Flashcards in Liver Deck (27):
Ligaments of the liver
Falciform ligament: Attaches anterior surface of the liver to the anterior abdominal wall
Coronary & triangular ligaments: Attaches superior surface to the diaphragm
Hepatic recesses (spaces)
Suphrenic: Either side of falciform ligament between diaphragm and liver
Subhepatic: Between interior surface of liver and transverse colon
Morison's pouch: Between right kidney and liver. Most commonly where fluid collects when patient is bedridden.
Four lobes of the liver
Right lobe and left lobe separated by by falciform ligament
Caudate lobe: Between IVC and fossa formed by ligament venosum (a remnant of the fetal ductus venosus)
Quadrate lobe: Between gall bladder and fossa formesd by ligament teres (remnant of fetal umbilical vein)
Arteriole: Branch of hepatic artery entering liver
Venule: Branch of hepatic portal vein entering liver
Duct: Branch of bile duct leaving the liver
Liver nerve innervation
Parenchyma: hepatic plexus (sympathetic: coeliac plexus, parasympathetic: vagus nerve)
Glisson's capsule innervated by the branches of lower intercostal nerves.
Hepatitis A virus
small, unenveloped, symmetrical RNA virus (picornavirus).
Route of transmission for Hep A
Most ccommonly foecal-oral. Can be by IV drug use
Pathophysiology of Hepatitis A
HAV is taken up by hepatocytes
Viral RNA uncoats binds to ribosomes to form polysomes
Utilises RNA polymerase to replicated RNA
Assembled viruses is shed via billary tree into faces
Most common form of acute viral hepatitis worldwide
Highest areas of risk for HAV
Indian subcontinent, Africa, Far east (except japan), Middle east, south and central america
Risk factors of HAV
Certain occupations (for example, staff of large residential institutions, sewage workers).
Travel to high-risk areas.
Male homosexuality with multiple partners.
Intravenous drug abuse.
People with clotting factor disorders who are receiving factor VIII and factor IX concentrates
Signs and symptoms of HAV
Nausea & Vomiting
Acholic stool (clay-coloured)
Investigations for HAV
IgM anti-hepatitis A virus: Usually detected within 5-10 days before onset of symptoms and stays positive for 4-6 months
IgG anti-hepatitis A virus: Starts soon after IgM and lasts for years. In absence of IgM indicated a previous infection or vaccination
LFTs: AST rises more than ALT.
Urea & Creatinine may be elevated
Management of HAV
Hepatitis B virus (HBV)
Double stranded DNA virus (hepadnavirus)
Route of transmission of HBV
Most common cause of hepatitis
Pathophysiology of Hepatitis B
HBV enters cell
Core particle enters nucleus
Strand synthesis repaired to form covalently closed circular DNA
Use reverse transcription and forms RNA for translation
Signs and symptoms of HBV
70% asymptomatic. They may have flu-like symptoms
Investigation of HBV
HBsAg, HBeAg, anti-HBe, anti-HBs, anti-HB core.
Quantitative hepatitis B virus DNA.
HBV genotype (for those considered for interferon).
Hepatitis delta virus (HDV) serology.
General liver investigations
Causes of fatty liver disease
Polycystic ovary syndrome
Starvation or rapid weight loss (gastric bypass surgery)
Hep B, Hep C
Presentation of fatty liver disease
Tends to be picked up on LFTs
Investigations to order if suspecting fatty liver disease
Biopsy is the only definitive test
ALT and AST raised (in NAFLD AST:ALT ratio <1 in AFLD >2)
Bilirubin, ALP, gGGT elevated
FBC (anemia due to hypersplenism)
Serum albumin decreased
<20 g of alcohol per day in women and <30 g in men is usually used to allow a diagnosis of NAFLD
Management of fatty liver disease
Bariatric surgery is obese
Chronic Hepatitis C (most common in western worlds)
Chronic Hepatitis B
Alcoholic liver disease
Presentation of liver cirrhosis
Jaundice and pruritus
Melaena ( decompensated cirrhosis secondary to GI haemorrhage from gastro-oesophageal varices in portal HTN)
Leukonychia, palmar erythema, spider angiomata
Telangiectasia (red focal lesions, blood vessel dialation)
Parotid gland swelling