Liver Disease Flashcards
what does hepatitis mean
means inflammation of the liver
describe the blood flow of the liver
- Hepatic artery 25% of total blood flow
- Portal vein is 75% drains the GI tract and spleen
define the acinus
this is the functional unit of the liver
how many zones are there of the acinus
3
- zone 1
- zone 2
- zone 3
describe the oxygen supply to zones of the acinus
- Zone 1 – well oxygenated closet to the arterial part,
- zone 2 – less oxygenated
- zone 3 – least oxygenated part of the liver
list some of the functions of the liver
- Protein metabolism - synthesis/degradation,
- Coagulation factors
- Carbohydrate metabolism - glycogen
- Lipid metabolism – lipoproteins/cholesterol
- Formation of bile
- Hormone and drug inactivation
- Immunological function – a sieve
Name the liver function tests
Liver function - protein synthesis - albumin - coagulation cascade - prothrombin time (INR) Liver biochemistry - AST ALT – cells in trouble - Alkaline phosphatase (ALP) – bile ducts function - Gamma GT – likewise to ALP Bilirubin high - Jaundiced
what is AST and ALT a marker for
– hepatocytes in trouble – hepatocellular pattern, they go up and they tell you that the cells are in trouble
- ALT is more specific to the liver whereas the AST can rise in heart problems
what is alkaline phophatase (ALP) and gamma GT a marker for
- bile ducts are effected - these can be due to obstruction, alkaline phosphatase is secreted in the bile duct, it can also come from bone and various other places so need to make ALP is due to liver and not bone
- Gamma GT – likewise to ALP
what are the types of hepatitis virus
A B C D E
what hepatitis viruses are acute
A and E
these are acute – get cured or rarely get killed – do not go on for chronic liver disease – most without getting jaundice – get a faecal oral transmission,
- in pregnant women there is a high mortality in E
what are the most common hepatitis viruses
B C D
if you have hepatitis D you must also have..
hepatitis B
- you have to have hepatitis B in order to get hepatitis D
what happens with liver cirrhosis
- If you damage the liver with virus, alcohol or drug you get fibrosis but because it regenerates itself you lose the good architecture of the liver, blockages all back up,
what do you get with liver cirrhosis
- get portal hypertension
name the complications of cirrhosis
- porto-systemic encephalopathy
- haematemesis
- ascites
describe the complications of cirrhosis
- Porto-systemic encephalopathy – cant clear everything things go into the brain and make you a bit foggy
- Haematemesis – oesophageal varices- this is because the porto systemic pressures are higher in the portal system, develop veins and you bleed from them
- Ascites – all of these have a reason of why they are there – fluid in the peritoneal cavity, this is a symptom of chronic liver disease
what is the difference between liver failure, portal hypertension, and cirrhosis
Liver failure
- Liver failure is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology.
portal hypertension
- Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system
cirrhosis
- a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. I
what can cause liver cirrhosis
- Hep B
- Hep C
- Alcoholic liver disease
- Diseases affecting bile ducts
- Non-alcoholic fatty liver disease
- Genetic disorders – excess amount of copper in your body, haemochromatosis – iron overload
- Paracetamol overdose
- Hepatocellular carcinoma
what is the most common cause of liver cirrhosis in UK
Hep B and Hep C
what are the types of organ transplant for the liver
- Deceased organ donation – when the liver has taken from someone who has died
- Living donor liver transplant – section taken and it can grow a back to normal
- Split donation – liver is split and given to two patients
what is the process for being chosen for a liver transplant
- Assessment- initial tests and investigations
- Model for end-stage liver disease (MELD) – looks at bilirubin, INR, and something
- Patient on waiting list
- Match found
- Surgery
- Treatment for life – immunosuppressants
what is the complications of liver transplants
- Liver rejection – usually happens in the first few weeks to months
- Infections – weakened immune system due to immunosuppressants – course of antibiotics, antivirals
- Biliary problems – 1 in 10 can get a biliary problem, like having a bile leak, obstruction and put a stent in
- Kidney failure – happens in 1 to 3 patients – side effect of taking the immunosuppressed
- Graft failure – when the transplanted liver doesn’t work as it should be, most common cause is reduce blood supply, only solution has to have another transplant
- Cancer
