The Patient Sem 2 - The Liver Flashcards
What is the largest single organ?
Liver
What are the two blood supplies to the liver?
Arterial blood (20% hepatic artery) Venous blood (80% portal vein)
Name five liver functions:
METABOLISM- drugs, hormones, bilirubin
SYNTHESIS - proteins, clotting factors, fibrinogen, cholesterol
CLEARANCE- bilirubin, drugs, toxins
PRODUCTION OF BILE - secretion of bile salts
STORAGE - fat soluble vitamin ADEK
Explain the classifications of liver disease:
- Cholestatic liver disease/cholestasis
- Disruption of bile flow (stagnation of bile in bile ducts)
- Can be intrahepatic or extra hepatic
- Increases bilirubin, alkaline phosphate - Hepatocellular ideasse - injury to hepatocytes e.g. toxins, viruses
- Fatty infiltration
- Inflammation - hepatitis
- Increase in transaminase enzymes GGT, bilirubin
What is fibrosis?
active deposition of collagen formation of scar tissue - this can disrupt blood flow.
What is acute liver disease?
History of onset of symptoms doesn’t exceed 6 months
What is chronic liver disease?
- Persists more than 6 months
- Permanent structural changes
- Most common cause = alcohol and chronic viral hepatitis
What is bilirubin?
Product of RBC breakdown.
Usual range = 5-20micromol/L
Transported to the liver in the serum attached to albumin.
What level of bilirubin indicates jaundice?
50micromol/L
What are the transaminases that give indication of liver function?
- ) Aspartate transferase (AST)
- usual range = 0-40 iu/L
- Found in liver, heart, skeletal muscle, pancreas, kidney and RBC - ) Alanine transferase (ALT)
- Usual range 5-30 iu/L
- LIVER specific
- When liver cells are damaged they burst and release these enzymes
What is ALP?
Alkaline phosphate.
Normal range = 20-120iu/l
Found in liver, bone and intestine and placenta
What is yGT?
y- Glutamyltransferase (GGT)
- Normal range = 5-55 iu/L
- Found in liver, biliary epithelial cells, pancreas, kidneys, intestine
What is Albumin?
One of the proteins produced by the liver.
Normal range 35-50 g/dL
What do decreased albumin levels indicate?
Oedema.
How to interpret LFT’s.
If liver dysfunction - usually at least 2 will be deranged.
LFT’s aren’t always abnormal even in patients with cirrhosis.
Other liver investigations apart from LFT’s?
- Fibroscan
- Liver biopsy
- Imaging e.g MRI, CT scan
What are some symptoms of liver disease?
- Fatigue
- General Malaise
- Fever
- Nausea
- Vomitting
- Jaundice
- Pale stool and dark urine
- Pruritus
- Finger clubbing
- Brusing and bleeding
- Liver problems
- Encephalopathy
What is ascites?
Accumulation of fluid in the peritoneal cavity leading to a swollen abdomen
What are the three theories for the cause of ascites?
- under fill
- Over fill
- Peripheral artery restrictionm
Treatment of ascites?
Diuretics–>
- spironolactone 100-600mg OD
- Furosemide 40 -160mg daily
Important to take daily U+E’s esp Na, K, Cr
What is spontaneous bacterial peritonitis?
- Infection of ascitic fluid without intra-abdominal source of sepsis.
- Neutrophil count >250 cells per mm3
- Mortality rate is approx 40%
What is hepatic encephaolopathy
Spectrum of neuropsychiatric changes in mood and behaviour, confusion, poor sleep rhythm and eventually
delirium and coma.
- Similar symptoms to alcohol intoxication/withdrawal
Theory behind cause of hepatic encephalopathy?
Accumulation of toxins esp ammonia, increased levels of NT’s
How do you treat hepatic encephaolopathy?
Treatment involves avoidance of precipitants and lowering ammonia levels therefore:
- LAXATIVES (e.g. lactulose liquid) BD-TDS
- Antibiotics (metronidazole, neomycin, sodium benzoate)
