PBL5: Liver Disorders by Cato van breemen https://padlet.com/catobreemen/b3mclit57t2a813h en-us 2021-02-28 14:51:38 UTC 2024-06-02 17:24:14 UTC hello@padlet.com catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250142878 2021-02-28 14:53:40 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250142878 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250143423
  • Liver is the largest internal organ and lies in the right hypochondrium.
  • It has 2 anatomical lobes & 8 segments divided by blood vessels 
  • 25% of heart bloods supply goes to the liver
    • ]]>     2021-02-28 14:54:00 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250143423     LIVER BLOOD FLOW catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250149322
  • Portal vein drains most of the GI tract and the spleen and then enters the Liver to give nutrient rich blood. 
  • Hepatic artery is necessary for liver oxygenation and supplies the biliary system. 
  • Liver acinus encompasses the liver tissue that is served by a single terminal branch of the hepatic artery
    • Zone 1 is best oxygenated & gluconeogenesis & urea 
    • Zone 2
    • Zone 3 most remote from afferent vessel
  • Lobule = organization of hepatocytes into the hexagon
    • around is are the portal triads (made out of bile duct, portal vein, hepatic artery)
    • ]]>     2021-02-28 14:57:32 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250149322     LIVER ORGANIZATION & CELLS catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250155368
  • Hepatocytes:
    • The functional cells of the liver. They are part of the Acinus
    • apical, basolateral, lateral
  • Endothelial cells --> make up the walls of the sinusoids
  • Kupffer cells --> specialized Macrophages
  • Stellate cells/Lipocytes --> fat-storing cells involved in vitamin A metabolism and lie between hepatocytes and endothelial cells 
  • Space of Disse --> space between sinusoid channels and hepatocytes and it contains a mixture of cell matrix and stellate cells.

    • ]]>     2021-02-28 15:01:03 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250155368     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250156379 2021-02-28 15:01:37 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250156379 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250159807 2021-02-28 15:03:26 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250159807 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250167890 2021-02-28 15:08:00 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250167890 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250169475 2021-02-28 15:08:52 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250169475 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250170817 2021-02-28 15:09:36 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250170817 Energy Metabolism catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250172278
  • Protein Metabolism
    • Main site of protein synthesis
    • Albumin synthesis
    • Degradation of amino acids --> conversion into urea --> excreted by kidneys
  • Carbohydrate metabolism
    • Glucose and blood sugar homeostasis 
    • Storage of glycogen
      • Can be broken down and stored during fasting
  • Lipid metabolism
    • Metabolizes VLDL & HDLs
    • Cholesterol synthesis
    • ]]>     2021-02-28 15:10:11 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250172278     Storage catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250183064 The liver stores vitamin A, D (also conversion), B12, glycogen]]> 2021-02-28 15:15:55 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250183064 Synthesis & Secretion of plasma proteins and hormones catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250185833 The liver has important roles in maintaining plasma oncotic pressure (serum albumin), coagulation (clotting factor synthesis and modification), blood pressure (angiotensinogen), growth (insulin-like growth factor-1), and metabolism (steroid and thyroid hormone–binding proteins).

    ]]>     2021-02-28 15:17:25 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250185833     Protective & Clearance functions catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250187167
  • Kupffer cells
    • The Kupffer cells have phagocytic and endocytic functions. The liver helps remove bacteria and antigens that breach the defences of the gut to enter the portal blood.
  • Filtering of blood:
    • liver breaks down drugs/hormones/alcohol
    • CYP450 enzymes
    • ]]>     2021-02-28 15:18:05 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250187167     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250196311 2021-02-28 15:23:06 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250196311 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250198890 2021-02-28 15:24:30 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250198890 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250199744 Synthesis ---> transport out of hepatocyte --> bile canaliculus --> biliary tract --> bile duct excretion --> terminal ileum reabsorption]]> 2021-02-28 15:24:57 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250199744 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250609101
  • Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids, and conjugated bilirubin
    • Bile formation requires the uptake of bile acids and other ions. Bile acids are also synthesized in hepatocytes from cholesterol
  • Bilirubin is produced mainly from the breakdown of mature red blood cells by Kupffer cells in the liver and reticuloendothelial system
  •  Steps bilirubin secretion:
    • Reticuloendothelial system uptake of heme
    • Bilirubin release into plasma & take up by albumin
    • Reaches the liver à hepatocyte uptake of bilirubin
    • Hepatocyte conjugates with glucuronic acid --> conjugates secreted into bile
      • Function of conjugation 
  • Conjugated bilirubin is metabolized and absorbed in the colonic epithelium = enterohepatic circulation! 

    • ]]>     2021-02-28 19:01:00 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250609101     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250617858 2021-02-28 19:05:38 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250617858 Blood tests catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250618681
  • Liver function tests
    • serum albumin and bilirubin
    • Prothrombin time
  • Liver biochemistry
    • Serum bilirubin
    • serum AST & ALT
      • Aminotransferases AST & ALT are contained in hepatocytes and leak into the blood when liver cells are damaged
    • Serum alkaline phosphatase ALP
  • Viral markers
  • Urine tests
    • bilirubin
  • Imaging techniques
    • Ultrasound
    • CT
    • MRI
    • X-ray
    • Upper GI endoscopy
    • Endoscopic retrograde cholangiopancreatography
    • Angiography
  • Liver biopsy
    • Histological examination of the liver

    • ]]>     2021-02-28 19:06:04 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250618681     Systemic manifestations catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250627447 2021-02-28 19:09:27 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250627447 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250628064 2021-02-28 19:09:45 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250628064 Symptoms catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250628273 Acute Liver disease:
    • May be asymptomatic 
    • Malaise, anorexia, fever, jaundice
    Chronic liver disease
    • Righ hypochondrial pain
    • abdominal distention
    • fluid retention
    • Haematemesis
    • Breast swelling
    ]]>     2021-02-28 19:09:52 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250628273     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250681111 2021-02-28 19:38:17 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250681111 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250683547 2021-02-28 19:39:35 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250683547 Unconjugated catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684079 2021-02-28 19:39:53 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684079 Conjugated catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684173 2021-02-28 19:39:57 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684173 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684800 Jaundice (icterus) is detectable clinically when the serum bilirubin is >50 μmol/L (3 mg/dL).

    ]]>     2021-02-28 19:40:18 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250684800     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250685316 2021-02-28 19:40:37 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250685316 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250685728 2021-02-28 19:40:52 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250685728 Extrahepatic catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686426 duct obstruction]]> 2021-02-28 19:41:15 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686426 Intrahepatic catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686604 some kind of failure inside the liver]]> 2021-02-28 19:41:21 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686604 Clinical presentation catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686712 2021-02-28 19:41:25 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250686712 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250687497 The accumulation of fluid in the peritoneal cavity, causing abdominal swelling.



    ]]>     2021-02-28 19:41:52 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250687497     Pathogenesis catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250687772 - Due to portal hypertension
    - Due to Na/H2O retention. More fluid is retained
    - Low serum albumin due to liver function being impaired
    - 
     ]]>     2021-02-28 19:42:02 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250687772     Causes catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250688320 Alcohol
    Hepatitis
    Non alcoholic fatty liver disease
    Acute liver injury]]>     2021-02-28 19:42:17 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250688320     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250689023 Cirrhosis is an irreversible distortion of normal liver architecture characterized by hepatic injury,
    fibrosis, and nodular regeneration.]]>     2021-02-28 19:42:41 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250689023     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250691811 2021-02-28 19:44:08 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250691811 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250692792 2021-02-28 19:44:38 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250692792 Pathogenesis catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250693054
  • Chronic injury to the liver in inflammation, necrosis, eventually fibrosis.
  • Fibrosis is initiated by activation of the stellate cells. Stellate cells are activated by many cytokines and their receptors, reactive oxygen intermediates, and other paracrine and autocrine signals.
    • Stellate cells become swollen and there is upregulation of cytokines, TGFbeta
  • The characteristic features of cirrhosis are regenerating nodules separated by fibrous septa and loss of the normal lobular architecture within the nodules.
  • The cell death and cirrhosis will cause the liver to shrink.

    • ]]>     2021-02-28 19:44:47 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250693054     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250695164 2021-02-28 19:45:52 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250695164 Complications catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250695550 1. increased risk massive GI bleeding
    2. Malabsorption of fat
    3. Hepatocellular carcinoma
    4. Pulmonary complications:
    • Hepatopulmonary syndrome
    • Portopulmonary syndrome
    • Hepatic hydrothorax
    5. Portal hypertension
    because of fibrosis/scarring, there is more resistance to blood flow. The pressure within the liver increases and therefore there is increased portal blood flow. This contributes to ascites and splenomegaly
    6. Altered consciousness due to liver disease. The toxics do not get filtered anymore, so they enter the brain
    ]]>     2021-02-28 19:46:06 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250695550     Investigations catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250698213
  • Liver function
    • albumin and prothrombin time
  • Biochemistry (raise in ALP)
    • AST & ALT --> indicate liver damage. AST is the least specific one (also seen in cardiac failure)
    • ALP
  • Viral markers
  • Hyponatraemia
  • Imaging: ultrasound, CT, endoscopy
  • Biopsy
    • ]]>     2021-02-28 19:47:31 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250698213     Excess fat buildup in the liver (with or without alcohol as a cause) catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250702830 2021-02-28 19:50:04 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250702830 Pathogenesis catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250704297
  • Insulin resistance 
    • leads to high levels of glucose. Due to changed metabolism, there is an increase in NADH. This leads to increased fatty acid synthesis
  • Increase in fat storage & fatty acid oxidation process
  • Steatosis
  • Steatohepatitis
    • ]]>     2021-02-28 19:50:51 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250704297     Symptoms catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250705546 2021-02-28 19:51:27 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250705546 Non Alcoholic fatty liver catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250705678 This is a form of chronic liver disease associated with the metabolic syndrome. NAFLD refers to the presence of hepatic steatosis, with or without inflammation and fibrosis, when no other causes of secondary hepatic fat accumulation (e.g., heavy alcohol consumption) are present.

    • NAFLD is strongly associated with metabolic risk factors such as obesity, dyslipidemia, insulin resistance, and type 2 diabetes mellitus 
    ]]>     2021-02-28 19:51:32 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250705678     Alcoholic liver disease catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250706156 Ethanol is metabolized by the liver. The pathways this happens through, can lead to hepatic accumulation of fatty acid.

    Genetic predisposition is recognized

    Pathology:
    • Fatty change
    o   The metabolism of alcohol produces fat in the liver 
    o   This is minimal with small amount of alcohol, but with larger amounts the cells become swollen with fat (steatosis) 
    o   No liver cell damage, fat disappears on stopping alcohol
    • Alcoholic hepatitis
    o   Infiltration by leucocytes and hepatocyte necrosis
    • Alcoholic cirrhosis

    ]]>     2021-02-28 19:51:48 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250706156     Investigations catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250712533 Imaging
    - changed echogenicity
    Biopsy
    ALT & AST increased

    ]]>     2021-02-28 19:55:11 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250712533     Treatment catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250713438 active lifestyle
    Stop drinking 

    ]]>     2021-02-28 19:55:41 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250713438     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250714688 2021-02-28 19:56:19 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250714688 Hepatitis is inflammation of the liver catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250715163 HAV is most commonly seen. 
    HDV is a RNA virus that requires HBD to cause infection]]>     2021-02-28 19:56:37 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250715163     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250717671 Toxic Hepatitis: Most cases of drug-induced liver injury present as acute hepatitis
    Alcoholic Hepatitis: Alcohol consumption is the major cause of the burden of liver disease in Western countries 

    ]]>     2021-02-28 19:58:05 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250717671     Pathogenesis catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250718245 The viruses infect the human body by different means of transmission. The Hepatitis viruses have special affinity for liver cells. The viruses infect the hepatocytes. They multiply inside the hepatocyte. Due to this, the antigen structure on the hepatocytes change. This is recognized as foreign and starts to destroy these hepatocytes by self-mediated immune damage. This leads to apoptosis, necrosis & fibrosis. 

    ]]>     2021-02-28 19:58:27 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250718245     Clinical features catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250718940
  • Prodromal phase 
    • symptoms due to viraemia (flu like symptoms)
  • Icteric phase
    • Due to liver damage
    • jaundice
    • dark urine
    • hepatomegaly
    • increased AST & ALT
  • Convalescent phase
    • recovery phase
    • symptoms gradually improve
    • HBV & HCV have potential to become chronic
    • ]]>     2021-02-28 19:58:51 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250718940     Investigations catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250721376 Liver biochemistry & viral markers]]> 2021-02-28 20:00:17 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250721376 Management catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250721900 Hepatitis usually has spontaneous resolution (HAV & HEV).

    ]]>     2021-02-28 20:00:35 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250721900     https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250914465 2021-02-28 21:58:38 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250914465 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250963825 2021-02-28 22:34:26 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250963825 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250963912 2021-02-28 22:34:31 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250963912 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250964918 2021-02-28 22:35:17 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250964918 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250965262 2021-02-28 22:35:33 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250965262 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250965634 2021-02-28 22:35:50 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250965634 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966040 2021-02-28 22:36:07 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966040 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966324 2021-02-28 22:36:22 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966324 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966686 2021-02-28 22:36:39 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250966686 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250967183 2021-02-28 22:36:54 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250967183 mmtzclaros1 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250967508 2021-02-28 22:37:09 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1250967508 Gilbert syndrome catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251974576 A mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish color of the skin or whites of the eyes may occur. ]]> 2021-03-01 08:21:29 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251974576 Bilirubin catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251979990 Bilirubin is insoluble. It needs to be binded to Albumin to transport = unconjugated. This can not be present in bile and not be excreted in urine.

    When it is in the liver bilirubin is conjugated to glucaronic acid and can then be binded to bile]]>     2021-03-01 08:23:09 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251979990     https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251984323 2021-03-01 08:24:28 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251984323 nicolineschuiling https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251996072 2021-03-01 08:28:09 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1251996072 Types of jaundice evakatgert https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252005036 Can be divided into types: 
    1. Hemolytic jaundice - due to breakdown of red cells bilirubin production is increased
      1. Causes elevated unconjugated bilirubin (because heme, that is produced when RBC breakdown, is needed to make unconjugated bilirubin) 
      2. No bilirubin in urine 
    2. Congenital - defects in conjugation or hepatic uptake of bilirubin (Gilbert’s syndrome, Crigler-Najjar syndrome)
      1. Causes elevated conjugated and unconjugated bilirubin
      2. No bilirubin in urine 
      3. Gilbert’s syndrome → UDP glucuronyl transferase 
    3. Cholestatic - duct obstruction (extrahepatic) or failure of bile secretion (intrahepatic)
      1. Causes elevated conjugated bilirubin 
      2. Bilirubin in urine (makes sense because only conjugated bilirubin can be excreted into the urine). Shows you that bilirubin is being formed but can’t be transported into the bile as it should be.
    ]]>     2021-03-01 08:31:10 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252005036     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252007991 Cholestasis is a condition where bile cannot flow from the liver to the duodenum.]]> 2021-03-01 08:32:10 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252007991 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252012708 2021-03-01 08:33:49 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252012708 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252049494 2021-03-01 08:45:50 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252049494 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252113039 2021-03-01 09:05:31 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252113039 catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252131775 Cholangitis = inflammation of the bile ducts
    - most common in middle aged females
    - autoimmune conditions which causes obstruction of intrahepatic bile ducts
    - leads to scarring 

    Investigations:
    - antibodies
    - elevated ALP & bilirubin

    Prevalence = 240/1.000.000

    ]]>     2021-03-01 09:11:27 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252131775     catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252137983 Fibrosing destruction of intra- and extrahepatic bile ducts. Associated with Destructive cholitis.

    Usually Asymptomatic (detected by change)

    Symptoms: Jaundice

    Treatment: transplantation

    ]]>     2021-03-01 09:13:26 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252137983     Indication catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252146857 Cirrhosis
    Persistent symptoms
    Severe chronic hepatitis
    Only if patients stopped drinking (6 months)

    ]]>     2021-03-01 09:16:11 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252146857     Prognosis catobreemen https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252148000 90% 1 year
    70-85% 5 year survival]]>     2021-03-01 09:16:34 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1252148000     https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253087208 2021-03-01 13:54:07 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253087208 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253087660 2021-03-01 13:54:12 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253087660 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253091139 2021-03-01 13:54:50 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253091139 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253091936 2021-03-01 13:54:58 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253091936 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253093022 2021-03-01 13:55:10 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253093022 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253093886 2021-03-01 13:55:20 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253093886 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253094359 2021-03-01 13:55:25 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253094359 https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253094622 2021-03-01 13:55:29 UTC https://padlet.com/catobreemen/b3mclit57t2a813h/wish/1253094622