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Flashcards in Liver Lecture 1 Deck (15):
1

What is the composition of bile?

1. Bile acids
-cholic acid
-chenodeoxycholic acid
(derivatives of cholesterol)
2. Phospholipids
3. Cholesterol
4. Bile pigments
-bilirubin

2

interface hepatitis

autoimmune hepatitis

3

What of liver function?

Prothrombin time
Albumin

4

AST
ALT
LDH

AST-mito, muscle intestine, brain, kidney, pancreas, RBC
ALT-hepatocytes
LDH-elevated in shock liver

5

Most liver disease ALT> AST what are some exceptions?

Flipped
1. Alcoholic liver disease--> 2:1 ratio
2. Wilson's Disease
-accompanying hemolytic anemia
3. Advanced fibrosis
-so in Hep C when fibrosis gets really

6

When do you see markedly elevated aminotransferase levels?

1. Drug/toxin induced injury
-Acetaminophen
-NOT Alcohol alone
2. Acute viral hepatitis
3. shock liver
4. autoimmune hepatitis
5. common bile duct stone

7

What are markers of cholestasis?

1. Alkaline phosphatase
-seen in infiltrative diseases (sarcoid, tb, fungal, amyloidosis, heme malignancy)
2. Gamma glutamyl transferase
-induced by alcohol, meds
3. 5' nucleotidase
-specific to liver
4. bilirubin

8

Causes of acute liver failure? Definition of acute liver

1.drugs, viral hepatitis, autoimmune hepatitis
-50% from suicide acetaminophen
2. sudden loss of hepatic function
-no underlying liver disease
3. massive hepatic necrosis

Definition
1. INR> 1.5 and Hepatic Encephalopathy
Both occurring within 24 weeks of first onset of symptoms without underlying disease
(exceptions-if disease has only be recognized for

9

Cause of chronic liver disease?

cirrhosis

10

Acute liver injury

hepatic dysfunction without encephalopathy

11

What is the definition of cirrhosis?

a diffuse process characterized by fibrosis and conversion of normal architecture into structurally abnormal nodules

12

What are symptoms with cirrhosis?

asymptomatic
non specific: anorexia, loss of muscle mass, weakness, fatigue
advanced cirrhosis:
-lower extremity edema
-abdominal distension (ascites)
-GI bleeding
-confusion (hepatic encephalopathy)
-muscle wasting and loss of muscle mass
-muscle cramping
-gynecomastia

13

Why does cirrhosis lead to portal hypertension?

1. increased vascular resistance
a. distortion of vascular architecture
b. increase in vascular tone
-contraction of myofibroblasts around hepatic sinusoids
-increased production of vasoconstrictors (endothelin-1)
-reduced release of vasodilators
2. increased portal inflow
-splanchnic vasodilation
-increased NO production
-angiogenesis

14

What leads into the portal vein?

Splenic and SMV
-75% of blood to liver
-within liver portal vein divides into R and L branches

15

What are complications of cirrhosis?

related to portal hypertension
1. ascites
2. variceal bleeding
3. hepatic encephalopathy
4. hepatorenal syndrome
unrelated to portal HTN
-hepatocellular carcinoma