (list 3 diseases associated)
- Other (list 3 diseases associated)
Complications of cirrhosis
- Portal circulation (what is this?)
- Systemic circulation (what is this?)
- Three main veins of portal system?
- Explain the route taken of these veins to get into the liver
- What is the name of the vein that leaves the liver?
Portal hypertension:
- What is this?
- Complication of what? ____
- How does ____ (the complication stated above) lead to portal hypertension?
- How can it lead to splenomegaly?
- How can it lead to varices?
Portal hypertension:
Main complication of cirrhosis
• Portal hypertension - build up of blood within this portal system
• Cirrhosis - lots of fi brotic tissue is laid down in place of healthy liver tissue. Fibrotic tissue is not expansive (healthy liver tissue is), liver tissue needs to be expansive as it allowing drainage from majority of GI to the liver before it enters IVC). This causes compression of veins entering the liver from the portal system. This causes an increase in hydrostatic pressure within the portal system, this leads to fl uid leakage and ascites. (Ascites can also happen as the liver isn’t producing albumin). Build up of pressure in the splenic circulation, this can cause splenomegaly.
• Varices - Blood can shunt from portal circulation to systemic circulation. There are small anastomoses between portal and systemic system that are normally used, shunting then happens, causing distension of veins at that site of anastomoses, distension of the veins is called varices, causing varices.
Sites of varices
- State and explain the 3 sites…
- What suspecting liver cirrhosis, what to think about when examining?
Sites varices can occur:
• Oesophagus varices: upper 2/3: drain into the oesophageal veins, into azygous veins, into the superior vena cava, but distal portion of the oesophagus: drains into the left gastric vein, this then drains into the portal vein. At the junction between veins draining into the main systemic circulation
(i.e. into the SVC) and the veins entering the portal system, this is where the pressure builds up. These superficial veins get dilated, they are very fragile, and can rupture = this can cause significant haemoptysis (vomiting blood - medical emergency).
• Anorectal varices: between superior, and middle and inferior rectal veins. Superior rectal vein drains into the inferior mesenteric vein that drains into the portal vein. The middle and inferior rectal vein, drain into the internal iliac vein which then drain into the inferior vena cava. Overlap between superior rectal vein, and middle and inferior rectal veins, at this point of anastomoses, they can
distend, causing varices. Usually painless as above the pectinate line, rarely bleed as not as fragile as the dilate oesophageal muscosa veins. Therefore, patients don’t often present with these
• Umbilicus varices: In foetus - umbilical vein supplies the arterial blood fl • ow to feotus, in adults, the remnant of this is the ligament up teres (non-functioning in adults, but connection is there between the umbilicus and circulation. These can become enlarged - sign: Caput medusae (can see wiggly pattern of the superificial veins on abdominal wall)
• Examining suspected liver cirrhosis: Hepatomegaly? Splenomegaly?
Hepatorenal Syndrome
- Explain the process of syndrome
- What happens in this syndrome?
Biliary System and Common Pathology:
- Bile is made in…?
- Explain the ducts connecting gall bladder to _____, liver to duodenum, pancreas to _____
- Sphincter involved…
Biliary colic:
- What happens with this syndrome? Why do you get the pain?
- Symptoms
- Treatment
Acute Cholecystitis:
- What happens with this syndrome? Why do you get the pain?
- Symptoms
- Treatment
Difference between biliary colic and acute cholecystitis?
Renal stones and Kidney stones
Ascending cholangitis:
- What happens with this syndrome? Why do you get the pain?
- Symptoms
- Treatment
CHOLANGITIS (Spelt wrong in the writing neck to the black)
3 conditions discussed earlier:
- Biliary colic
- Acute cholecystitis
- Ascending chlangitis
Which have each symptom/sign: RUQ pain, fever, juandice
Acute pancreatitis
- What is this?
- Symptoms/signs, typical presentation?
- Blood test show…
Jaundice definition
Bilirubin
How haemoglobin broken down, bilirubin, what should happen to bilirubin…
3 places bilirubin can ‘end up’
- Haemoglobin in RBC
- Converted to bilirubin in the liver
- Bilirubin albumin in the blood stream
- Bilirubin conjugated (added glucoronic acid) by UDP glucoronyl transferase (the made it water soluble)
- Excreted via the bile into the GI tract - majority egested in factors as stercoblin and in urine as urobilinogen
Types of Jaundice:
- 3 types
- Biliruibin ‘type’ in each of these
- Can you tell jaundice from LFTs?
- Which jaundice is most likely if you see dark urine and pale stall?
4th type of jaundice
- Example of conditions leading to this
Which type of jaundice might the following conditions lead to?
- Inflammation/oedema
- Tumours in the liver
- Cirrhosis
Painless jaundice - which condition/disease could this suggest?
LFTs:
- What are LFTs (list them)
- Explain list of LFTs and give examples of when then can be raised
What LFTs levels may be seen with:
- Haemolysis
- Paracetomol overdose
note - may be jaundice in paracetomol overdose! this example, the person wasn’t
What LFTs levels may be seen with:
- Acute pancreatitis
- Liver metastasis
Summary of RBC breakdown….
