Flashcards in Chronic Liver Disease Deck (30):
key functions of liver
gluconeogensis and glycogenesis
where are ALT and AST located in the body?
they are intracellular
ALT is mostly in liver but AST is also in skeletal muscle
what do liver enzymes actually tell us about liver funciton?
they indicate the pattern of injury but don't indicate whether the liver is managing to perform its function
what is cholestasis
where bile cannot flow into the duodenum
what are the 2 main liver enzyme patterns
hepatic : elevated AST and ALT
elevated ALP and GGT
what is ALP and where is it found?
produce in liver and bone
how will a patient with compensated chronic liver disease present?
not many symptoms as liver can still perform its function
may get leuconychia, clubbing, dupuytrens
signs of decompensation in chronic liver disease?
what is asterixis? what is it a sign of?
a sign of ammonia neuropathy
signs of chronic liver disease
bruising (lost platelets, clotting factors)
cause of thrombocytopenia in CLD
splenomegaly retains platelets
cause of palmar erythema
altered estrogen metabolism
Fibrosis 0-4 grading in liver?
F0 = normal
F1 = periportal fibrosis
F2 = + some septa
F3 = many septa, no architectural distortion
F4 = architectural distortion and nodule formation due to fibrous septa
what does fibroscan measure
the level of fibrosis in the liver
CAUSES OF CHRONIC LIVER DISEASE: rule of 3s
BIG: HBV, HCV, Alcohol
Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
Metabolic 3: haemachromatosis, wilsons disease, alpha 1 antitrypsin deficiency
chronic biliary obstruction
complications of chronic liver disease
metabolic failure (ammonia, estrogen, bilirubin)
Child Pugh A, B and C
A = compensated liver disease, good prognosis
B = some loss of function
C = severe loss of function (albumin, bilirubin, INR, encephalopathy present)
what is hepatic hydrothorax
a complication of chronic liver disease where ascites tracks into the plerual space
how is ascites related to renin system activation?
reduces the effective ECF volume and thus stimulates fluid and sodium retention to maintain fluid homeostasis
treatment of varices
primary prevention: band ligation, beta blockers
octreotide and endoscopic banding
what is TIPSS
transjugular intrahepatic portosystemic shunt
reduces portal pressure
cause of hepatorenal syndrome
increased blood flowing in portal system leads to less flow to the kidneys. creatinine rises, urinary volume and sodium decrease
what antibody confers HBV immunity
what antibody indicates an infection of HBV, current or past
what antigen indicates active infection of HBV
causes of jaundice
pre-hepatic: hemolytic, unconjugated so doesnt darken urine
hepatic: any hepatitis really
post-hepatic: obstructive - stone, pancreatic carcinoma, mirizzis, cholangiocarcinoma
locations of liver enzymes in the cell
cytoplasm: ALT, AST, LD
membrane: ALP, GGT
why does alcoholic hepatitis have higher AST than ALT
alcohol toxins kill mitochondria as well as cells, releasing mitochondrial AST as well as cytoplasmic
what cycle is ALT involved in?
converting alanine to pyruvate for gluconeogenesis
only in liver