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GI System > Liver Function And Pathology > Flashcards

Liver Function And Pathology Flashcards

1
Q

What are 3 main functions of the liver

A
  • Storage (Fe, Cu, Glycogen, Vitamins)
  • Synthetic (Glucose/lipids, Cholesterol, Bile, Clotting factors, Albumin)

Metabolic (Bilirubin, NH3, Drugs, Alcohol, Carohydrates and lipids)

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2
Q

Name the 2 main protein made by liver

A

Albumin

Clotting factors

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3
Q

What are 4 specific symptoms of Liver disease?

A
  • Jaundice
  • Oedema/ Ascites
  • Bleeding/ easy bruising
  • Confusion
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4
Q
  1. Relate the metabolic function of the liver to jaundice

2. Relate the synthetic function of the liver to Oedema/ Ascites

A
  1. Increase in Bilirubin in blood

2. Reduced function to make albumin which exerts oncotic pressure in blood

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5
Q
  1. Relate the synthetic function of the liver to Bleeding

2. Relate the metabolic function of the liver to Confusion

A
  1. Reduced ability to make clotting factors

2. Reduced ability to detoxify NH3

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6
Q

List 4 causes of Acute Liver failure

A
  • Alcohol
  • Paracetamol
  • Viral
  • Medications (Aspirin in children)
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7
Q

All causes of liver disease lead to Cirrhosis

What is Cirrhosis?
What does it develop in response to?
What does it lead to?

A

Permanent damage to liver, resulting in impairment of liver function and distortion of architecture of liver

Develops in response to any chronic inflammation-> Fibrosis and hepatocyte necrosis-> Nodules

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8
Q

What are 5 groups causes of Chronic Inflammation leading to Cirrhosis?

A
  • Drugs
  • Infection
  • Deposition
  • Autoimmune
  • Other
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9
Q

List ways that Drugs can cause chronic inflammation leading to Cirrhosis

A
  1. Iatrogenic causes (unintentional damage)
  2. Alcoholic liver disease;
    - Fatty change/ Steatosis (in weeks, usually reversible)-> Hepatomegaly
  • Alcoholic hepatitis (Usually over years)->RUQ pain, Hepatomegaly, Jaundice
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10
Q

List ways that Infection can cause chronic inflammation leading to Cirrhosis

A
  • Hep B: Vaccine, no cure, Symptomatic
  • Hep C: (IV Drug use) Cure, no vaccine, mostly Asymptomatic

(These can also cause hepatocelluar carcinoma)

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11
Q

List ways that Deposition can cause chronic inflammation leading to Cirrhosis

A
  1. Non Alcoholic Fatty Liver Disease (NAFLD);
    - Insulin resistance, Triglyceride accumulation in hepatocytes
    - Called Non Alcoholic Steatohepatitis (NASH) if inflammation present
  2. Hereditary Haemochromatosis; (Autosomal recessive)
    - Increased Fe absorption-> Increased Ferritin
    - Risk of hepatocellular carcinoma
  3. Wilson’s Disease;
    - Reduced Cu secretion from biliary system
    - Reduced Ceruloplasmin (carries Cu in blood)
    - Can affects CNS
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12
Q

List ways that Autoimmune abnormalities can cause chronic inflammation leading to Cirrhosis

A

Autoimmune hepatitis;

  • Autoantibodies against hepatocytes (E.g ASMA, ANA)
  • PBC (Primary Biliary Cirrhosis, AMA +ve)
  • PSC (Primary Sclerosing Cholanitis, AMA-ve)

(PSC associated with IBD, especially Ulcerative Colitis)

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13
Q

List ways other than Drugs/ Infection/ Deposition/ Autoimmune that can cause chronic inflammation leading to Cirrhosis

A
  • Budd Chiari
  • Glycogen Storage Disorders
  • Alpha1 Antitrypsin deficiency
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14
Q

What are the 3 main veins of the Portal Circulation

A
  • Inferior Mesenteric Vein (Descending colon)
  • Superior Mesenteric Vein (Ascending Colon mainly)
  • Splenic Vein
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15
Q

Describe the Portal Circulation

A
  • IMV drains into Splenic vein
  • Move to the right side, and combine with SMV
  • This makes the Portal Vein->Hepatic vein-> IVC
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16
Q

Why does Cirrhosis lead to Portal Hypertension?

A

Cirrhosis of liver-> Fibrosis, reducing expansive capability and compressing Portal Vein-> Hypertension

17
Q

What are 4 consequences of Portal Hypertension?

A
  • Ascites (Increased hydrostatic pressure and reduced albumin production)
  • Splenomegaly (Pressure buildup in Splenic circulation)
  • Varices (Blood shunts from Portal-> Systemic circulation via anastomoses not normally in use, leading to distension of veins at anastomoses)
  • Hepatorenal Syndrome
18
Q

What are 3 common sites where Varices can occur?

A
  • Oesophageal Varices (Can lead to Haematemesis)
  • Ano Rectal Varices (Typically painless, rarely bleed)
  • Umbilical Varices (‘Caput medusa’ is the clinical sign)
19
Q

Describe and explain Hepatorenal Syndrome (A consequence of portal hypertension)

A

Acute, rapidly declining kidney function

  1. Hypertension affects arterial/ Splanchnic circulation causing Vasodilator release
  2. Perceived drop in circulatory volume> RAAS activation
  3. Leads to Renal Artery vasoconstriction-> Reduced perfusion
20
Q

Outline how the Biliary System and how bile enters the duodenum

A
  • Bile Canaliculi in Liver form R and L Hepatic Ducts, which combine-> Common Hepatic Duct
  • Cystic duct from Gallbladder joins CHD-> Common Bile Duct
  • Pancreatic duct joins CBD to later enter Duodenum at Ampulla of Vater
  • Sphincter of Oddi controls rate of entry of bile and secretions into Duodenum
21
Q

Gallstones form in the Gallbladder are quite common
What are they made of?

What are 4 risk factors

A
  • Cholesterol/ Bile Pigments/ A mixture (Not normally visible on X Ray)
  • Diet and lifestyle
  • Female
  • 40s
  • Pregnancy
22
Q

Gallstones don’t often have any complications. Name 4

A
  • Biliary Colic
  • Acute Cholecystitis
  • Ascending/ Acute Cholangitis
  • Acute Pancreatitis
23
Q

Describe Biliary Colic and it’s presentation

A
  • Sudden onset RUQ pain that lasts for a while, as CCK makes GB contract and GSs pushed up against neck of GB (typically after a fatty meal)
  • No inflammation
24
Q

Describe Acute Cholecystitis and it’s presentation

A
  • RUQ pain as Cystic Duct is obstructed by Gallstones
  • Inflammation present
  • +ve Murphy’s sign (Put hand on right side, breathe in, Gallbladder hits hand + pain)

(Treat: Pain relief, Cholecystectomy)

25
Q

Describe Acute/ Ascending Cholangitis and it’s presentation

A
  • Caused by infection
  • Gallstone reaches and obstructs CBD

Present with Charcot’s Triad;

  • RUQ pain
  • Jaundice
  • Evidence of inflammation
26
Q

Describe Acute Pancreatitis and it’s presentation

A
  • Gallstone in CB at/ after the point at which the Pancreatic Duct joins the CBD
  • Autodigestion of pancreas
  • Epigastric pain, which radiates to back
  • Vomiting
  • Cullens and Grey Turners’ signs
  • Raised pancreatic Amylase and Lipase in blood

GI System (26 decks)

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