Week 1- Liver Disease And Transplantation

Question 1

What does the liver do?

Answer 1

1. Metabolises (carbs, fat and protein)
2. Detoxifies blood
3. Synthesis of digestive enzymes
4. Protein production
5. Storage of nutrients
6. Amazing regenerative properties

Question 2

What is important to remember in terms of transact and liver segments

Answer 2

The left lateral section can be used for adult-> child liver transplant

Question 3

Main liver micro anatomy

Answer 3

Hepatocytes- main cells of the liver, maintain liver homeostasis
Hepatic portal vein and hepatic artery- supplying liver with oxygenated blood and removing deoxygenated blood
Central vein - drains blood into hepatic veins
Bile ducts- transport bile from liver and gallbladder to small intestine

Question 4

Main chronic liver injuries

Answer 4

1. Substances abuse
2. Infective viruses- hept
3. Autoimmune - hep, biliary chol
4. Vascular- budd- chairi
5. Inherited - haemochromatosis
6. Metabolic- NAFLD obesity

Question 5

Alcohol liver injury

Answer 5

• does dependant
• consider gender and genetics
• very common (especially in Scotland)
• Presents as jaundice, coagulation issues and can lead to renal failure

Question 6

Hepatitis C

Answer 6

Injection transmitted - blood borne
Not terribly common in uk
Variety of treatment options - tablets over 8 weeks or 12 weeks if needed

Question 7

Hepatitis B

Answer 7

Less common that hept c
Mainly transmitted through sex in uk
Treated through drugs- tenofovir, entecavir

Question 8

Autoimmune hepatitis

Answer 8

Can occur at any age
More women affected than men
Alt increased
Increased igG level
Responds to steroids (prednisolone) and if it needs more help then azathioprine

Question 9

Primary biliary cholangitis

Answer 9

Chronic cholestatic disorder- issue with bile ducts
Mainly affects females
Bilirubin clear progression marker
Treated by ursodeoxycholic acid
Obeticholic acid therapy, bezafibrate

Question 10

Primary sclerosing cholangitis

Answer 10

Chronic cholestatic problem
Pruritus, jaundice
Symptoms severe and life threatening
Increased incidence of cholangiocarcinoma
MRCP now used for diagnosis
No treatment apart from transplantation

Question 11

Haemochromatosis

Answer 11

Present at any age earlier in males
Increased ferritin, transferrin saturation
Treatment by venesection
High risk of heoatocellular carcinoma

Question 12

NAFLD metabolic association steatosis

Answer 12

More common reason why alt would be increased in the world
Associated with metabolic syndrome dyslipidaemia
Pathogenesis linked to insulin resistance

Question 13

Cirrhosis

Answer 13

Chronic liver disease that happens when liver is damaged over long period of time
Causes scarring
Affects portal vein which affects stomach, kidneys etc

Question 14

Ascites

Answer 14

Fluid accumulation in the abdomen
Frusemide
No salt diet and diuretics

Question 15

Hepatic encephalopathy

Answer 15

Altered level of consciousness as a result of liver failure
Is a result of the toxic N2 metabolites from intestines
Treat for infection, dehydration, constipation

Question 16

Transplant considerations

Answer 16

No extra-hepatic malignancy
No active intravenous drug use
No active alcohol abuse
No advanced cardiopulmonary disease