Tests
What does an isolated increase in GGT suggest
alcohol intake
What are the zones of the portal triad
Zone 1:Bile duct, portal vein, hepartic artery
Zone 2. Sinusoids, endothelial cells, stellate cells
Zone 3: Kupffer cells,central vein
What symptom can be present in posthepatic jaundice due to excess bile salts
Itching
What is the definition of acute liver failure
development of hepatic encephalopathy in presence of jaundice, where jaundice has lasted less than 3 month, and in the absence of chronic liver disease
hyperacute - less than 1 week
acute - 1-4 weeks
subacute - 4-12 weeks
I Can't think of any more questions - get 100 point FREE
Well done!
How to check if liver injury is hepatocullular or cholestatic
ALT:ALP ratio
1. divide ALT by upper normal limit (40)
2. Divide ALP by upper normal limit (120)
3. What is their ratio?
>5- hepatocellular
<2- cholestatic
2.1-4.9 - mixed
Which structures are reponsible for blood flow to the liver
From portal triad
hepatic artery (30% O2 & nutrition)
portal vein (70% O2 & nutrition)
therefore can ligate the hepatic artery without stopping the liver from functioning
Portal vein sinusoids secrete angiogenic factors and vasodilators to bypass blood vessel 'blockage' in the lover. What are the consequent effects of secreting vasodilators
activating RAAS
sympathetic NS activation
due to perceived hypovolaemia, therefore fluid retention
Why is an increase in blood ammonia an indication of severity of disease
urea cycle dysfunction therefore increase in ammonia
ammonia causes glutamate to be converted to glutamine
glutamine pulls water into astrocyte
astrocyte swells = brain herniation
What percentage of acute liver failure causes brain oedema
75%
What is the serum albumin-ascitic gradient
Difference between the serum albumin and ascites albumin
the difference is the 'gradient'
>11 = portal hypertension
Which area of the lobule is affected during toxic injury of the liver
Zone 3
Near central vein
toxins are deposited here and hepatocytes necrose here
What causes splenomegaly
portal hypertension
Due to shunting, blood backs up to spleen causing it to trap RBC (anaemia) WBC (leucopenia) & platelets (thrombocytopenia)
What is haemachromatosis
condition causing body to absorb too much iron over time, accumulating in the liver
What is the histological definition of cirrhosis
cluster of hepatocytes surrounded by collagen tissue to form nodules
>12mmHg
Which cells become activated when injured/inflamed?
Stellate cells
activate and become star shaped
take up space of disse (between sinusoid & hepatocytes)
What is the mechanism that causes blood too bypass the liver
activated stellate cells cause fibrosis
this causes squeezing of venous sinusoids
this increases intrahepatic resistance
backlog of blood flow causes stretching of prtal vein
new route generated by angiogenic factors release by portal vein sinusoids
blood bypasses liver to get to the heart
What factors are associated with poor prognosis of chronic liver failure (which isnt a factor in acute liver failure)
Albumin
What are the top 3 chronic liver diseases in UK
Hepatitis B & C
Alcohol liver disease
metabolic dysfunction associated steatotic liver disease (MASLD)
Which immunological test would you do for autoimmune hepatitis (4)
antinuclear antibody
Anti-smooth muscle antibody
liver kidney microsomal type 1 antibody
IgG
If an immunological disease affects the liver, which structure is it centred around?
Portal vein
This is the point the antigen in circulation will meet the liver cells, therefore inflammation will be here
What is the physiology of developing oesophageal varices
portal vein cant take blood through liver into circulation
alternative vessels get bigger
usually in stomach & oesophagus
no support for them likely to bleed
What is Wilsons disease
genetic disorder prevents removal of excess copper therefore build up in lover, brain & eyes
causes jaundice as protein responsible for adding copper to bile for excretion is faulty - therefore build up of copper
What are mallory bodies
damage of the intermediate filaments in the liver cell cytoplasm due most frequently to chronic alcohol usage.