Liver Disorders by Base MN https://padlet.com/baselmn1997/3tx6870xlvqd7yji Made with love en-us 2022-02-26 09:08:04 UTC 2024-02-26 11:58:01 UTC hello@padlet.com jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461132 2022-02-27 20:49:28 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461132 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461363 2022-02-27 20:49:52 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461363 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461451 2022-02-27 20:50:02 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461451 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461517 2022-02-27 20:50:09 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461517 Causes of Jaundice jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461638 2022-02-27 20:50:25 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461638 DD & Investigations jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461755 2022-02-27 20:50:38 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461755 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461851 2022-02-27 20:50:48 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461851 Chronic liver disease jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461935 2022-02-27 20:50:57 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068461935 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068462277 2022-02-27 20:51:34 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068462277 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068463321 2022-02-27 20:53:31 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068463321 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068463592 2022-02-27 20:54:05 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068463592 jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068464362 2022-02-27 20:54:54 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068464362 Hepatomegaly jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068465347 2022-02-27 20:56:35 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068465347 Causes: chronic hepatitis jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068465661 2022-02-27 20:57:11 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068465661 Viral hepatitis jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068466055 2022-02-27 20:57:46 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068466055 Viral hepatitis jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068466176 2022-02-27 20:57:57 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068466176 HAV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467028 2022-02-27 20:59:13 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467028 HAV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467130 2022-02-27 20:59:24 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467130 HBV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467930 2022-02-27 21:01:00 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068467930 HBV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468071 This figure is only applicable for Hepatitis B]]> 2022-02-27 21:01:19 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468071 HCV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468169 2022-02-27 21:01:30 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468169 HCV jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468233
  • Hepatitis C is the worst 
  • it is asymptomatic
  • For hepatitis C, it is better for the patient to be listed on the transplantation list

    • ]]>     2022-02-27 21:01:40 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468233     Pathology jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468507
    a. Fibrosis is the blue area
    b. fibrosis is the red area
    The spleen should be small

    ]]>     2022-02-27 21:02:09 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468507     Fibrosis jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468779 2022-02-27 21:02:28 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068468779 Complications jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068469217 2022-02-27 21:03:21 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068469217 Causes jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470017 2022-02-27 21:04:23 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470017 Prognostic indicators jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470160 2022-02-27 21:04:42 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470160 Complications jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470596 2022-02-27 21:05:32 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068470596 Portal hypertension jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068472015 2022-02-27 21:06:39 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068472015 Gastrointestinal hemorrhage jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068472347 2022-02-27 21:07:01 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068472347 Overview mankshbasel https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068967773
  • (A) is the least worse among the other
  • if you are vaccinated for B then you will be protected from B and D
    • ]]>     2022-02-28 06:53:54 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2068967773     Structure mankshbasel https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069162312
  • Blood supply enter through the liver helium
    • The hepatic artery, a branch of the coeliac axis, supplies 25% of the hepatic blood flow.
    • The portal vein drains most of the gastrointestinal tract and the spleen. It supplies 75% of hepatic blood flow
  • Acinus (functional hepatic unit)
    1. consists of parenchyma (hepatocytes) supplied by the smallest portal tracts containing portal vein radicles, hepatic arterioles, and bile ductules
    2. Cells in zone 1 more resistance to damage than those in zone 3
  • Sinusoids
    • It is a channel
    • Lacks a basement membrane and are loosely surrounded by specialist fenestrated endothelial cells and Kupffer cells (phagocytic cells).
    • Sinusoids are separated by plates of liver cells (hepatocytes). 
    • The space of Disse is between sinusoids and hepatocytes, which contains a matrix of basement membrane constituents and stellate cells
  • Stellate cells: store retinoids in their resting state and contain desmin (intermediate filament). When activated (to myofibroblasts) they are contractile and regulate sinusoidal blood flow. Activated stellate cells produce signal proteins for synthesis or inhibition of degradation of extracellular matrix components, including collagen, as well as cytokines and chemotactic signals.
  • The biliary system

      1. Bile canaliculi form a network between the hepatocytes. 
      2. These join to form thin bile ductules near the portal tract, which in turn enter the bile ducts in the portal tracts.
      3. These then combine to form the right and left hepatic ducts that leave each liver lobe
      4. The hepatic ducts join at the porta hepatis to form the common hepatic duct. 
      5. The cystic duct connects the gall bladder to the lower end of the common hepatic duct.
    • The common bile duct and pancreatic duct open into the second part of the duodenum most often through a common channel at the ampulla of Vater, which contains the muscular sphincter of Oddi

    • ]]>     2022-02-28 09:37:32 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069162312     Functions of the Liver mankshbasel https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069163138
    1. Protein metabolism
      1. Synthesis and storage
        1. synthesis of proteins
          1. such as albumin and fibrinogen
          2. albumin has a role in oncotic pressure
        2. The liver receives amino acids from the intestine and muscles and, by controlling the rate of gluconeogenesis and transamination, regulates plasma levels.
        3. The liver also synthesizes all factors involved in coagulation
      2. Degradation (nitrogen excretion)
        1. degradation of aminoacids in the liver
    2. Carbohydrate metabolism
      1. Glucose homeostasis
      2. It stores approximately 80 g of glycogen. 
        1. In the immediate fasting state, blood glucose is maintained either by glucose release from breaking down glycogen (glycogenolysis) or by synthesizing new glucose (gluconeogenesis).
    3. Lipid metabolism
      1. It synthesizes very-low-density lipoproteins (VLDLs) and high-density lipoproteins (HDLs).
      2. Triglycerides can be synthesized in the liver
      3. Cholesterol can be synthesized in the liver from acetyl-CoA
    • Formation of bile (look at the figure below!)

    • Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Two processes are involved in bile secretion across the canalicular membrane of the hepatocyte – bile salt-dependent and bile salt independent processes.
    • Bile formation requires uptake of bile acids and other organic & inorganic ions across the basolateral (sinusoidal) membranes by transport proteins.
    • Bile acids are also synthesised in hepatocytes from cholesterol.
    • Secretion of a bicarbonate-rich solution is stimulated mainly by secretin and is inhibited by somatostatin.
    • Bile acids act as detergents; their main function is lipid solubilization. Bile acid molecules have both a hydrophilic and a hydrophobic end. In aqueous solutions they form micelles, with their hydrophobic (lipid-soluble) ends in the centre. Micelles are expanded by cholesterol and phospholipids (mainly lecithin), forming mixed micelles.



    ]]>     2022-02-28 09:38:13 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069163138     mankshbasel https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069164264 2022-02-28 09:39:02 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069164264 mankshbasel https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069165335
  • Blood tests
    • Liver "function" tests
      • serum albumin and bilirubin
        • Serum albumin: falling serum albumin is a bad prognostic sign.
      • prothrombin time (PT)
        • prothrombin time: Because of its short half-life, it is a sensitive indicator of both acute and chronic liver disease
    • Liver biochemistry
      • serum aspartate (AST) and alanine aminotransferases (ALT) - reflecting hepatocellular damage
        • AST: High levels are seen in hepatic necrosis
        • ALT: is a cytosol enzyme, more specific to the liver so a rise only occurs with liver disease.
      • serum alkaline phosphatase (ALP), gamma-glutamyl transpeptidase – reflecting cholestasis
        • raised in both intrahepatic and extrahepatic cholestatic disease of any cause
      • total protein
        • The proteins in the globulin fraction, raised in liver disease
      • gGT (see table)
        • obstruction of bile excretion
      • ammonia
        • degradation of aminoacids to urea
        • accumulation of ammonia in the brain is toxic and indicates (??? check)
    • Viral markers
    • Additional blood investigations: haematological, biochemical, immunological, markers of liver fibrosis and genetic analysis. (there is a figure for that!)
  • Urine tests – for bilirubin and urobilinogen
  • Imaging techniques – to define gross anatomy
  • Liver biopsy – for histology

    • ]]>     2022-02-28 09:39:54 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069165335     baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069274017
  • Acute liver disease
    • Signs: 
      • jaundice → seen in the conjunctivae and sclerae
      • pale stools and dark urine
      • Spider naevi and palmar erythema
    • Symptoms: 
      • malaise, anorexia and fever. Jaundice may appear as the illness progresses.
  • Chronic liver disease
    • Signs (see the figure)
    • Symptoms
      • Right hypochondrial pain due to liver distension
      • Abdominal distension due to ascites
      • Ankle swelling due to fluid retention
      • Haematemesis and melaena from gastrointestinal haemorrhage
      • Pruritus due to cholestasis
    • ______________________________________________________________________________
    (Look at the figure)
    • Blood changes
      • If the liver is fibrotic --> portal hypertension --> blood stream change splenomegaly caused by the blood builds up --> more breaking down --> bone marrow changes
    • caput medusea --> contributes to ascites
    • functional
      • coma caused by hyperammonemia
      • jaundice --> bilirubin
      • anemia --> iron deficiency
      • hyperestrogenism --> too much oestrogen caused by the liver dysfunction (the liver normally catabolizes that hormone)
        • The skin will be red
      • spider naevi (pic included)
    _______________________________________________________________
    Ascites
    • Causes
      • Sodium & water retention
      • Portal hypertension
        • exerts a local hydrostatic pressure and leads to increased hepatic and splanchnic production of lymph and transudation of fluid into the peritoneal cavity
      • Low serum albumin
        • contribute by a reduction in plasma oncotic pressure.
    ________________________________________________________________

    • The skin
      • spider naevi on chest and upper body
      • telangiectases that consist of a central arteriole with radiating small vessels.
      • In haemochromatosis the skin may have a slate-grey appearance
    • The abdomen
      • hepatomegaly & Splenomegaly (due to portal hypertension)
    • The endocrine system
      • Gynaecomastia and testicular atrophy

    ]]>     2022-02-28 11:07:57 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069274017     Acinus of the Liver rockhardstones123 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069298712 2022-02-28 11:30:03 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069298712 Structure and function of liver zones mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069301222 2022-02-28 11:31:55 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069301222 Markers of liver function mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069301756 2022-02-28 11:32:30 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069301756 Function of the liver mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069303166 Protein metabolism
    • The liver is the principal site of synthesis of all circulating proteins apart from γ-globulins 
      • Albumin
    • Controls plasma levels by controlling gluconeogensis and transamination
    • Transport of carrier proteins
    • Synthesises coagulation factors
    • Storage of vitamins and minerals
    • Degradation of amino acids produces ammonia -> urea

    Carbohydrate metabolism
    • Glucose homeostasis and the maintenance of the blood sugar is a major function of the liver. 
    • In the immediate fasting state, blood glucose is maintained either by glucose release from breaking down glycogen (glycogenolysis) or by synthesizing new glucose (gluconeogenesis). 
    • In prolonged starvation, ketone bodies and fatty acids are used as alternative sources of fuel as the body tissues adapt to a lower glucose requirement

    Lipid metabolism
    • It synthesizes very-low-density lipoproteins (VLDLs) and high-density lipoproteins (HDLs)
    • HDLs are the substrate for lecithin-cholesterol acyltransferase (LCAT), which catalyzes the conversion of free cholesterol to cholesteryl ester
    • MDLs remove triglycerides 
    • Cholesterol may be of dietary origin but most is synthesized from acetyl-CoA mainly in the liver, intestine, adrenal cortex and skin.

    Bile formation
    • Bile secretion & metabolism
      • Bile formation requires uptake of bile acids and other organic and inorganic ions across the basolateral (sinusoidal) membranes by multiple transport proteins; NTCP and sodium independent OATP2,
      • Two processes are involved in bile secretion across the canalicular membrane of the hepatocyte – bile salt-dependent and bile salt independent processes – each contributing about 230 mL/ day. 
        • Bile salt-dependent process: 
          • the bile acid receptor, farnesoid X, blocks bile acid formation from cholesterol and also regulates the transport proteins (NTCP, OATP2) that increase bile acid uptake by the liver Na+ and water follow the passage of bile salts by diffusion across the tight junction between hepatocytes. 
        • In the bile salt-independent process, water flow is due to other osmotically active solutes such as glutathione and bicarbonate.
      • The bile acids are excreted into bile and then pass via the common bile duct into the duodenum
    • Bilirubin metabolism
      • Bilirubin is produced from breakdown of mature red cells by Kupffer cells in the liver and reticuloendothelial system; 15% of bilirubin is formed from catabolism of other haem-containing proteins
        • Normally, 250–300 mg daily. 
      • unconjugated bilirubin is water-insoluble, due to internal hydrogen bonding, and is transported to the liver attached to albumin. 
      • Bilirubin dissociates from albumin and is taken up by hepatic cell membranes and transported to the endoplasmic reticulum by cytoplasmic proteins, where it is conjugated with glucuronic acid and excreted into bile. 
        • conjugated bilirubin is water-soluble and is actively secreted into biliary canaliculi and excreted into the intestine within bile 
      • not absorbed from the small intestine because of its large molecular size
      • In the terminal ileum, bacterial enzymes hydrolyse the molecule, releasing free bilirubin which is then reduced to urobilinogen, some of which is excreted in the stools as stercobilinogen. 
        • The remainder is absorbed by the terminal ileum, passes to the liver via the enterohepatic circulation, and is re-excreted into bile. Then excreted kidneys
          • = When hepatic excretion of conjugated bilirubin is impaired, a small amount is strongly bound to serum albumin and is not excreted by the kidneys; it accounts for the persistent hyperbilirubinemia


    Hormone and drug activation
    • The liver catabolizes hormones such as insulin, glucagon, oestrogens, growth hormone, glucocorticoids and parathyroid hormone. 
    • It is also the prime target organ for many hormones (e.g. insulin). 
    • It is the major site for the metabolism of drugs and alcohol. 
    • Fat-soluble drugs are converted to water-soluble substances that facilitate their excretion in the bile or urine. 
    • Cholecalciferol is converted to 25-hydroxycholecalciferol.


    Immunological function
    • The hepatic reticuloendothelial system contains many immunologically active cells. 
    • The liver acts as a ‘sieve’ for bacterial and other antigens carried to it by the portal vein from the gastrointestinal tract. 
      • These antigens are phagocytosed and degraded by the Kupffer cells, which have specific membrane receptors for ligands and are activated by several factors, such as infection. 
    • Antigens are degraded without the production of antibody, as there is very little lymphoid tissue and thus, they are prevented from reaching antibody-producing sites and thereby prevent generalized adverse immunological reactions
    • Cytokines also stimulate hepatic apoptosis.

    ]]>     2022-02-28 11:33:58 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069303166     Lipid metabolism mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069304561 2022-02-28 11:35:22 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069304561 Recirculation of bile acids mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069307823 2022-02-28 11:38:31 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069307823 Cholesterol synthesis mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069308149 The bile is then reabsorbed in the intestines]]> 2022-02-28 11:38:48 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069308149 Bilirubin metabolism and elimination (important) mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069310470 2022-02-28 11:41:12 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069310470 Overview dobberlisa https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069315814 2022-02-28 11:46:08 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069315814 mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069317452 Hepatic encephalopathy, a condition that happens when the liver is too diseased or damaged to properly process ammonia. In this disorder, ammonia builds up in the blood and travels to the brain. It can cause confusion, disorientation, and coma. It can sometimes be fatal]]> 2022-02-28 11:47:37 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069317452 dobberlisa https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069329902 2022-02-28 12:00:01 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069329902 baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069339383 Types
    • Haemolytic jaundice
      • Increased bilirubin load for the liver cells
        • because there is more breakdown of red blood cells
      • Urinary urobilinogen is increased
    • congenital hyperbilirubinemias (non-haemolytic) 
      • Unconjugated (lipid-soluble, bound to albumi) 
        • Gilbert's syndrome
          • asymptomatic
        • Crigler-Najjar syndrome
      • Conjugated (soluble, addition of glucuronic acid to unconjugated in the liver.
        • Dubin-Johnson & Rotor syndromes
        • Benign recurrent intrahepatic cholestasis
        • Progressive familial intrahepatic cholestasis (PFIC) syndromes
    • Cholestatic jaundice (acquired)
      • Extrahepatic: is due to large duct obstruction of bile flow at any point in the biliary tract distal to the bile canaliculi
      • Intrahepatic: occurs owing to failure of bile secretion
    Differential diagnosis:
    You ask for the history of the patient to see whether it is possible to get infected by trevelling.
    • we look at age
      • a young person is more likely to have hepatitis, so questions should be asked about drug and alcohol use, and sexual behaviour
      • An elderly person with gross weight loss is more likely to have a carcinoma
    Clinical features
    • Hepatomegaly: seen in hepatitis and with extrahepatic obstruction
    • Splenomegaly: indicates portal hypertension
    • Ascites: found in cirrhosis but can also be due to carcinoma
    ]]>     2022-02-28 12:08:48 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069339383     baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069339779
  • Acute hepatitis
    • Acute parenchymal liver damage can be caused by many agents

    • Chronic hepatitis
      • is defined as any hepatitis lasting for 6 months or longer

    ]]>     2022-02-28 12:09:14 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069339779     Hepatitis A baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069341206 2022-02-28 12:10:23 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069341206 Hepatitis B baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343085 2022-02-28 12:12:03 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343085 Hepatitis C baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343209 2022-02-28 12:12:09 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343209 Hepatitis D baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343302 2022-02-28 12:12:15 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343302 Hepatitis E baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343409 2022-02-28 12:12:21 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069343409 baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069349185 There are vaccines only for Hepatitis A, B & E

    ]]>     2022-02-28 12:17:44 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069349185     baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069351990
  • Incidence
    • affects 3–6% of the population in the USA
    • 25% according to the lecture (check this p: )
  • Histological changes
    • from simple fatty change to fatty inflammation to fibrossi
  • Risk factors
    • Oxidative stress injury
  • Diagnosis

    • ultrasound, with the exclusion of other causes of liver injury
    • Liver biopsy allows staging of the disease but when this should be performed is unclear
    • Elastography is being used to evaluate the degree of fibrosis.
  • Management
    • weight loss, exercise, strict control of hypertension, diabetes and lipid levels are the only treatments

    • ]]>     2022-02-28 12:20:30 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069351990     Cirrhosis mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069354597 Aetiology
    • Alcohol
    • Viral infections
    • NASH
    • Autoimmune disorders
    • Cholestatic disorders
    • Metabolic diseases


    Pathogenesis
    • Injury -> cirrhosis can take 5-50 years, affected by risk factors
    • Injury -> fibrosis (resolvable!)
      • Inflammatory damage
      • Matrix deposition
      • Parenchymal necrosis
      • Angiogenesis
    • Fibrosis -> Cirrhosis (can regress)
      • Disrupted architecture
      • Loss of function
      • Aberrant hepatocyte regeneration


    Pathology
    • Destruction of extracellular matrix
      • formation of micro and macro nodules
    • Micronodular
    • Macronodular
      • aggregated cells, clumps
    • Redistribution of blood supply in liver

    Investigations - to check prognosis & liver function
    • Severity
    • Type 
    • Imaging
    • Biopsy

    Management
    • Transplant
    • Reversing damage by removing underlying cause


    Course and prognosis
    • 5 year survival rate of 50%
    • Depends on influencing factors
      • Genetic
      • Environment


    Liver transplantation
    • Indications
      • Mainly: cirrhosis or conditions which result in this
    • Contraindication
      • sepsis
      • rate of recurrence of carcinoma is high
    • Preparation
    • Rejection
    • Prognosis
      • 90% 1 year, 70-85% 5 year survival
      • Carcinoma's can recur

    Complications and effects




    ]]>     2022-02-28 12:22:47 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069354597     aetiology & pathogenesis baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355484
  • aetiology: alcohol, viral infection, hepatitis B and C
    • there is also a table for the causes


    • Pathogenesis
      • Chronic injury to the liver results in inflammation, necrosis and, eventually, fibrosis
      • Fibrosis is initiated by activation of the stellate cells. 
      • Kupffer cells, damaged hepatocytes and activated platelets are probably involved. 
      • Stellate cells are activated by many cytokines and their receptors, reactive oxygen intermediates and other paracrine and autocrine signals
      • Inflammatory cells contribute to fibrosis via cytokine secretion
      • In the space of Disse, the normal matrix is replaced by collagens



    ]]>     2022-02-28 12:23:36 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355484     Fibroses liver vs normal mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355494 2022-02-28 12:23:37 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355494 Pathology & Investigations baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355907
  • Investigations
    • Severity
      • Liver function – serum albumin & prothrombin time are the best indicators of liver function. Prognosis poor with albumin below 28 g/L.
      • Liver biochemistry – All biochemistry deranged in decompensated cirrhosis. Can be normal, depending on severity.
      • Serum electrolytes – Low sodium indicates severe liver disease.
      • Serum creatinine – Elevated concentration = worse prognosis.
    • Type
      • Viral markers
      • Serum autoantibodies
      • Serum immunoglobulins
      • Iron indices and ferritin
      • Copper, ceruloplasmin
      • Alpha1-Antitrypsin
    • Imaging
      • Ultrasound – can demonstrate change in size & shape. Useful in detecting hepatocellular carcinoma.
        • to measure fibrosis we use elastography
      • CT scan – shows hepatosplenomegaly and dilated collaterals. Can detect hepatocellular carcinoma.
      • Endoscopy – detection and treatment of varices and portal hypertensive gastropathy.
      • MRI scan – Diagnosis of both benign and malignant tumours.
    • Liver biopsy – usually necessary to confirm the type & severity of disease.

    • ]]>     2022-02-28 12:23:59 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069355907     mmtzclaros1 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069360117 https://www.webmd.com/hepatitis/digestive-diseases-liver-transplantation
    • Criteria MELD (look at them in the  article/lecutre)
      • you need to know this

    ]]>     2022-02-28 12:27:32 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069360117     management/course & prognosis baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069366595
  • management of complications seen in decompensated cirrhosis. 
    • Patients with compensated cirrhosis should lead a normal life. 
    • Reduce dietary salt intake
    • avoid aspirin and NSAIDs, and avoid alcohol.

    • Course is varaible depending on severity and locations
    ]]>     2022-02-28 12:33:17 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069366595     Liver transplantation baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069367232
  • Liver Transplantation – 
    • Indications for transplantation – acute: fulminant hepatic failure of any cause. Chronic: complications of cirrhosis no longer responding to therapy.
    • Contraindications – active sepsis, malignancy outside the liver, liver metastases, no psychological commitment. Patients 70 or older are not usually transplanted.
    • Prognosis – in low-risk patients, 90% 1-year survival. 5-year survival is as high as 70-85%.

    • ]]>     2022-02-28 12:33:41 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069367232     complications baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069373733 Complications that could kill the patient:
    • renal failure
    • bleeding
    • carcinoma
    • heptopulmonary syndrome
    • vasorenal system
    • Portal hypertension & gastrointestinal haemorrhage
      • Prehepatic – due to blockage of the portal vein before the liver
      • Intrahepatic – due to distortion of the liver architecture, which can be presinusoidal or post-sinusoidal (cirrhosis)
      • Post-hepatic – due to venous blockage outside the liver (rare)

    ]]>     2022-02-28 12:39:01 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069373733     Secondary liver tumors baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069375028
  • Secondary liver tumours – secondary (metastatic) tumours, most common.
    • Clinical features – variable but usually include weight loss, malaise, upper abdominal pain, and hepatomegaly, with or without jaundice.
    • Diagnosis – ultrasound is primary, with CT or MRI to look for primary. Serum alkaline phosphatase is elevated.
    • Treatment – Depends

    • ]]>     2022-02-28 12:40:00 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069375028     Primary malignant tumours baselmn1997 https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069378524
  • Hepatocellular carcinoma – 5th most common cancer worldwide
    • Aetiology – carriers of HBV or HCV. Also associated with cirrhosis.
    • Pathology – single or occurs in multiple nodules. Histologically consists of cells resembling hepatocytes.
    • Clinical features – weight loss, anorexia, fever, ache in the right hypochondrium, and ascites.
    • Investigations – Ultrasound scans show filling defects in 90% of cases. CT, MRI, biopsy.
    • Treatment & prognosis – median survival rate of 5 years if surgical resection is possible. Transplantation is usually limited due to the underlying cause of HCC. Conventional chemotherapy and radiotherapy unsuccessful.
    • Prevention – vaccination against HBV.
      • this reduces the annual incidence of the disease

    • Cholangiocarcinoma – increasing in incidence. Can be intra- or extrahepatic. Not associated with HBV or cirrhosis. Clinical features similar to primary HCC. Patients usually die within 6 months.
    ]]>     2022-02-28 12:42:52 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2069378524     jasminedragomir https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2070349108 2022-02-28 21:41:24 UTC https://padlet.com/baselmn1997/3tx6870xlvqd7yji/wish/2070349108