Liver tings Flashcards
functions of the liver
Protein synthesis and metabolism- albumin, carrier proteins and coag factors, hepcidin and ferratins
Lipid and glucose metabolism
hormone and drug inactivation- converts to hydrophillic
conjugation of bilirubin to be excreted
bile synthesis
Immune function- consumes antigens
activation of Vit D
Breakdown of RBCs
Haemoglobin in macrophage in spleen liver or bonemarrow- splits into globin (get reused) and haem.
haem broken into Fe and porphyrin which becomes biliverden then bilirubin that binds to albumin and leaves. Bilirubin goes ot the liver gets conjugated and secreted into bile where it becomes urobiliogen or sterobillin
causes of acute liver disease
commonest: Drug induced liver disease usually paracetamol Hepatitis, AB???? Malignant cause congestion due to heart vascular ischaemic
symptoms of acute liver disease
Constitutional symptoms like malaise fever anorexia
signs of acute liver disease
usually non but can show jaundice or hepatomegally
symptoms of chronic liver disease
Prutius, earliest symptom Fever Anorexia, Malaise lack of appetite weakness Right hypochindriac pain- due to liver distension abdominal distension
signs of chronic liver disease
Jaundice hepatomegally spleenomegally- indicates portal hypertension ascites-due to cirrhosis or metastatic peripheral oedema dupytrens contracture- late easy bruising and purpura palmar erthyma clubbing leuconychia terrys nails parotid enlargement loss of body hair xanthosis, xantholilsma spider naevi enlarge breast- gyanecomastia testicular atrophy amenhorrea confusion- encephalitis grey skin if haemochromatosis
causes of chronic liver disease
Cirrhosis causes by alcoholism is commonest
Hep B C D
non alcoholic fatty liver disease
Metabolic causes, haemochromatosis, wilsons, alpha 1 antitrypsin deficiency
biliary tract diseases and stones
autoimmune-pcb, autoimmune hepatitis
drugs: methotrexate or amiodarone
causes of jaundice
Haemolytic- increased turnover= increased unconjugated bilirubin. liver functional so there is no bilirubin in urine just very dark urine due to increased uobiliogen
congenital hyperalbuminuria- Gilbert disease
cholestatic- hepatic or extrahepatic- PCB, carcinoma cholangitis
natural progression of alcoholic liver disease
Alcoholic fatty liver- asymptomatic
alcoholic hepatitis- mild symptomatic or asymptomatic
Alcoholic cirrhosis- signs and symptoms of liver diease
Alcoholic Fatty liver disease symptoms signs pathophysiology and damage investigation and results in serum Treatment
asymptomatic or nausea, vomiting diarrhoea- effect of excess alcohol
no liver damage and everything reversed on stopping alcohol. excess alcohol makes liver cells take up fat.
elevated MCV, anemia, serum Transaminase and Gamma glutymyl transpeptide
view by CT
Stop drinking and will return to normal
alcohol hepatitis symptoms signs pathophysiology and damage investigation Treatment
hepatic necrosis and presence of mallory bodies and giant mitochondria
mild signs and symptoms of chronic liver disease. the more severe the closer it is to cirrhosis
can be confirmed by biopsy
has increased serum bilirubin, Gamma Glytumal, ALT AST prothrombin time and decreased albumin
vitamin supplements and steroids
Alcohol cirrhosis symptoms signs pathophysiology and damage investigation Treatment
Signs symptoms and makers of liver disease
seen on ultrasound and biopsy
stop alcohol and same treatment for cirrhosis
general management for alcoholic liver disease
stop drinking offer cessation
monitor for withdrawal delirium tremeus- treat with diaepan
offer vit B and other supplementary ADEK
bed rest
Haemochromatosis causes
Iron overload due to increased turnover like sickle cell or spherocytosis
or due to increased transfusions due to thalassemia
commonest cause is hereditary haemochromatosis- autosomal recessive- 1 in 10 carrier 1 in 400 affected
Haemochromatosis Presnetation
present with Triad usually in 5th decade
bronze skin- becomes slated grey ove time
DM
hepatomegally
also: arrhythmia, hypogonadism, artrropathy
why does haemochromatosis present like this
iron deposition in liver, skin heart pancreas pituitary
Haemochromatosis investigation
Serum iron= elevated serum ferratin= elevated LFT- elevated biposy- diagnostic and can stage level of damage genetic test for HFE gene
DEXA Glucose tolerence and Echo- Dilated C
haemochromatosis management conservative
screen family members
avoid excess iron and vit C D and alcohol
Vaccinate hep A and B
haemochromatosis management disease modifying
venesection on a weekly bases for up to 2 years. montior serum iron ferratin and MCV
this will treat all symptoms except DM and testicular atrophy and arthropaty
haemochromatosis management disease modifying drug
Desferrioxamine- med for iron overdose
what is wilsons disease
Increased copper deposition in liver cornea and basal ganglia
autosomal Reseccive
wilsons disease Presentation
children- hepatic problems
adults- neurological roblems- ataxia, dysarthia, tremou, dementia, dysdiadochokinesia
Investegation for Wilsons disease
Serum copper Low urinary copper= Hifg LFT= elevated DNA test Kayser Fleisher sign in eyes LIVER BIPOSY
Treatment in wilsons disease
Trasnplant or Penicillamine (copper Clearer) and zinc
Alpha 1 antitrypsin deficiency
What is it and what does it cause
Autosomal Recessive and it causes liver cirrhosis in children or emphysema in adults
Alpha 1 antitrypsin deficiency
diagnoses and treatment
Serum Alpha 1 antitrypsin deficiency is low
dont smoke, screen relatives
same managmen for cirhossis and put on transplant if needed
what is Primary Billiary Cirrhosis
chronic autoimmune disease which causes destruction of the bile ducts
Primary Billiary Cirrhosis
prevalence and risk factors and average onset
Assosiated with other autoimmune conditions (sjorgens, thyroid)
reoccuring UTIs, Smoking. family history. past pregnancy
90% are women and average onset is 40-50 YO
4 in 100,000
Presnetation of Primary Billiary Cirrhosis
first symptom is prutius and severe fatigue
can develop into more severe symptoms as disease progresses
