S6. liver function and pathology

Question 1

functions of liver

Answer 1

storage
(glycogen, vitamins,iron,copper)

synthesis of
glucose, lipids,cholesterol,bile,clotting. factors, albumin

metabolic
>generates energy and detoxifying harmful substances like (bilirubin, ammonia, drugs, alcohol, carbohydrates,lipids)

Question 2

non specific symptoms of liver disease

Answer 2

• nausea
• vomiting
• loss of appetite
• abdominal pain

Question 3

specific symptoms of liver disease

+ relate this to impairments in function

Answer 3

• jaundice (bilirubin build up. metabolic function)
• oedema/ ascites (fluid. within peritoneal cavity)
  > less albumin synthesis. reduced oncotic pressure. can’t draw water in

-bleeding
> less clotting factor synthesis

-confusion
>impaired metabolic function NH4 build up

Question 4

what’s the difference between acute liver failure and decompensated liver failure?

Answer 4

ALF= happens acutely with no underlying background of liver disease
>e.g. excessive acute alcohol intake/ paracetamol overdose/ viral infections e.g. EBV/ acute hepatitis/ some medications ASPRIN IN CHILDREN!

DL= symptoms seen suddenly

Question 5

what is cirrhosis?

Answer 5

permanent, irreversible damage to liver that results in impairment of liver function and distortion of shape of liver itself.
> response to chronic inflammation of liver

Question 6

cirrhosis can cause

Answer 6

fibrosis and hepatocyte necrosis

> healthy liver tissue pops out between the bands of fibrous tissue > appearance of NODULES on liver

Question 7

broad causes of cirrhosis

categories

Answer 7

• drugs/alc
• infection
• deposition
• autoimmune

Question 8

hepatomegaly seen when?

Answer 8

alcoholic liver disease
> fatty change over weeks

and
alcoholic hepatitis

Question 9

example drug related causes of cirrhosis

Answer 9

• iatrogenic (e.g. from prescribed drugs)
• alcoholic liver disease (weeks)
• alcoholic hepatitis (worsening symptoms seen - years)

Question 10

infection related causes of cirrhosis

Answer 10

• hep B> vaccine no cure. symptoms.
• heb C> cure but no vaccine. asymptomatic.
• can cause malignancy due to the chronic inflammation

Question 11

deposition related causes of cirrhosis

Answer 11

fat!! 
non alcoholic fatty liver disease. 
> deposition of fat then inflammation of liver itself 
> link to insulin resistance 
>accumulation of triglycerides. 

‘NASH’ = specifically if inflammation is present.
(non alcoholic steatohepatitis)

Question 12

explain hereditary haemochromatosis

Answer 12

• autosomal recessive
• inc absorption of iron
• excessive iron deposition in liver
• inc ferritin
  > treated through venesection. take blood from patient to reduce amount of iron in circulation

Question 13

explain Wilson’s disease

Answer 13

abnormal copper matabolism
- reduced secretion of copper into circulation to be removed
> accumulation of copper in tissues and liver
> presents in children and young people
- can also affect CNS causing seizures and memory problems

Question 14

autoimmune related causes of cirrhosis

Answer 14

• autoimmune hepatitis
  > affect hepatocytes
• primary biliary sclerosis
• primary biliary cholangitis (can have association with ulcerative colitis)
  > affect bile duct

Question 15

difference between portal and systemic circulation

Answer 15

portal= anything that drains to liver before IVC

systemic= venous network that DOES NOT go thru liver

Question 16

which veins merge to form portal vein

Answer 16

Inferior MesentericV
splenic
Superior Mesenteric V

Question 17

what is portal hypertension?

Answer 17

build up of blood within the portal venous system

Question 18

complications with portal hypertension?

Answer 18

ascites (inc hydrostatic pressure. fluid in peritoneal cavity)

slenomegaly (enlarged spleen)

varices (distension of veins) > shunt of blood from systemic circulation to portal. points of anastomoses.
> oesophageal. (emergency as can bleed. haememesis)

> anorectal (typically painless as above pectinate line and rarely bleed)

> umbilical

Question 19

umbilicus remnant remains as

Answer 19

ligamentum teres

Question 20

what is hepatorenal syndrome

Answer 20

presence of rapid deteriorating kidney function due to underlying liver cirrhosis causing portal hypertension

Question 21

what happens with hepatorenal syndrome?

Answer 21

leads to arterial (splanchnic) vasodilation
> perceived as decreased circulating volume
> RAAS activated
> renal artery vasoconstriction
> reduced perfusion to kidney so reduced kidney function

Question 22

which ducts join at the ampulla of Vater?

Answer 22

common hepatic duct (formed from L and R) and pancreatic duct

Question 23

rate at which duct substances get released into duodenum is controlled by?

Answer 23

sphincter of oddi

Question 24

gallstones formed from?

Answer 24

cholesterol

bile pigments

Question 25

renal stones formed from

Answer 25

calcium based

Question 26

risk factor of gallstone formation

Answer 26

• diet and lifestyle e.g. high cholesterol diet
• women in 40s
• pregnancy

Question 27

what is biliary colic

Answer 27

gallstones that cause right upper quadrant pain soon after eating a fatty meal
cholescystokinin released> gall bladder contracts and pushes a gallstone up against neck of gall bladder. causes temporary obstruction of duct.
- no inflammation

Question 28

what is acute cholecystitis

Answer 28

RUQ pain
impaction of stone in cystic duct itself>nothing else can go thru. complete blockage
- inflammatory features (fever)

Question 29

what is ascending cholangitis

Answer 29

infection of biliary tree
- charcots triad: 
> RUQ pain
> inflammation (fever)
> jaundice

• give Abx and fluids
• relieve obstruction surgically

Question 30

what is acute pancreatitis?

Answer 30

stone within common bile duct at the point it joins with pancreatic duct
>auto digestion of pancreas due to the enzymes which are blocked
>epigastric pain that radiates to the back (retroperitoneal)
> vomiting

• look for raised levels of amylase and lipase in blood to identify