The Liver Flashcards
(34 cards)
Name some functions of the liver.
(Clancy and McVicar, 2013)
- bile production and secretion
- immune functions
- glycogen, mineral and vitamin storage (ADEK and B12)
- protein synthesis
- carbohydrate, protien, and fat metabolism
- blood clotting factor synthesis
- detoxification of drugs, alcohol, chemcials, gut organisms (metabolism)
- hormone synthesis
- blood filtration and storage
What are some things that can injure liver lobules?
(Clancy and McVicar, 2013)
- toxic- drug, alcohol, drugs
- infective- Hep B and C
- autoimmune diseases- autoimmune hepatisis, primary biliary cholangitis, primary sclerosing cholangitis
- genetic/inherited
- metabolic (fatty liver disease)
What is fibrosis?
(Clancy and McVicar, 2013)
When the liver gets chronically injured and goes from a smooth tissue to nodular, scar tissue.
describes any degree of scarring in the liver,
What is cirrhosis?
(Clancy and McVicar, 2013)
build up of severe fibrosis, preventing normal liver function and chance of complications of liver disease is higher.
Takes a long time for fibrosis to develop into cirrhosis although dependent on age- faster for older people.
Disturbs the architecture of the liver meaning venous blood which normally drains through at low pressure has difficulty due to cirrhosis causing portal hypertension which can cause varices.
How does alcohol infleunce chronic liver disease?
(Kalra et al., 2023)
The effects depend on the dose, frequency, and duration of consumption as well as genetics and gender.
List some chronic liver diseases:
(NHS, 2017)
- Non-Alcoholic Fatty Liver Disease (NAFLD) aka (MASLD) Metabolic dysfunction- associated steatotic liver disease
- Alcohol-Related Liver Disease (ALD)
- Chronic Hep B and C
- Autoimmune Hepatitis
- Primary Biliary Cholangitis (PBC)
- Primary Sclerosing CHolangitis (PSC)
List the indications for liver transplantation for chronic liver disease.
(NHSBT, 2024)
- CLD with poor predicted survival
- CLD with associated poor quality of life
- hepatocellular carcinoma
- acute liver failure- most common cause in Scotland is paracetamol overdose
List some rationing points to consider when decising to add to transplant list.
(NHSBT, 2024)
- benefit
- fairness (justice)
- utilitarian- greatest good for greatest number of people
listing should only happen if there is 50% sruvival after 5 years with a quality of life acceptable to the patient
List some contradictions for general liver transplantation.
(NHSBT, 2024)
Relative:
- age above 70
- long standing diabetes mellitus- how long are they likely to survive
- significant sepsis outside the liver
- active substance misuse, including alcohol
- recent malignancy- if less than 5 years special regional expert advice is needed
- porto-pulmonary hypertesnion 25-50 transplant is considered if there is signficant response to therapy
Absolute:
- active alcohol abuse
- advanced cardiopulmonary disease
- active IV drug use
- extra-hepatic malignancy (advanced liver cancer)
- mean PAP > 50
What criteria must be met before someone is out on the list for a liver transplant?
(NHSBT, 2024)
- Hepatocellular carcinoma (HCC), liver cancer
- UK end stage liver disease (UKELD) score of 49 or more
- cirrhosis with a UKELD >49
- point at which survical is better at 12 months with a transplant than without- uses UKELD 49+
- a variant syndrome- atypical from of an existing disease or syndrome
Give some statistics about liver transplantation in Scotland.
- hepatocellular carcionoma is most common in recent years- since 2019
- alcohol liver disease closely following and on rise in recent years
- then NAFLD, Hep C virus, and Primary-billiary colangitis
Transplants for alcoholic liver disease can be quite controveral. List some absolute contra-indications for transplantation.
(NHSBT, 2024)
- alcoholic hepatitis
- more than 2 episodes of non-adherance to medical care with no explanation
- more than 2 episodes of return to drinking following professional assessment
- conceurrent or consecurive ilicit dur use
- drinking on list, results in permanent removal
List some absolute contra-indications for transplantation for illicit drug use.
(NHSBT, 2024)
- ongoing IV use of illicit or non-prescribes substances
- more than 2 episodes of non-adherance with medical care with no explanation
- current failure to comply with assessment
- recent hisotry of cross dependency within last 2 years- swapping from one drug to another with problematic use.
List the critera for transplantation for liver cell cancer.
(NHSBT, 2024)
- up to 5 tumours, all less than 3 cm diameter
- single lesion 5-8 cm that does not increase in size over 6 months
- Alpha fetoprotein (AFP) of less than 1000
What areas are covered in the transplant assesment?
(NHSBT, 2018)
- need for liver transplantation, are there alternative therapies availabke
- suitability for transplantation- pyshco-social contraindications
- fitness for transplantation, fraility, cardiovasular fitness
What is the Liver Offering Scheme?
(NHSBT, 2018)
- UK wide waiting list
- transplant
- best outcome for liver, after 5 yeards
- cOmbiantion of severity of liver disease, cause of disease, age, liver donor profile,
- however shortage of organs- every donor has 5 names patients across the UK
What are some things to consider following a liver transplant?
(NHSBT, 2024)
- on immunosuppression for life
- disease reccurance is possibly in most aetiologies
- increased risk of malignancy, espeically skin cancer due to immunosupperssants
- hypertension, renal impairment, and cardiovasular promlems are common.
What is non-alcoholic liver fatty diease and its symptoms? (NALFD or MASLD)
(Chalasani et al., 2017)
caused by accumulation of fat in liver cells unrelated to alcohol consumption
associaiated with metabolic synfrome, obesity, insulin reistsance, diabetes, and hyperlipidemia
can be asymptomatic at start but symptoms include:
- fatigue
- discomfort or pain in upper right quadrant
- hepatomegaly (enlarged liver)
in more serious cases:
- jaundice
- ascites (swelling in legs and abdoment)
- spider veins
How is non-alcoholic fatty liver disease (NAFLD) diagnosed and treated?
(Chalasani et al., 2017)
Diagnosis
- evaluation of metabolic risk factors
- blood tests to test for insulin resistance or diabetes, high triglycerides, andf elevate
- ultrasound to detect fatty liver, MRI or CT scan can give better detailon quantities of fat accumulation
- FibroScan to measure fibrosis progression
- liver biopsy in advanced cases
Treatment
- lifestyle modifications: diet, exercise, weight loss
- medical management- treat insulin resistance with meds e.g. metformin, statins to treat abnormal lipid numbers without worsening liver function
- transplant in advanced cases where cirrhosis and liver failure has started
What is alcohol-related liver disease (ALD)?
(Crabb et al., 2019)
caused by chronic alcohol consumption.
risk factors:
- genetics (genes affecting alcohol metabolism
- sex (women more susceptible) - nutritional deficiencies due to disrupted nutrient absorption from alcohol,worsening liver damage
- coextising liver diseases such as Hep B and C and NAFLD worsen outcomes
- obesity
What are the symptoms of Alcohol-related Liver disease?
(Crabb et al., 2019)
based on the stage of the disease
- fatty liver (steatosis) normally asymptomic presening as fatigue and discomfort in RUQ of abdomen
- Alcoholic hepatitis- acute inflammation of the liver presenting as:
- jaundice
- nausea and vomiting
- fever
- absominal pain
- ascites (fluid build up in abdomen)
- confusion, sign on encephalopathy in server cases- altering of brain function - Cirrhosis
- severe fatigue and muscle wasrting
- swelling in legs (oedema) and abdoment (ascites)
- easy bruising and bleeding
- cogntivie changes or confusion due to hepatic encephalopathy
How is alcohol-related liver disease diagnosed?
(Crabb et al., 2019)
- medical history of excessive alcohol consumption
- blood tests showing elevated liver enzymes (AST and ALT), elevated bilirubin which is shown in alcoholic hepatitis, GGT often elevated in alcohol related damage and anaemia, thrombocytopenia, or leukocytosis
- MRI, CT or ultrasound to see swelling, fatty liver, fibrosis etc.
- liver biopsy if diagnosis unclear and to distinguish from other conditions
How is alcohol-related liver disease treated?
(Crabb et al., 2019)
- abstience from alcohol to halt progression and imrpove outcomes
- nutritional support to restore liver function and prevent muscle wasting and vitamin supplementation to correct deficiencies
- meds like steroids to reduce imflammation in alcoholic hepatitis
- liver transplant for extreme cases
What is hepatitis B and what are the symptoms?
(CDC, 2024)
- viral infection of liver spread through blood and body fluids
- acute HBV can be reversed by the liver itself wihtout need for intervention
- leads to cirrhosis, liver failure, increased risk of cancer (hepatocellular carcinoma)
symptoms include:
- fatigue
- nausea and vomiting
- abdominal pain- RUQ
- jaudnice
- dark urine or pale stools
- can lead to cirrhosis- ascites, oedema, easy bruising, hepatic encephalopathy
