Term
| Liver Anatomy & Blood Flow |
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Definition
2 blood supplies--portal vein and hepatic supply
Venous blood flows up portal vein and into liver. From hepatic capillaries into the hepatic vein to inferior vena cava and into main circulatory system. |
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Term
| Enterohepatic circulation |
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Definition
bile acids are secreted into the bile, absorbed back into blood and recirculated via the portal vein.
Excretion of bile acids by the intestine for recirculation thru the portal system and reused by the live.
Most cholesterol absorbed into the system comes from the bile and not the diet. |
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Term
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Definition
--Detoxification and excretion of wastes, toxins, & hormones
--Lipid and Carb metabolism
--Protein synthesis (such as coagulation factor and albumin)
--conjugation & excretion of bile acids
--storage of glycogen in liver is used to maintain blood sugar levels. |
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Term
| Metabolic Consequences of Liver Disease |
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Definition
--Toxic accumulations of waste, drugs, toxins, hormones
--Bleeding due to deficiency of coagulation factors
--Edema due to deficiency of plasma albumin
--Failure to absorb intestinal fat b/c of lack of bile acids
--Buildup of ammonia b/c ammonia not getting converted to urea. |
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Term
| Determinants of Liver Disease |
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Definition
Viral Hepatitis--common contagious disease
Cirrhosis--end point of many liver diseases
Portal Hypertension |
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Term
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Definition
| can be a consequence of cirrhosis; associated with liver failure and hemorrhage. Stones form in the gallbladder and may pass into or obstruct bile duct. the blockage will cause blood to back up into the GI tract. |
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Term
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Definition
--Inlfammation: from hepatitis or viral infection
--degeneration: from hydropic or fatty liver, toxins or autoimmune disease.
--Necrosis
--Fibrosis: of liver tissue caused by cirrhosis
--Fatty Liver: accumulation of fats |
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Term
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Definition
Elevated enzymes may be a sign of liver dysfunction.
Bilirubin may be elevated.
Proteins may be low (plasma albumin & coagulation factors)
Test for hepatits virus markers or autoimmune antibodies. |
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Term
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Definition
| Prothrombin & Partial Thromboplastin times will check for clotting ability to determine if coagulation factors are low which could be a sign of liver dysfunction. |
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Term
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Definition
Jaundice
Cholestasis--bile deposits show in skin
Hepatic Failure |
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Term
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Definition
accumulation of excessive amounts of bilirubin in the blood.
Causes yellow skin and sclera known as icterus.
3 Types of jaundice |
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Term
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Definition
Prehepatic--seen in hemolytic anemia; increased levels of uncojugated bilirubin the blood
Hepatic--interference with ability to conjugate bilirubin causes hyperbilirubinemia or kinicterus (the bilirubin is deposited in the brain)
Posthepatic--caused by obstruction of bile flow; causes increase in bilirubin in blood (conjugated or unconjugated) |
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Term
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Definition
-90% of liver function must be lost for failure to occur.
--death is imminent
--often accompanied by kidney failure: kidney and brain function impaired.
-an increase in estrogen can lead to atrophy, balding, and gynocomastia
--can also cause bleeding disorders. |
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Term
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Definition
the end stage of many liver diseases is cirrhosis.
Scarring with patterned fibrosis
Classified by cause...66% of cirrhosis is alcoholic cirrhosis. |
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Term
| Pathophysiology of Cirrhosis |
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Definition
| 2 Types: Biliary or Portal |
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Term
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Definition
| The portal triad in the liver is damaged. It regenerates but causes scarring. Alcoholic or viral causes. Leads to ascites and splenogmegaly. |
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Term
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Definition
| Caused by a chronic inflammation of the bile ducts |
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Term
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Definition
Initial features include anorexia, fatigue, weight loss, and jaundice (which may appear suddenly)
Death occurs due to liver failure, esophageal hemorrhage or carcinoma. |
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Term
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Definition
Types A through E. Types differ by:
Mode of Transportation, incubation Period, Carrier State, and whether they are chronic or fulimant (progresses rapidly) |
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Term
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Definition
Most common
transferred by oral-fecal contamination of food and water, personal contact,
Benign disease with no carrier state or chronic condition |
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Term
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Definition
transfusion, injection of blood products, renal dialysis, needle-stick accidents among health care workers, intravenous drug use, and sexual activity.
More serious, may cause acute hepatitis or fulminant hep with necrosis. |
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Term
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Definition
| largely the consequence of intravenous drug abuse. It has a high rate of progression to chronic hepatitis and cirrhosis. |
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Term
| Clinicopatholigic Syndromes of Liver Disease |
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Definition
Assymptomatic Hepatitis
Carrier State--you can pass it on to someone else
Acute Viral Hep--s/s liver failure
Chronic Viral Hep--longterm and prolonged s/s. Often due to autoimmune disease or alcohol.
Fulminant Hepatic Failure (HAV, HBV) also could be due to Tylenol OD or heat stroke. Sudden onset and rapid progression.
Hepatocellular Carcinoma |
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Term
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Definition
20% of all chronic hepatitis
Occurs more often in young women
accompanies such things as Lupus or RA |
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Term
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Definition
can be asymptomatic to fatal.
caused by Tylenol OD or other dose related injury |
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Term
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Definition
10% of all adults abuse etoh
#1 cause of liver disease
occurs more in women than in men
progresses from fatty liver to alcoholic hepatitis to cirrhosis
Need to drink 200+ grams per day for 10-20 years. |
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Term
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Definition
Is reversible, but NOT always. Usually follows a binge
Steatosis--another term for fatty liver.
hepatitis may appear suddenly after years of steatosis. |
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Term
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Definition
| healthy liver is replaced with scar tissue. Irreversible. |
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Term
| Intrahepatic Bile Duct Diseases |
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Definition
--Gallstones--which lead to inflamed intrahepatic bile duct
--Primary biliary cirrhosis--autoimmune
--Primary sclerosis cholangitis--inflammation of the bile ducts which can lead to biliary cirrhosis. occurs in men with ulcerative colitis. |
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Term
| Circulatory Disorders of Liver |
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Definition
Hepatic or portal vein occlusion
chronic passive congestion
liver infarcts |
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Term
| Hepatic or Portal Vein Occlusion |
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Definition
| similar symptoms to portal hypertension caused by liver disease. |
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Term
| Chronic Passive Congestion |
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Definition
right sided heart failure
caused by a back of the inferior vena cava to liver up into the right side of the heart. |
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Term
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Definition
| usually not serious because of the dual blood supply of the liver. Supplied by the hepatic artery and the portal vein. This helps to make the liver resilient to blood loss. |
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Term
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Definition
Usually a metastasis from the colon, lung or breast. Can be benign such as hemongiomas or adenomas.
Hepatocellular carcinomas--are invasive and metastatic with a high mortality rate. 200x more common in the presence of HBV, HCV. |
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Term
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Definition
| malignancy of the bile duct epithelium |
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Term
| Diseases of the Gallbladder |
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Definition
most inflammatory diseases are closely r/t to gallstones. Cholelithiasis or choledoncholithasis--cholesterol gallstones. Occur in old women more than men. Also increased with obesity and depending on ethnicity. About 1 million cases per year.
Other diseases include: cholecystits (associated with gallstones), and adenomcarcinomas |
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Term
| Extrahepatic Bile Duct Diseases |
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Definition
Obstruction is the most common problem. Anything that obstructs the flow can lead to a problem.
Blocks can be caused by gallstones, surgery, pancreatic cancer and they can all lead to inflammation of the gallbladder. |
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Term
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Definition
an obstruction causes bile to move backwards and bacteria moves with it upwards.
Bacteria associated with the obstruction of a bile duct. |
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