Introduction to Liver Cirrhosis

Question 1

what ligaments divides the right and left lobes

Answer 1

falciform ligament

Question 2

5 functions of the liver

Answer 2

detoxification
synthesis of digestive enzymes
protein production
storage of nutrients
metabolism

Question 3

functions of periportal zone

Answer 3

gluconeogenesis
bile salt formation

Question 4

functions of perivenous/pericentral zone

Answer 4

glycolysis
lipolysis
glucuronidation

Question 5

what is the cholangiole

Answer 5

the bile channels/bile cannaliculi

Question 6

what % of the liver is hepatocytes

Answer 6

80%

Question 7

what are pit cells

Answer 7

natural killer cells of the liver

Question 8

what cell types are found in the perisinuosoidal space

Answer 8

stellate cells
dendritic cells

Question 9

what substances can be used to make glucose in gluconeogenesis

Answer 9

lactate
pyruvate
glucogenic amino acids
glycerol

Question 10

describe the steps of lipid metabolism

Answer 10

1. bile digests lipids in the gut
2. chylomicrons are formed
3. these travel in the lymphatic system to the liver
4. chylomicrons are metabolised by lipoprotein lipase to cholesterol, phospholipids, triglycerides and free fatty acids

Question 11

how does the liver metabolise proteins

Answer 11

via the citric acid cycle

Question 12

function of vitamin k

Answer 12

required for post translational modification of many of the clotting factors

Question 13

key protein made in the liver

Answer 13

albumin

Question 14

what is a cause of brain damage in liver disease

Answer 14

the blood is diverted past the liver due to cirrhosis
which means ammonia is not removed from the blood
the ammonia damages the astrocytes in the brain

Question 15

what is ammonia a waste product of

Answer 15

protein metabolism

Question 16

what does the liver do to ammonia

Answer 16

detoxifies it by converting it to urea in the urea cycle

Question 17

what are the three phases of drug metabolism

Answer 17

1. oxidation, reduction and hydrolysis
2. conjugation in cytoplasm of hepatocytes
3. secretion into the bile

Question 18

what enzymes control phase 1 (oxidation, reduction and hydrolysis) of drug metabolism and where are these found

Answer 18

CYP450
in endoplasmic reticulum of the liver

Question 19

what control excretion of metabolised drugs into bile

Answer 19

ATP

Question 20

how much bile is made in a day

Answer 20

1-2L

Question 21

what are the constituents of bile

Answer 21

bile acids
phospholipids
cholesterol
conjugated drugs
electrolytes (Na+, Cl-, HCO3-, Cu)
bilirubin

Question 22

what’s the difference between primary and secondary bile acids

Answer 22

primary - made in liver
secondary - absorbed

Question 23

what contributes to the brown colour of stool

Answer 23

stercobilin
a form of urobilinigon

Question 24

where is heme broken down into unconjugated bilirubin

Answer 24

spleen

Question 25

what vitamin are stored in the liver

Answer 25

A D B12 K

Question 26

what minerals are stored in the liver

Answer 26

copper iron (as ferritin and haemosiderin)

Question 27

how much vitamin K is stored in the liver and how quickly does it deplete with decreased dietary intake

Answer 27

small quickly

Question 28

what does the liver do to vitamin D

Answer 28

metabolises from inactive form (cholecalciferol vitamin D3) to active form (25-hydroxyl vitamin D)

Question 29

what mechanisms does the liver have for immune regulation

Answer 29

filters all blood from gut kupffer cells phagocytose pathogens from gut supply chemokines prime T cell responses

Question 30

what chemokines are supplied by the liver

Answer 30

interleukins tumour necrosis factor

Question 31

what mediates resolution from early fibrosis back to normal liver

Answer 31

macrophages

Question 32

cirrhosis without treatment leads to

Answer 32

hepatocellular carcinoma

Question 33

what two proteins/peptides are released when hepatocytes are damaged

Answer 33

TGF alpha IGF1

Question 34

what follows stellate cell activation in hepatocyte injury

Answer 34

cells transform into myofibroblast like cells this causes increased collagen and proinflammatory factors

Question 35

what follows stellate cell activation in hepatocyte injury

Answer 35

cells transform into myofibroblast like cells this causes increased collagen and proinflammatory factors an autocrine loop is formed where stellate cells activate themselves

Question 36

steps of liver cirrhosis

Answer 36

1. stellate cells transform into myofibroblasts and increase collagen production 2. metabolite and oxygen exchange decrease across the space of disse 3. hepatocytes disfunction 4. new blood vessels are formed and sinusoid is remodelled 5. sinusoidal resistance increases causing portal hypertension

Question 37

what metabolic diseases can cause cirrhosis

Answer 37

haemochromatosis wilson disease

Question 38

why is sodium and water retention a feature of liver cirrhosis

Answer 38

portal hypertension causes splanchnic (abdominal) vessels to vasodilate which causes hypotension in the rest of the body so the RAAS is activated which causes vasocontriction and Na+ and water retention

Question 39

difference between compensated and decompensated stage of liver disease

Answer 39

compensated - asymptomatic decompensated - symptomatic

Question 40

median survival of compensated liver disease

Answer 40

12 years

Question 41

median survival of decompensated liver disease

Answer 41

2 years

Question 42

what signs can be seen on the hands of someone with liver cirrhosis

Answer 42

xanthoma duputren's contracture clubbing liver palms

Question 43

symptoms of decompensated liver cirrhosis

Answer 43

neurological (disorientation, drowsy, coma) hepatic flap variceal bleeding jaundice ascites oedema caput medusae

Question 44

how does albumin change in liver cirrhosis

Answer 44

decreased in end stage due to decreased function

Question 45

how does prothrombin time change in liver cirrhosis

Answer 45

increases due to decreased synthesis of clotting factors

Question 46

what PT time is an indicator of liver dysfunction

Answer 46

>12s

Question 47

how does bilirubin change in liver cirrhosis

Answer 47

increase due to decreased clearance

Question 48

how does platelets change in liver cirrhosis

Answer 48

decreased increased consumption due to splenomegaly

Question 49

investigations to diagnose fibrosis and cirrhosis

Answer 49

liver biopsy serum markers transient elastography (fibroscan)

Question 50

advantages of liver biopsy

Answer 50

quantitative can detect cause of cirrhosis

Question 51

disadvantages of liver biopsy

Answer 51

prone to sampling error risk of bleeding and others

Question 52

advantages of serum markers

Answer 52

cheap widely available

Question 53

disadvantages of serum markers

Answer 53

nonspecific grey zone for intermediate fibrosis

Question 54

advantages of transient elastography

Answer 54

non invasive quick

Question 55

disadvantages of transient elastography

Answer 55

machine cost user and patient experience

Question 56

what does the fibroscan detect

Answer 56

liver stiffness and (some machines) fat

Question 57

what score can be used for prognosis of liver disease

Answer 57

child-pugh score