Week 11 Flashcards
liver function
- bile production
- clearing meds
- metabolism
- protein production
- breakdown toxins
- clotting factors
loss of bile production leads to
jaundice
loss of med clearance leads to
drug toxicity
loss of clotting factors leads to
coagulopathy
loss of toxin breakdown leads to
encephalopathy
loss of protein production leads to
low albumin > edema / ascites
loss of metabolism leads to
hypoglycemia, lethargy, cachexia
hepatitis
liver injury due to inflammation
what are acute hepatitis
hepatitis A / E
what are chronic hepatitis
hepatitis B / C
what leads to increased risk of liver cirrhosis / cancer
hepatitis B / C
what are the sources of hepatitis A / E
contaminated food & water, acute illness
what are the sources of hepatitis B / C
blood products / bodily fluids
those infected with acute hepatitis B present with __
lethargy, body-aches, fever, jaundice and dark tea-
colored urine
what is a rare complication of hepatitis A / E
liver failure; transplant is the only life saving option
risk of liver cancer increased in
- males > 40 yrs, females > 50 yrs
- liver cirrhosis
- family history
- high level of hep B
- alcohol, smoking, obesity
what does lipogenesis result in
- dyslipidemia
- insulin resistance
- obesity
- metabolic syndrome
- Type 2 diabetes
what does inflammation result in
- lipid peroxidation
- mitochondrial dysfunction
- oxidative stress
- apoptosis
- pro-inflammatory cytokine activation
what does fibrosis result in
- advanced cell damage
- scarring
what are the 3 stages involved in fatty liver disease
lipogenesis, inflammation, fibrosis
what gene is associated with autoimmune hepatitis
human leukocyte antigen
gallbladder diseases
cholelithiasis, cholecystitis, biliary colic, choledocholithiasis, cholangitis
cholelithiasis
gallstones in gallbladder
cholecystitis
GB & cystic duct inflammation
biliary colic
abdominal pain due to gallstone in gallbladder neck
choledocholithiasis
gallstones in CBD
cholangitis
infected bile ducts
causes of cholelithiasis
bile saturated due to high cholesterol, obesity, estrogen
causes of biliary colic
Gallstone lodged in the neck of the gallbladder or cystic duct
causes of Cholecystitis
infected GB leading to inflammation
causes of choledocholithiasis
Obstruction of biliary flow into the duodenum due to gallstone stuck in CBD
causes of Cholangitis
biliary tract infected causing obstructed bile flow
cirrhosis
hardening of liver
causes of cirrhosis
hepatitis B / C
excessive alcohol
autoimmune liver disease
fatty liver
iron build up
copper accumulation
repeated heart failure with liver congestion
most common causes of liver cirrhosis in SG
chronic hepatitis B & alcoholic liver disease
symptoms of compensated cirrhosis of the liver
- abnormal function tests
- low platelet count
- spider like blood vessels
- fatigue and weight loss
symptoms of decompensated cirrhosis of the liver
- abdominal swelling
- leg swelling
- jaundice
- vomit blood
- confusion
how is cirrhosis diagnosed
US, MRI, CT
complications of portal hypertension
dilated vessels > splenomegaly > fluid accumulation in abdomen
complications of liver failure
low protein > easy bruising > jaundice
complications of cirrhosis
ascites, varices, encephalopathy, jaundice, liver cancer
ascites
fluid accumulation in abdomen due to low protein levels in body
leg swelling
fluid accumulation in feet
spider naevi
dilated blood vessels on upper chest wall
palmar erythema
reddish discoloration of palms due to dilated blood vessels
jaundice
yellowing of sclera of eyes due to bilirubin accumulation
varices
swollen veins in esophagus & stomach leading to rupture and bleeding
hematemesis
vomit blood
malena
dark stool
encephalopathy
confusion & drowsiness due to toxins in brain
liver cirrhosis severity determined by
- cirrhosis / child’s score A, B, C
- MELD score
- liver siffness / fibroscan
liver cirrhosis treatment
- treat hepatitis B / C
- stop alcohol
- treat autoimmune hepatitis
- exercise / weight loss
varices treatment
reduce variceal bleeding via
- non selective beta blockers for portal hypertension
- endoscopic banding / ligation
mild ascites treatment
avoid development of ascites & leg swelling via
- low salt diet
- diuretics to increase water clearance
severe ascites treatment
remove excess fluid to reduce abdominal swelling & breathlessness
- abdominal paracentesis
- TIPS shunt
- liver transplant
hepatic encephalopathy treatment
- clear bowels regularly to reduce toxins
- lactulose to prevent constipation
- fleet enema to clear retained stools
types of liver transplant
cadaveric & living donor
how is cirrhosis diagnosed
biopsy & fibroscan (measures stiffness)
how should one survey for liver cancer
Ultrasound & AFP every 6 months; confirm using CT/MRI
arterial phase characteristic is __
hypervascular
delayed venous phase characteristic is __
washout
what test is used for liver function
child pugh class & portal hypertension
what test is used for physical status
ECOG, co-morbidities, symptoms
what is the material used for selective internal radiation therapy
Yttrium-90
TACE
transarterial chemoembolization
systemic chemotherapy used for HCC is __
sorafenib
when is RFA suitable for HCC
single nodules < 3cm & outcome similar to surgery for nodules < 2cm
RFA
radiofrequency ablation
TACE is recommended for __
BCLC B; multifocal HCC w/o PV invasion or metastasis
SIRT w/ Y90 is suitable for __
multifocal HCC w/ PV invasion
what hormones are inactivated in liver
aldosterone & estrogen
gluconeogenesis
protein & fat > glucose
glycogenolysis
glycogen > glucose
hepatic artery function
supplies oxygenated blood from general circulation
hepatic portal vein function
supplies nutrients
what neutralizes HCl
bicarbonate ions
endocrine hormones produced by islet of langerhans
insulin, glucagon
where is vitamin K synthesized
resident normal flora
what does congested spleen & varices lead to
hemolysis
what is the most common primary tumor
hepatocellular carcinoma
