Flashcards in Liver Lecture 1 Deck (15):
What is the composition of bile?
1. Bile acids
(derivatives of cholesterol)
4. Bile pigments
What of liver function?
AST-mito, muscle intestine, brain, kidney, pancreas, RBC
LDH-elevated in shock liver
Most liver disease ALT> AST what are some exceptions?
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
When do you see markedly elevated aminotransferase levels?
1. Drug/toxin induced injury
-NOT Alcohol alone
2. Acute viral hepatitis
3. shock liver
4. autoimmune hepatitis
5. common bile duct stone
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
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
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
Cause of chronic liver disease?
Acute liver injury
hepatic dysfunction without encephalopathy
What is the definition of cirrhosis?
a diffuse process characterized by fibrosis and conversion of normal architecture into structurally abnormal nodules
What are symptoms with cirrhosis?
non specific: anorexia, loss of muscle mass, weakness, fatigue
-lower extremity edema
-abdominal distension (ascites)
-confusion (hepatic encephalopathy)
-muscle wasting and loss of muscle mass
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
-increased NO production
What leads into the portal vein?
Splenic and SMV
-75% of blood to liver
-within liver portal vein divides into R and L branches