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Liver Flashcards

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1
Q

2 blood supplies to the liver

what’s the benefit?

A 
Hepatic artery (bringing oxygenated blood)
Hepatic portal vein (bringing everything from gut, still has a bit of O2 in it)

don’t get big infarcts like in other organs!

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2
Q

portal triad

A
  1. bile duct
  2. hepatic artery
  3. hepatic portal vein

2&3 will empty into sinusoids, gets to centre of lobule and drain into terminal hepatic venule –> hepatic vein –> vene cava –> systemic

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3
Q

Difference in cells in periphery of lobule vs. central?

A

oxygen concentrations

synthesis will occur centrally (eg. protein) ZONE 3

degradation/metabolism will occur on periphery (where conjugation enzymes will be) ZONE 1

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4
Q

Why do we get portal hypertension?

A

eg. due to alcohol
fibrosis/lose cells in Zone 3 will cause venule to get less blood, pressure required to get blood in through will increase = portal hypertension

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5
Q

Three main functions of liver

A

Synthesis (albumin, clotting factors, complement)
production (bile through conjugation of bilirubin)
breakdown (of any foreign substance eg. drug, insulin ammonia)

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6
Q

Role of Kupffer cells

A

sitting in the sinusoids acting like macrophages.

phagocytose old RBCs, bacteria and foreign materials from the blood or gut

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7
Q

what’s the bilirubin concentration to be classified as jaundice?

A

over 40umol/L

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8
Q

Why is jaundice associated with intense itch?

A

It’s not to do with bilirubin - it’s the accumulation of bile acids. Tells you about where the jaundice occurred (ie. at a point where the liver wasn’t able to properly excrete the bile acid ie. at the bile duct or distal to that. OBSTRUCTIVE).

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9
Q

Unconjugated vs conjugated jaundice

A

unconjugated: water insoluble
Conjugated: water soluble (can be excreted in urine so urine will be DARK)

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10
Q

3 classifications of jaundice

A

pre-hepatic: haemolysis (maybe sickle cell disease, exposure to a toxin, autoimmune disease, causing RBCs to break down) -> release of bilirubin from RBCs
but bili isn’t getting conjugated, normal urine (can’t solubilise it in kidney to throw it out)

Intrahepatic: liver disease destroys hepatocyte -> excess bilirubin in liver and bloodstream

Post-hepatic (obstructive) - obstruction of bile outflow –> dark urine and pale stools SMELLY (and itch)

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11
Q

BARNEY GUMBLE

Causes

A

Acute Liver Injury
Causes: viral infection, ALCOHOL, adverse drug reactions, biliary obstruction (gallstones)

Presentation: jaundice, malaise.
Raised serum bilirubin and transaminases.
Liver failure: decreased albumin, ascites, bruising, encephalopathy

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12
Q

Where does alcohol-induced hepatocyte injury usually occur?

A

zone 3

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13
Q

Where will autoimmune hepatitis injuries usually occur?

A

zone 1 (mostly cell mediated and antibody)

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14
Q

Steatosis leads to what

A

steatosis: fat build up which alters metabolism. Get big fat globule (with messed up metabolism) messes up cytoskeleton into Mallory’s hyaline.

can lead eventually to cirrhosis (liver becomes scarred and lumpy. fibrosis bridges from structures. Regeneration abnormal.
can lead to liver failure)

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15
Q

Describe alcohol hepatitis pathology

A

acute inflammation of bits of the liver (spotty necrosis)
Kupffer (macros) sat and fibroblast precursor sitting waiting to create fibrosis. little bits of fibrosis eventually merge (after many binges over time)
regeneration occurs, expanding cells but scar tissue resitricts the expansaion. continuous scar tissue creates CIRRHOSIS

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16
Q

Define cirrhosis

A

continuous scar tissue.

recurrent inflammation with fibrosis (collagen) and regeneration

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17
Q

What’s in alcohol that causes hepatocyte damage?

A

acetaldehyde binds to hepatocytes causing damage, inflammatory reaction, fibrosis

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18
Q

Complications of cirrhosis

A

Liver failure: can’t detoxify things! (hepatic encephalopathy (ammonia), build up of steroid hormones –> hyperoestrogenism (palmar erythema and gynaemastia)

Portal hypertension (increased hepaticvascular resistance, AV shunting –> oesophageal varices, haemorrhoids, caput medusea)

Hepatocellular carcinoma

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19
Q

KRUSTY

A

drug-induced liver injury
10% drug reactions involve liver
Hepatocellular damage from paracetamol dose
Injury to cholestatic cells (bile production/secretion) - methyl testosterone

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20
Q

PATTY AND SELMA

A

have ACUTE BILIARY OBSTRUCTION
usually due to gallstones
causes collicky pain and jaundice (waves as peristalsis is trying to get it out)

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21
Q

Complication of acute biliary obstruction

A

infection of the blocked CBD = cholangitis

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22
Q

why might we want to do an ultrasound rather than xray in someone with acute biliary obstruction?

A

as gallstones can be radiolucent (as mostly cholesterol)

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23
Q

what type of jaundice would you get with acute cholesistitis (patty/selma)

Study These Flashcards
A

dark urine and pale stools (would be obstruction +/- secondary infection)

24
Q

Definition of chronic hepatitis

Study These Flashcards
A

liver inflammation lasting more than 6 months

sustained elevation of transaminases (but liver biopsy will classify cause)

25
Causes of chronic hepatitis
viral autoimmune drugs alcohol (but is chronic recurrent acute injury, not chronic)
26
Which ways would we classify chronic hepatitis
Type (aetiology) Grade (degree of inflammation) Stage (degree of fibrosis)
27
COMIC BOOK GUY
NASH/NAFLD non-alcoholic steatohepatitis/fatty liver disease associated with METABOLIC SYNDROME (DM II, hypertension, HDL and triglycerides increased) fat deposition in hepatocytes (can lead to cirrhosis)
28
LISA SIMPSON
Autoimmune Chronic Active Hepatitis females > males mid to late teens interface hepatitis (plasma cells and swollen hepatocytes. fibrosis from zone 1-zone 1 cirrhosis
29
diagnosis of lisa simpson/autoimmune chronic active hepatitis
presence of ANA SMA (smooth muscle antibodies) *** key diag! often serum IgG and transaminases are raised as it's an immune response anti-LKM (liver-kidney-microsomal)
30
Treatment of Lisa Simpson/Autoimmune Chronic Active Hepatitis
steroids | more serious -> immunosuppression
31
MARGE SIMPSON
PRIMARY BILIARY CHOLANGITIS/CIRRHOSIS females > males (40-50 y/o) Stages: - autoimmune destruction of bile duct epithelium (dense lymphocytic infiltration and granulomas) - proliferation of small bile ducts - architectural disturbance: portal and bridging fibrosis - cirrhosis
32
Diagnosis of Primary Biliary Cholangitis/Cirrhosis
Jaundice, pruritis, xanthelasma | Raised ALP and IgM, AMA
33
Primary Sclerosing Cholangitis
inflammation in bile ducts (cholangitis) which results in hardening (sclerosis) and narrowing of ducts as result. Bile cannot be released properly and builds up in liver where prolonged exposure results in liver damage
34
3 differences between PBC and PSC
Age/gender (>50, F vs. any age, M) Serum immunoglobulins (inc IgM vs. none) Autoantibodies (AMA, ANA vs. none) Bile duct injury (small ducts vs. large ducts and obliterative fibrosis of them) Portal inflammation (prominent vs. absent)
35
GROUNDSKEEPER WILLIE
Haemochromatosis - iron deposition in the liver causing alteration of architecture --> fibrosis --> cirrhosis Autosomal recessive (mutation in liver cells HFE gene - so a major RF for cancer)
36
Treating haemochromatosis/Groundskeeper Willie
Regular venesection - test iron and ferritin levels
37
alpha-1-antitrypsin deficiency
``` autosomal recessive disorder low levels of alpha-1-trypsin proteins build up in hepatocytes as hyaline can lead to cirrhosis associated with emphysema ```
38
CRAZY CAT LADY
WILSON'S DISEASE young women autosomal recessive disorder failure of liver to excrete copper in bile --> build up of copper in liver --> cirrhosis also deposits into brain and cause neurological dysfunction get KAYSER FLEISCHER rings
39
Diagnose Wilson's disease
low caeruloplasmin | Kayser Fleischer rings in eyes
40
Examples of developmental/hamartomas liver tumours
cysts | hamartomas
41
Examples of benign liver tumours
incidental finding adenoma, haemangioma liver cysts
42
Examples of malignant liver tumours
metastases COMMON primary: hepatocellular carcinoma cholangiocarcinoma
43
aetiology of hepatocellular carcinoma
aflatoxins - fungal origin hepatitis B and C cirrhosis (of any cause)
44
2 examples of congenital malformations of biliary system
atresia | choledocal cysts
45
Other name for gallstones
cholelithiasis
46
Cholangiocarcinoma
arises from bile duct epithelium anywhere in biliary system associated with UC causes obstructive jaundice, itch weight loss, lethargy can lead to rupture of common bile duct or gallbladder (poor prognosis)
47
Risk factors for gallstones Types Complications
``` female fat fair forty fertile diabetes mellitus ``` Cholesterol, bile pigment or mixed cholescystitis, obstructive jaundice, cholangitis, pancreatitis, cholangiocarcinoma
48
what is cholecystitis usually caused by?
gallstones
49
symptoms of cholecystitis
RUQ pain (biliary colic) fever nausea/vomiting
50
MAGGIE SIMPSON
HAS annular pancreas occurs in 2nd part of duodenum (wraps around SI) causes OBSTRUCTION: polyhydramnios, low birth weight, poor feeding
51
HOMER SIMPSON
has pancreatitis Acute: causes catastrophic metabolic consequences (decreased calcium, decreased albumin, increased glucose) massive fluid losses can lead to SHOCK
52
diagnose acute pancreatitis
serum amylase
53
chronic pancreatitis
multiple episodes of acute causes fibrosis of pancreas: may lead to diabetes mellitus reduced production of enzymes (require supplements)
54
MONTY BURNS
has PANCREATIC CARCINOMA an adenocarcinoma associated with smoking and diabetes mellitus presents with painless, progressive jaundice weight loss poor prognosis operable if small and close to ampulla
55
adenocarcinoma
starts in mucous secreting glandular cells (breast, colorectal, lung, pancreatic, prostate)

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