The Liver & NAFLD Flashcards
How is the liver involved in protein metabolism?
Synthesis of serum proteins
synthesis of blood clotting factors
deamination/transamination to produce non-essential amino acids
removal and detoxification of ammonia through urea synthesis
How is the liver involved in lipid metabolism?
Synthesis of cholesterol, phospholipids, triglycerides
Breakdown of fatty acids for energy production
What vitamins are stored in the liver?
B vitamins
Fat soluble vitamins
What minerals are stored in the liver?
Iron, Copper, Magnesium, Zinc
How does the liver assist in digestion?
Bile production which assists in fat and fat soluble vitamin absorption
Conjugation and excretion of bilirubin which is a breakdown product of red blood cells
What is jaundice?
Jaundice is a build up of bilirubin (not being excreted by the liver). Leads to yellowed skin and a build up of bilirubin can also lead to extremely uncomfortable itchy skin. try to give medications that normalize the bile pool
How does the liver aid in hormonal detoxification?
conjugation and excretion of aldosterone & alcohol dehydrogenase hormone
enzymes in the liver detoxify alcohol, drugs, poisons
What are the signs and symptoms of liver disease?
Mild abdominal pain and generalized fatigue - most common sign
Anorexia
Muscle wasting
weight loss
jaundice - end stage
Hypo or hyperglycemia
Anemia
portal hypertension - which can lead to swollen arteries that connect to the stomach or esophagus which can bust open and bleed esophageal varices
Ascites
Hypoalbuminemia
Encephalopathy - liver fails to detoxify waste products such as ammonia into urea (breakdown product of amino acids). pH goes up dramatically, proteins can denature
What is billiary atresia?
A condition in which the bilde ducts outside and inside the liver are scarred and blocked, bile can’t flow into the intestine so builds up in the liver and damages it.
***Problems with absorption of fat soluble vitamins (D and K) and supplement with MCT because it doesn’t need bile to abosrb MCT.
Which bile salts are toxic?
Non-polar bile salts
What do AST and ALT tell us?
Liver function tests but are very sensitive and can jump and down
ALT very sensitive to hepatic damage or if you injure yourself
Can go up with liver disease **ESPECIALLY if patients are being fed TPN
What is ascites?
Build up of acidic fluid related directely to the lack of albumin synthesis (Hypoalbuminemia)
What two liver biomarkers DECREASE in the liver disease states?
Albumin - not a good marker for visceral protein status, more a sign of how well your liver is making protein
BUN (can also be normal)
What would elevated ammonia, low albumin and a delayed Prothrombin time (PTT) indicate?
Liver disease/malfunction
What is ALP indicative of?
Non specific - can also be elevated during periods of growth (reflects bone function) however elevations in the presence of a liver diagnosis usually mean billiary flow is poor
What is Hepatitis A?
Viral infection that is extremely contagious
Associated with contaminated water (sewage, natural disaster etc.)
usually resolves in a few months
Vaccinations available
Does not tend to cause permanent liver damage
What is Hepatitis B?
HBV
Transmitted through bodily fluids through infected needles or blood, sexual activity
More serious chronic illness can result (Liver cancer), can lead to liver failure
vaccinations available