Liver

Normal liver function

• produces clotting factors

• vitamin, mineral, protein, + glycogen storage

• converts ammonia to urea

• can store + synthesize glucose, cholesterol, TGs, + protein

• secretes conjugated bilirubin into bile

• drug and hormone detoxification

• albumin production

Hepatitis

• inflammation of liver tissue

• causes: viral hepatitis (MCC), alcoholic hepatitis, NASH

• S/S: fatigue, flu-like symptoms, N/V, abd pain, jaundice

alcoholic hepatitis

S/S

• all general hep symptoms

Labs

• AST:ALT > 2

• increased y-GT

• increased bilirubin

Histology

• ballooning degeneration (ballooning —> enlarging —> hepatomegaly)

• mallory bodies (misfolded keratin)

• steatosis (BIG ASS LIVER)

viral hepatitis

• viral types A,B,C,D,E,G

• vaccines available for type A + B

• A + E caused by water/food contamination

• B + C caused by sexual transmission or blood

• type D leads to co-infection with type B

• types B + C lead to cirrhosis

• S/S: same as general hep

• Dx: viral antibody/antigen tests, increased bilirubin, AST:ALT<1

NASH

• phat deposition in the liver that causes inflammation + fibrosis

• cause: high cholesterol, high TGs, type 2 DM

• S/S: general hep with dull abd pain

• silent liver disease

• Dx: AST:ALT < 1, U/S picks up fatty liver, increased bilirubin

Cirrhosis

• end stage liver disease or chronic liver failure

• cause: alcoholic + viral hep, NASH

• liver color: green, yellow, brown

• Liver size: normal/small (viral hepatitis), enlarged (alcoholic hepatitis)

• histology: loss of normal parenchyma, fibrotic tissue & nodules

S/S

• portal HTN

  • esophageal varices

    • high risk of hemoptysis

    • MC symptom

• splenomegaly

  • increased B

• ascites

• caput medusa

• bleeding disorders

• hypoglycemic, encephalopathy

• increased estrogen —> spider angiomas, gynecomastia

Dx

• 1<AST:ALT>2

• increased bilirubin

• increased y-GT

• decreased albumin

• increased PT and aPTT (if splenomegaly —> increased BT)

• increased estrogen

• CT scan

complications of cirrhosis

• increased PT + aPTT —> increased risk of bleeding

• hepatic encephalopathy: high ammonia in blood can affect brain —> AMS, seizures, asterixis (hand flapping tremors)

• increased bilirubin —> jaundice

• increased estrogne —> gynecomastia

wilsons disease

• autosomal recessive

• pathophys

  • defect of copper metabolism

  • toxic levels of copper accumulate in the liver, brain, kidneys, cornea

• S/S

  • neuromuscular abnormalities

    • intention tremors

    • dysarthia

    • dystonia

  • klayer-fleischer rings

  • hepatomegaly —> cirrhosis

  • increased serum copper

  • decreased ceruplasmin levels