Unit 8: Alcohol, drugs and STIs Flashcards
Why might a doctor request an ultrasound of the liver?
Jaundice
upper right abdominal pain
Elevated liver enzymes
What are the key things that a liver ultrasound can identify?
Gallstones
Cirrhosis
Growths and lesions
inflammation (hepatitis)
What three factors must be considered on a liver ultrasound?
Echogenicity
Surface
Echotexture
How does cirrohis appear on an ultrasound?
Increases texture
And nodular surface
How does fatty liver disease appear on an ultrasound?
Hyperechoic liver compared to the kidney
What substances are tested for in a liver function test?
ALT and AST
Alkaline phosphatase and y-glutamyltransferase
Bilirubin
Albumin
How and why do you expect levels of AST and ALT to change if the liver is damaged?
Liver enzymes inlvoved in protein metabolism
If the liver is damaged these substances will be released into the blood - hence level increases
Level AST are less reliable as can also be released from muscle damage
How and why do levels of alkaline phosphatase and y-glutamyltransferase change if the liver is damaged on a blood test?
Found in the bile duct of the liver.
Elevated when the bile duct or gall bladder is obstructed
GGT - indicative of fatty liver disease
Normally enzymes involed in protein metabolism
How and why do levels of bilirubin change on a blood test when the liver is damaged?
Increase
Bilirubin is a product of rbc breakdown - billirubin is converted into a soluble form by the liver, made into a componenet of bile, and is excreted
When the liver is damaged this process fails and billirubin accumulates in the blood.
How and why do levels of albumin change in a liver function test when the liver is damaged?
Decreases
Albumin is a protein produced by the liver, liver damage impairs metabolism
What are some of the observable characteristics of liver disease?
Jaundice - yellowing of the eyes, urine and stool
Males - decreased oestrogen breakdown, breast tissue growth, spider naevi and testicular atrophy
Encephalopathy - decreased absoprtion of vitamin B6 needed for neural function
Ascites - swollen abdomen, hepatic failure increases levels of NOx, hypotension, activates RAAS, accumulation of salt and water in the peritoneal cavity
palmar erythema - redness of hands
What does an abdominal exam indicate?
Upper right abdominal pain - most commonly gall bladder
Gall bladder acute, liver more chronic and dull present after a few weeks of pain
Seperate gut in for - epi, mid - gastri and hind - hypo
Unilateral structures, pain often radiates through to the back and is worse when bending forward
How is CAGE used to test alcohol dependency?
C - cut down
Annoyed - pestered by others to cut down
Guilty -
Eye opener - drinking in the morning or to calm nerves
Score of 2 or higher is clinically significant
How does the AUDIT test screen for alcohol dependency?
Up to 10 questions, scored out of fourty.
Key three questions: how much do you drink on a night out? how often do you drink? Do you binge drink over the recommended limit?
If yes to two of the above will answer following questions ont he effect of alcohol e.g guilt, injury, memory loss
Score below 7 is a low risk
Score below 14 is hazardous
Acore baove 14 indicates dependence
What is the progression of disease from the alcohols effect on the liver?
Steatosis - alcohol fatty liver disease
Hepatitis - inflammation of the liver
Cirrhosis - scarring of the liver
How is alcohol metabolised in the liver?
Ethanol is oxidised to acetaldehyde by alcohol dehydrogenase
Acetaldehyde denhydrogenase will oxidise acetaldehyde down into acetate.
How does alcohol metabolism in the liver lead to fatty liver disease?
Oxidation of alcohol - increases NADH and decreases NAD+ available
This impairs glycolysis and gluconeogenesis/beta oxidation (lactic acidosis and hypoglycaemia)
This can lead to abnormal lipid metabolism - TG synthesis and accumulation of fat within hepatocytes
How does alcohol lead to hepatitis?
Acetaldehyde - toxic substance - prolonged liver damage and necrosis
Damps trigger inflammation leading
How does liver damage lead to cirrhosis?
Damps trigger inflammation leading to fibrosis
Disregulates normal levels of liver regneration and repaiir causinf nodule formation
What are the symptoms of hepatitis?
Pain, jaundice, fatigue and fever
What are teh symptoms of cerrhosis?
Fatigue, weight loss, abdominal pain, jaundice and a swollen abdomen
What are the effects of alcohol on the CNS? (short term)
Inhibitory efffect - effects learned process and cognition before mechanical tasks
Activates GABA A receptors
INhibits Glutamates NDMA receptors
Activates seratonin and dopamine receptors
Inhibits monoamine oxidases
Decrease ADH
Anti-convuslive effects