Liver and Gall Bladder Disease Flashcards
Demonstrate knowledge of the function of the liver in metabolism, synthesis and excretion. Describe the common causes of pre-hepatic, hepatic and post hepatic jaundice. Recognise jaundice and the peripheral signs of chronic liver disease. Demonstrate knowledge of liver and biliary tract disease such as viral hepatitis, drug-induced hepatitis, cirrhosis, gallstones and tumours of the bile duct and pancreas Demonstrate knowledge of the ways in which liver disease creates risks during dental su (41 cards)
3 circulations through liver
Arterial and venous
Portal - between liver and pancreas and kidneys and rest of body
Bile flow
Bile flow description
Why reabsorbed?
Produced in liver as bile salts
Bile stored by gall bladder
Released into duodenum to break down lipids
Bile acids reabsorbed in terminal ileum and reenter circulation
Energy efficient
Return to liver and then gall bladder
Micro anatomy
Lobules with central hepatic vein
Hexagonal triads in corner
Fx of liver (7)
What happens if fat metabolism is not functional
Detoxification - filters and cleans blood of metabolic waste
Immune functions - fights infections and disease
Synthesis of clotting factors, proteins, enzymes, glycogen and fats
Production of bile and breakdown of bilirubin
Energy storage (glycogen and fat)
Regulation of fat metabolism
Fatty liver occurs - too much fat for function - asymptomatic
Ability to regenerate cells
Metabolic role of liver
When does this role vary?
How is the liver regulated?
Maintains continuous supply of energy for the body
Controls metabolism of cholesterol and fats
Fasting, digestion, absorption and metabolism
Multiple pathways
Endocrine glands
Nerves
Liver injury categories and different types
Chronic definition
Time line - acute/chronic Ongoing for more than 6 months Pattern - hepatic/cholestatic/mixed Presentation - symptomatic/asymptomatic Severity - cirrhotic/non-cirrhotic Cause
Types of liver injury - acute
Outcomes and causes
Recovery
Acute liver failure
Viral (A, B, E, EBV)
Drugs
Vascular
Types of liver injury - Chronic
Outcomes and causes
Recovery
Cirrhosis - (varices, hepatoma)
Chronic liver failure - decompensated
Alcoholism
Viral (B, C)
Autoimmune
Vascular metabolic
Presentation of liver injury - acute
Asymptomatic
Abnormal LFTs and coagulopathy
Malaise, nausea, anorexia
Jaundice
CONFUSION - suggests failure rather than disease
Rarer - bleeding and liver pain
Presentation of liver injury - CHRONIC
Abnormal LFTs Hepatomegaly Malaise, abdo pain Itching Oedema Varices Bruising easily (coagulopathy) Confusion Cachexia - anorexia Jaundice
LFTs Comprised of? ALP GGT ALT AST Normally functional if....
Which two tests are actually effective
What is slightly reduced in cirrhosis/elevated and important to test in case of
Liver Function Tests Albumin ALP - alkaline phosphatase GGT - gamma GT ALT - alanine aminotransferase AST - aspartate aminotransferase Bilirubin Globulin Normal LFT and PT and platelet count
Albumin and bilirubin indicate ability of liver to synthesise products
Platelet count and INR/PT time
Excessive bleeding
Jaundice due to?
Increased bilirubin as liver fails to break it down
Scleral jaundice first noticed
Mild jaundice can be difficult to spot
Bilirubin metabolism
Where
Excreted how
What happens to faeces if not excreted
Breakdown product of haemoglobin - usually conjugated in liver Metabolised in liver Excreted via intestine and really Motion is pale if not Can be interrupted at several points
Causes of jaundice 3 types (at which point)
Pre-hepatic
Hepatic
Post-hepatic
Causes of jaundice - pre-hepatic
Haemolysis due to increased substrate
Causes of jaundice - hepatic
Intrinsic liver disease
Cirrhosis
Infiltration of liver by tumours e.g hepatoma
Acute hepatitis (viral, alcoholic, autoimmune, drug related)
Causes of jaundice - post hepatic
Examples
Examples of external compression
Obstruction of biliary outflow
Gall stones
External compression - pancreatitis, lymphadenopathy, pancreatic tumour
Liver disease - most common causes
Alcohol
Non alcoholic steatohepatitis NASH
Viral hepatitis (B, C)
Liver disease - less common causes and examples
Auto-immune - hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
Metabolic - haemochromatosis, Wilson’s, a1 antitrypsin deficiency
Vascular - Budd-Chiari, portal vein thrombosis
Drugs
Amiodarone
Chemotherapy
Liver disease - alcoholic
Common cause of cirrhosis
Deaths rising
Non-alcoholic fatty liver disease
Risk factors
LFTs
Affects who
Obesity, diabetes, hypertension, dyslipidaemia
LFTs normal maybe
20% of western popn
Chronic viral hepatitis
Caused by?
Transmitted through?
Hep B/C
Blood and body fluids
1/3 people exposure to one or both
Hepatitis B
Features
DNA virus Reads in hepatocyte genome Persists in liver Can reactivate Intercourse/vertically Vaccination available Longterm treatment
Hepatitis
RNA virus IVDA Reinfection possible Time limited treatment but 90% cure No vaccine
