The Liver in Health and Disease

Question 1

List the functions of the liver

Answer 1

Metabolism - glucose, lipid, protein, bilirubin, drugs, toxins
Synthesis - proteins (albumin, coagulation factors, acute phase), bilirubin
Deamination of amino acids
Urea production

Question 2

Define the term ‘jaundice’

Answer 2

Increased bilirubin in blood

Yellow discolouration of skin, sclera, mucous membranes

Question 3

List the causes and effects of jaundice and how they may be differentiated by blood tests

Answer 3

Pre-hepatic (haemolytic) - infections, immune, genetics –> unconjugated bilirubin in blood
Hepatic - hepatocyte injury –> unconjugated bilirubin in blood
Post-hepatic (obstructive) - gallstones, pancreatic cancer –> conjugated bilirubin in blood

Question 4

Describe the functions of the gall bladder and the pathophysiology and effects of gallstones

Answer 4

Store and appropriately release bile
Bile solubilises fat to increase absorption
Gallstones form due to high concentration –> hardened, calcium deposits
Effects - RUQ pain after eating, jaundice

Question 5

Describe the effects of chronic alcohol ingestion in the liver

Answer 5

Fatty liver –> hepatitis - stellate cell activation

Cirrhosis - architectural change, scarring, nodular regeneration, necrosis

Question 6

Describe common pathology of the liver

Answer 6

Toxic - drugs, alcohol
Infectious - hepatitis virus, bacteria, parasites
Immune - autoimmune, primary biliary cirrhosis
Tumours - primary, metastatic, benign
Inherited - haemochromatosis, a1-antitrypsin deficiency, Wilson’s disease

Question 7

Describe the normal anatomy of the liver and related structures

Answer 7

Portal vein, hepatic artery –> hepatic vein
Hepatic vein –> biliary duct
Hepatocytes - endothelial, kupffer, stellate, biliary epithelium, natural killer cells