0225 - Intro to Liver Disease Flashcards
Name some products the liver synthesises
Albumin Lipoproteins Coagulation factors (2, 7, 9, 10) Glycogen Urea Bile Salts Cholesterol
Name 5 compounds the liver stores
CHO Lipids Iron Copper Fat-soluble vitamins (ADEK)
Identify some acute liver diseases
Onset days/weeks after exposure. Resolution within 3 months (usually)
Viral Hepatitis (HAV-HEV, CMV, EBV)
Other infections (bacterial/parasite)
Toxins
Vascular disorders (heart failure)
Uncommonly - fatty liver, alcoholic liver, autoimmune hepatitis, and other metabolic disorders (haemochromatosis, Wilson’s disease).
What are the signs and symptoms of acute hepatitis (hepatocellular necrosis)?
Anorexia, nausea, vomiting Lethargy Jaundice and scleral icterus Bilirubinuria Tender liver ALT >10-fold increased Bruising/bleeding, and prolonged coagulation time not corrected by vit K injection present in liver failure.
What is cholestasis? What are the signs and symptoms?
Impaired bile flow. Signs/symptoms may include:
Jaundice
Bilirubinuria
Pale Stools
Malabsorption (LFCA’s, fat-soluble vitamins), leading to impaired coagulation
Pruritis (itching).
Identify three causes of cholestasis
Gallstones Malignancy Scarring Infection Drug-induced (Amox/clavulanic acid) Pregnancy Primary biliary cirrhosis
What are some causes of chronic liver disease
Hep B/C
Alcohol
Metabolic disorders (NAFLD, haemochromatosis)
Less common:
Drugs, Wilson’s disease/glycogen storage disorders, autoimmune hepatitis/primary biliary cirrhosis/primary sclerosing cholangitis.
What is the pathophysiology of ascites (3 key areas)?
Cirrhosis leads to:
Low albumin -> low oncotic pressure
High portal pressure -> high capillary hydrostatic pressure
High aldosterone and ADH -> Na+, water retention
All lead to fluid transudation and ascites
How does circulatory dysfunction manifest in cirrhosis?
Vasodilation via renal prostacyclin and NO, due to portal hypertension and insufficient hepatic flow.
This leads to reduced pressure on baroreceptors, and activation of RAA, and ADH (vasopressin), which attempt to compensate by retaining Na and H2O.
What are the major complications of cirrhosis?
Portal hypertension (portal-hypertensive gastropathy, oesophago-gastric varicies, thrombocytopenia, and ascities/hepatic encephaloptohy)
Bacterial infection (impaired immunity, particularly spontaneous bacterial peritonitis (infected ascites), septicaemia, pneumonia).
Metabolic defects (hypoglycaemia, glucose intolerance, diabetes, impaired drug clearance).
Circulatory disorders - renal failure (hepatorenal syndrome - RAA), hepatopulmonary syndromes (hypoxia, clubbing, pulmonary hypertension)
Hepatocellular carcinoma
Why does cirrhosis lead to thrombocytopenia
Not just about marrow and hypersplenism/platelet turnover.
Lack of thrombopoietin due to cirrhosis means that no platelets are formed.
Briefly outline primary liver cancer (hepatocellular carcinoma) and its relationship to cirrhosis.
Cirrhosis responsible for >90% of cases.
5th most common cause of cancer death worldwide, incidence trebled in AUS in last 3 decades.
Most common in chronic viral hepatitis (B and/or C), and longstanding cirrhosis (particularly haemochromatosis and alcohol).
How would you diagnose someone with liver disease?
History - features of acute hepatitis, biliary tract disease, cholestasis, cirrhosis etc. And risk factors (hepatitis, alcohol, meds, FHx, metabolic disease).
Physical Exam - Look at liver size and consistency, spleen. Jaundice, stigmata, liver failure
Labs - LFTs, prothombin time.
What do the major liver enzyme tests mean?
ALT - Alanine aminotransferase
AST - Aspartate aminotransferase
ALP - Alkaline phosphatase (also in bone)
GGT - Gamma glutamyltransferase
What is the pattern of hepatocellular LFTs? Cholestatic? Mixed?
Hepatocellular - ALT >2x ULN - Alcohol, drugs, viral hepatitis, fatty liver, haemochromatosis, autoimmune hepatitis
Cholestatic - ALP>2x ULN - Gallstones in the duct, drugs, malignancy (liver or pancreas), primary biliary sclerosis
Mixed - Fatty liver, alcohol, drugs, viral hepatitis.
