Week 5 Liver In More Detail Flashcards
Which segments of the liver are suitable for living transplant? e.g. will grow back in doner and grow into a new one in receiver
Based on your knowledge of liver function tests, which if these markers within the hepatacycte is which?
ALP - Choleostasis
AST/ ALT - Hepatocyte damage
GGT - Both
Complete this liver cell table
Complete this liver cell table
How to remember difference between glycogen and glucagon?
GlycoGEN - is generated when there is plenty of glucose
GlucaGON - is released when glucose is gone from the bloodstream
Describe the livers role in lipid metabolism
What is an enterocyte?
Absorption cell in small and lerge intestine
Functions of liver in proteine metabolism
- Catabolism of circulating protein/peptides
- Interconversion of amino acids
- Deamination of amino-acids allowing gluconeogenesis
- Synthesis of non-essential amino acids
- Catabolism of hepatic (stored) proteins in fasted state
- Protein synthesis
Proteins that are synthesised by the liver
What is the liver’s role in ammonia metabolism?
Ammonia is absorbed in the gut
It is then turned into urea by the liver thus detoxifying it
What are the three phases of liver drug metabolism?
Which parts are involved?
- endoplasmic reticulum
- cytoplasm
- bile side of cell
What role does the liver play in immune regulation, why is this important?
‘firewall’ filtering all blood from gut
Kupffer cells phagocytose pathogens from gut
Supply of important chemokines/cytokines
Interleukins
Tumour necrosis factor
Priming T cell responses
Takeaway is that you can recover from acute liver failure but then catch a severe infection due to immunosurpression
What is the gold standard for diagnosing liver cirrhosis?
Two other methods as well
What is Hepatic Encephalopathy
This is where toxins absorbed by the gut that normally get detoxified on first pass don’t get detoxified due to portal hypertension and shunting.
They therefore make it to the brain causing brain toxicity
What are the serum markers of liver function?
Fill these signs in
What are the causes of ALF that we will actually get asked about in 2nd year?
Paracetamol and viral hepatitis
23 female
Nausea and abdominal pain
Intentional overdose of paracetamol (64 tablets) 2
days before
2 previous overdoses
Drinks ½ bottle wine and 4-5 vodkas/night at
weekends
No stigmata of cirrhosis
ALT 4500 (< 50)
Bilirubin 110 (< 21)
PT 23 (< 13)
Albumin 38 (>36) (Albumin normal rules out chronic liver damage)
Lactate 6 (< 2)
Ultrasound normal
What would you do?
Started on N-acetyl cysteine infusion
Given vitamin K
Moniter
If doesn’t get better refer for liver transplant
Why is albumin only raised in chronic liver failure and not acute liver failure?
Albumin half life is about 20 days so in acute liver damage there often isn’t enough time for albumin to fall
Why would you give vitamin K in chronic liver failure?
It’s not actually to fix coagulation.
If the liver if damaged giving vitamin K won’t help PT as the liver can’t make clotting factors in response to vitamin K.
So it is to rule out raised PT through vit K deficiency, if it rises with vit K then liver ok.
What is prothrombin time?
It is the time it takes for blood to coagulate.
With regards to liver a raised PT is a sign of liver damage as the liver is required for the production of clotting factors
In paracetamol induced ALF, considering PT, anuria, creatinine and encephalopathy. At what point is spontaineous recovery extremely unlikely (transplant required)
PT>100 AND
Anuric / creatinine >300 AND
Grade 3-4 encephalopathy (stupor/coma)
What is Hepatorenal Syndrome (HRS)?
This is where portal hypertension leads to portal system dialating and releasing NO in order to vasodialate.
This systemically dialates the vessels particularly the splanchic vessels resulting in reduced renal perfusion.
RAAS fails to compensate through Na/H2O retention as it mostly leaks into abdomen through ascites.
Result is percieved renel failure when actually the kidneys are functioning just fine.
Why might you get percieved kedney failure such as anuria and raised serum creatinine in ALF when in ALF you don’t get portal hypertension?
ALF causes release of inflammatory cytokines, nitric oxide, and other mediators still leading to widespread systemic vasodialation and perceived hypovolaemia
