liver, gallbladder, pancreas, + bile duct

what does the liver do

filters blood, produces bile, breakdown of rbc, many things

2 main causes of liver dysfunction

hepatocellular injury

cholestasis: bile flow obstruction

different hepatitis types

hepatitis a: fecal/oral, has vaccine and goes away

hep b: blood or sexual, has vaccine, no cure

hep c: blood, no vaccine, has cure

chronic hepatitis

inflammation and necrosis of hepatic tissue

lasting longer than 6 months

caused by HBV, HCV, drug toxicity or autoimmune dz

non-alcohol related fatty liver dz

NAFLD

patho?

build up of extra fat in liver cells not caused by alc consumption

insulin resistance leads to free fatty acid storage shifts from adipose tissue to non-adipose tissue

steatosis

abnormal accumulation of fat in a cell which leads to interrupted function and cell rupture

NASH

non-alcoholic steatohepatitis

macrovesicular steatosis - large amount of fats in cells

obvious liver impairment

elevated liver enzymes (LFTs)

What happens as NAFLD progresses to NASH

microvesicular steatosis becomes macrovesicular steatosis

microvesicular steatosis is asymptomatic but has elevated LFTs

macrovesicular steatosis is associated with NASH

alcohol related hepatitis vs alcohol related cirrhosis

alcohol related hepatitis: acute/reversible/transient

alcohol related cirrhosis: permanent, 60% mortality at 4 yrs

What are the 2 main processes that drive damage in alcohol related liver disease?

steatosis and inflammatory damage

cirrhosis

patho?

irreversible damage with widespread destruction of hepatocytes and presence of fibrosis and scarring

steatosis and cellular injury lead to inflammation/fibrosis/scarring which impairs hepatic function

portal HTN

elevated pressure in the portal vein and varices

cirrhosis causes portal HTN bc pressure builds up from increasing scarring/fibrosis

back up of blood from GI tract due to resistance caused by portal HTN

varices are formed (collateral circulation), varices are prone to rupture/fragile

increased hydrostatic pressure due to back up of blood from GI tract

increased hydrostatic pressure leads to leaking of fluid

ascites

AKA: peritoneal effusion

accumulation of fluid within the peritoneal cavity

caused by cirrhosis (bc causes backup of fluid due to portal HTN which leads to increased hydrostatic pressure)

hepatomegaly

enlargement of liver beyond normal size

caused by inflammation or congestion

why does cirrhosis cause bleeding

cirrhosis impedes liver function

liver produces coagulation factors so cirrhosis leads to decreased production of clotting factors which leads to clotting deficiency which leads to bleeding

how does cirrhosis cause jaundice

liver converts unconjugated bilirubin into water-soluable conjugated bilirubin which can be excreted

but impaired liver function due to cirrhosis leads to elevated bilirubin levels which causes jaundice

hepatic encephalopathy

liver dysfunction means unable to metabolize toxic substances

build up of ammonia causes brain dysfunction

symptoms include: insomnia, hypersomnia, mood changes, asterixis, confusion and coma

spontaneous bacterial peritonitis

bacterial infection of peritoneal cavity WITHOUT identifiable source

symptoms of cirrhosis

cholelithiasis

gallstones in gallbladder

biliary sludge

highly concentrated bile

biliary stasis

delayed emptying of gallbladder

what causes formation of calculi

calculi - gallstones

biliary stasis - delayed emptying of gallbladder

biliary sludge - highly concentrated bile

calculous cholecystitis

inflammation of the gallbladder plus stones