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DIG E > E9 Liver structure and function > Flashcards

E9 Liver structure and function Flashcards

1
Q

state 6 roles of the liver

A
  • glycogen, iron and vitamins storage
  • protein, hormones and cholesterol synthesis
  • detoxification (including of drugs and medicines)
  • red blood cell destruction
  • bile production
  • metabolism of protein, fats and carbohydrates
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2
Q

explain the role of the liver: glycogen, iron and vitamins storage

A
  • vitamins essential for homeostasis in humans
  • glycogen essential for energy release
  • iron is stored in other tissues but mainly the liver in combination with ferritin
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3
Q

explain the role of the liver: protein, hormone and cholesterol synthesis regarding albumin

A

albumin is synthesised in the liver to control oncotic pressure

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4
Q

explain the role of the liver: detoxification

A

medicine is metabolised and excreted - it isn’t kept in our tissues

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5
Q

explain the role of the liver: red blood cell destruction

A
  • have 120 day half live before recycling
  • one of the ingredients of haemoglobin is metabolised and recycled in the liver for new RBCs
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6
Q

explain the role of the liver: bile production

A
  • no bile without a proper functioning liver
  • this means no fat digestion (bile emulsifies lipids)
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7
Q

explain the relationship the liver has to the GIT

A
  • most nutrients and drugs will pass through liver on way to systemic circulation
  • disaccharides and monosaccharides, amino acids etc.
  • this is the first pass effect: go through the liver first for checking before they enter the systemic circulation
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8
Q

what is the basic functional unit of the liver?

A

liver lobule

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9
Q

label the liver lobule

A
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10
Q

describe the structure of sinusoids

A
  • hepatocytes produce most functions of liver
  • Kupffer cells: macrophages, removal of viruses, bacteria etc.
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11
Q

describe chronic liver diseases

A
  • initially, patients still have enough capacity to perform functions of liver (‘compensated’ liver disease)
  • advanced stages, capacity of liver is insufficient, normal function, metabolism is affected (‘decompensated’ liver disease)
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12
Q

what is hepatitis?

A

inflammation of liver

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13
Q

what 2 things can hepatitis be caused by?

A
  • alcohol
  • viruses eg. hepatitis A, B and C
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14
Q

explain alcohol as a cause of hepatitis

A
  • chronic alcohol consumption / alcoholism
  • major cause of hepatitis
  • can severely affect structure of liver and hepatocytes
  • results in failure of liver to perform its function
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15
Q

explain viruses as a cause of hepatitis

A
  • leads to jaundice due to liver not being able to excrete bilirubin (therefore stored under the skin)
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16
Q

compare hepatitis A, B and C as causes of hepatitis

A

hepatitis A
- self-limiting
- caused by contamination of food and drinks

hepatitis B and C
- can be chronic
- caused by contamination of blood
- eg. contaminated blood transfusions after someone has donated blood and it is given to others

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17
Q

what is alcoholic liver disease?

A
  • build-up of fatty acids in liver
  • reversible
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18
Q

what is alcoholic hepatitis?

A
  • second stage of liver damage
  • prolonged alcohol misuse
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19
Q

what is cirrhosis?

A
  • final stage and irreversible
  • scarring and loss of function
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20
Q

describe non-alcoholic liver disease

A
  • caused by build-up of fatty acids in liver due to high BMI / obesity
  • can lead to steatohepatitis
  • eventually leads to cirrhosis
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21
Q

describe liver cancer

A
  • similar symptoms to alcoholic and non-alcoholic liver disease
  • involves malignancy
  • can be result of damage caused by cirrhosis
  • 1 in 3 cases due to alcohol misuse
  • smoking enhances a risk of cancer with hepatitis B and C
22
Q

what is liver drug toxicity?

A
  • liver damage caused by drugs or environmental factprs
  • damage can be caused by drug itself
  • damage can be caused by toxic metabolite
23
Q

state a list of drugs that can cause liver toxicity

A

amiodarone
antibiotics
azathioprine
carbamazepine
isoniazid
methotrexate
NSAIDs
paracetamol
phenytoin
rifampicin
sodium valproate
statins

24
Q

how is paracetamol metabolised and excreted?

A

major metabolic pathway in the liver forms metabolites and they are excreted

25
explain the metabolism of paracetamol by 2 different pathways in overdose
- at normal doses, only safe metabolic pathway occurs - in overdose, enzymes in safe pathway are saturated - oxidation pathway works instead and metabolises paracetamol into NAPBQI
26
what does NAPBQI lead to in paracetamol overdose?
cell damage and death
27
can NAPBQI be removed from the body?
- in lower overdoses, glutathione conjugate can remove the toxic compound from the body - in extremely high doses, this becomes saturated and the toxic compound NAPBQI remains in the body
28
in extremely high paracetamol doses, what can NAPBQI cause if it remains in the body?
confusion convulsions coma death
29
draw a flowchart showing the different metabolic pathways of paracetamol for normal and toxic doses
30
symptoms of cirrhosis
- pain around liver - jaundice - very itchy skin or pruritus - tiredness - nausea - oedema in legs and ankles - ascites
31
how is cirrhosis diagnosed?
- altered liver enzymes - liver function tests
32
in cirrhosis, why do patient experience jaundice?
- yellow skin and whites of eyes due to build up of bilirubin - this is because the liver cannot excrete it
33
why do patients with cirrhosis experience nausea?
can be caused by buildup of ammonia
34
what is cholestasis?
impaired flow of bile to duodenum
35
what is cholestasis caused by?
blockage of bile duct - eg. gallstones, cancer - cholecystitis may require the removal of the gallbladder disturbances in bile formation and metabolism of fats - eg. cirrhosis
36
what is the removal of the gallbladder to treat cholecystitis called?
cholecystectomy
37
describe gallstones
- small stones in gallbladder - often due to excess cholesterol in bile - can lead to blockage of bile ducts leading to intense pain
38
management of pruritus from liver disease
- reduce bile acids with cholestyramine (binds to bile acids) - histamine receptor antagonists - menthol in aqueous cream (cooling effect)
39
how must liver disease caused pruritus be managed?
- managed for years unless a liver transplant is available
40
how does cholestyramine work?
chelates with bile and causes excretion of bile accumulation
41
describe hepatic encephalopathy as a complication
- major neuropsychiatric complication of cirrhosis - complication of end stage liver disease caused by accumulation of ammonia that enters the brain
42
what is hepatic encephalopathy characterised by?
- confusion - drowsiness - disorientation - difficulty concentrating - personality changes
43
what is hepatic encephalopathy caused by?
- accumulation of toxins - eg. ammonia not cleared by the liver
44
treatment of hepatic encephalopathy
- reduce plasma ammonia - lactulose (disaccharide laxative) inhibits the growth of ammonia-producing organisms - neomycin and rifaximin (antibiotics) block and reduce urease-producing colonic bacteria
45
what is ascites and what is caused by? what does it cause?
- accumulation of fluid in the peritoneal cavity - due to lack of albumin because liver cannot synthesise it - causes reduced oncotic pressure and oedema
46
therapy for ascites
- reduce sodium intake - fluid restriction - diuretics to encourage urination - drain accumulated fluid (paracentesis)
47
max units of alcohol per week?
14 for men and women
48
describe the treatment of alcoholism
- disulfiram, acetaldehyde dehydrogenase inhibitor
49
what is acetaldehyde?
the intermediate compound formed by alcohol dehydrogenase action on ethanol
50
what does acetaldehyde dehydrogenase act on?
acts on the intermediate (acetaldehyde) to form acetate
51
symptoms of alcoholism
- generalised vasodilation - fall in blood pressure - sweating - dyspnoea - headache - chest pain - nausea and vomiting

DIG E (10 decks)

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