Topic 7 - Hepatic and Renal Impairment

Question 1

Does the liver have a good supply of blood?

Answer 1

Yes from hepatic portal vein and artery

Question 2

What are the functions of the liver?

Answer 2

Digestion and storage of carbohydrates. Carbs are metabolised to glucose and stored in the liver. Glucagon is given in cases of hypoglycaemia - won’t work if there’s depleted glycogen stores such as in liver cirrhosis.

Synthesis of bile which is essential for digestion of lipids. Without bile, can get loose fatty foul smelling stools and nutritional deficiencies as vitamins not absorbed.
Bile enters into the common hepatic duct and is excreted for storage in gall bladder.

Stores iron and vitamin b12.

Synthesises coagulation factors II, VII, IV, X which are essential for coagulation.

Synthesises albumin which is important for blood osmotic control (without it there’s risk of oedema) and important for binding to circulatory drugs.

Has Kuppfer cells which are important in immunity. Fight infections in venous blood.

Essential in Vitamin D metabolism which promotes healthy bones.

Important in homeostasis of sex hormones. Without this, males can get testicular atrophy and clinical feminitisation.

Drug metabolism - phase I and phase II

Question 3

What impact can paracetamol overdose have on the liver?

Answer 3

Glutathione removes toxic metabolites. When there’s no more glutathione, the metabolite affects the liver and causes liver damage and failure.
Can result in death unless there’s an urgent liver transplant.

Question 4

What are the three main causes of liver impairment/failure?

Answer 4

• Alcohol abuse
• Hepatitis
• Congenital