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Flashcards in Liver Disease Deck (23):
1

What are the 2 blood supplies to the liver?

1. Arterial blood (20%) via hepatic artery)
2. Venous blood (80%) via portal vein

2

What are the functions of the liver?

1. Storage of glycogen and fat soluble vitamins
2. Synthesis of proteins, albumin and clotting factors
3. Immune system - T cell proliferation and acute phase production
4. Clearance and metabolism of drugs and cholesterol via liver enzymes

3

What is the structure of the liver?

- Before the stomach
- Gall bladder is positioned within the liver

4

LFT - Billirubin

Billirubin is the breakdown product of RBC. It is conjugated in liver and then excreted in bile. If liver not working, expect an INCREASE in billirubin

5

LFT - GGT

Gamma-glutamyl transferase is a specific ennzyme that is induced in the presence of alcohol. INCREASE in GGT indicates alcohol induced liver disease

6

LFT - ALT and AST

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
These INCREASE when hepatocytes are injured

7

LFT - Alkaline phosphatase

This is an inflammatory enzyme that is NOT specific to the liver, however, when there is liver disease, you will see an increase in these

8

LFT - Albumin

Tells us how well liver is synthesising plasma proteins. Only see a DECREASE in albumin if it is a long standing liver condition (takes 3 months to be affected)

9

LFT - Prothrombin time

Time (sec) taken for a sample of blood to clot. Gives an indication og how well the liver is producing clotting factors.
INCREASE in prothrombin time = long standing liver disease

10

Hepatocellular picture (What is it and how are LFTs affected?)

Damage INSIDE the liver to the hepatocytes
↑ ALT; ↑ AST; ↑ GGT; ↑ Total bilirubin

11

Cholestatic picture (What is it and how are LFTs affected?)

Damage OUTSIDE the liver e.g. blockage of bile duct
↑ Conjugated bilirubin; ↑ Alkaline phosphate; ↑ Total cholesterol; Pruritis (itching) is common

12

Acute liver disease (What is it and how is it caused?)

- Usually self-limiting
- < 6 months
- Hepatitis = Inflammation or damage to hepatocytes
- Caused by drugs (paracetamol) or viral hepatitis (Hep A and B)

13

Drug induced liver disease (What are the 2 different types of reactions? Examples? Latent period?)

1. Type A = Predictable. Dose dependent (take sufficinet amount of the drug). Paracetamol and methotrexate. Hours to weeks
2. Type B = Unpredictable. Dose INdependent. Isoniazid and chlorpromazine. Weeks to months

14

What is acute hepatitis?

- Jaundice (yellow eyes and skin)
- Recover spontaneously
- Supportive therapy = treat symptoms, not cause

15

Chronic liver disease (How is it caused?)

- > 6 months
- Caused by alcohol and chronic viral hepatitis (Hep C)

16

Chronic liver disease (Signs and symptoms)

- Fatigue; general malaise; fever; nausea; vomiting
- Abdominal pain
- Pruritis (itch) = most common in obstructive disease (bile salts)
- Jaundice = pale stools, dark urine (bilirubin >50micromol/L)

17

Later stage of chronic liver disease (Signs and symptoms)

- Spider naevi (red markes due to haemorrhage)
- Enlarged breasts and spleen
- Oedema
Red palms
- Cholesterol deposits in eye lids

18

End stage of chronic liver disease (Signs and symptoms)

- Ascites (accumulation of fluid in abdomen)
- Hepatic flap (tremor)
- Dilated abdominal blood vessels
- Oesophageal varices
- Neurological changes due to thiamine defficiency

19

Alcohol liver disease - LFT

Elevated GGT

20

Hepatitis LFT

Elevated billirubin

21

Cirrhosis LFT

High PT and low albumin

22

Steatosis LFT

Elevated FFT +/- AST

23

TBC

TBC