7b Liver Disorders

increased unconjugated bilirubin

increased RBC hemolysis

increased conjugated bilirubin

• cirrhosis,, hepatitis

• bile duct obstruction

Jaundice

• yellowing of the skin, eyes and mucus membranes

• sign not a disease

Function of unconjugated bilirubin in the liver

• binds to glucoronic acid to become conjugated bilirubin

• leaves liver through biliary tree

Normal liver functions

• produce clotting factors

• vitamin, mineral, protein glycogen storage

• albumin production

• converts ammonia to urea

• drug and hormone detoxification (breakdown)

• secreted conjugated bilirubin into bile

• can store and synthesize glucose, cholesterol, TGs and proteins

Liver Function Tests = LFT’s

• Aspartate Transaminase (AST)

• Alanine Transaminase (ALT)

• Bilirubin

• Albumin

• Gamma-Glutamyl Transpeptidase

Alcoholic Hepatitis LFT

• AST:ALT >2

• increased GT

• increased bilirubin

Viral Hepatitis or NASH

• AST:ALT < 1

• Increased Bilirubin

Cirrhosis

• 1 < AST:ALT < 2

• decreased albumin, increased bilirubin

• increased GT

Steatosis

Fatty Liver

Hepatitis

Liver Inflammation

Steatohepatitis

Fatty Liver + Inflammation

Causes of hepatitis

• viral hepatitis (MCC)

• alcoholic hepatitis

• NASH

signs and symptoms of hepatitis

• fatigue, flu-like symptoms

• abdominal pain, n/v

• jaundice

labs for hepatitis

• bilirubin , ALT, AST, GT

• AST:ALT Ratio

signs and symptoms of alcoholic hepatitis

• n/v, anorexia, weight loss

• abdominal pain , fever

• hepatomegaly, jaundice

histology for alcoholic hepatitis

• ballooning degeneration

  • ballooning→ enlarging → hepatomegaly

• mallory bodies (misfolded keratin)

• steatosis (fatty changes)

hepatomegaly

portal HTN happens in all cirrhosis regardless of the cause

ballooning degeneration and mallory bodies

• in alcoholic cirrhosis

Types of Viral hepatitis

A, B, C, D, E, G

Which types of viral hepatitis are vaccines available for

A and B

Viral Hepatitis A and E

contaminated food/water transmission

Viral Hepatitis B and C

• Blood (IV drug abusers) or sexual transmission

• leads to cirrhosis and HCC (liver cancer)

Viral Hepatitis D

co infection w/ hep B

testing for viral hepatitis

• viral antigen/antibody tests

• increased bilirubin, increased ALT, increased AST

• AST:ALT <1

Nonalcoholic Steatohepatitis aka NASH

• fat deposition in the liver that causes inflammation and fibrosis (scar tissue)

• 1-2% of americans

cause of NASH

• high cholesterol

• high TG’s

• type 2 DM

signs and symptoms of NASH

• “silent” liver disease

  • may take decades to progress

• dull abdominal pain

• jaundice, fatigue

testing for NASH

• increased ALT and AST

• AST:ALT<1

• increased bilirubin

• ultrasound picks up fatty liver

• biopsy to determine if cirrhosis is present

Other names for Cirrhosis

• end stage liver disease

• chronic liver failure

cause of cirrhosis

viral hepatitis, alcoholic hepatitis, NASH

liver color of cirrhosis

yellow, green, or brown

liver size of viral hepatitis

normal or small

liver size of alcoholic hepatitis

enlarged

histology for cirrhosis

• loss of normal parenchyma

• fibrotic tissue and nodules

portal HTN

• obstruction to the flow of blood and bile

• blood flow into the liver backs up in the portal vein

  • esophageal varices

    • high risk of hemoptysis

    • mc symptom

  • splenomegaly (increased BT)

  • ascites

  • caput medusa

treatment for portal htn

TIPS aka trasnjuglar intrahepatic porto-systemic shunt

signs and symptoms of cirrhosis

• fatigue, n/v, edema, jaundice, GI bleeding, pruritus

• portal HTN → ascites, esophageal varcies, caput medusa, spleomegaly

• increased estrogen → spider angiomas, gynecomastia in men

tests for cirrhosis

• increased AST, increased ALT, increased GT

• 1 < AST:ALT < 2

• increased bilirubin

• decreased albumin

• increased PT, increased aPTT

  • increased BT if splenomegaly

Wilson Disease

• hepatolenticular degeneration

• autosomal recessive

• defect of copper metabolism

signs and symptoms of wilson disease

• neuromuscular abnormalities

  • intension tremors

  • dysartria

  • dystonia

• kayser-fleischer rings

• hepatomegaly → cirrhosis

• increased serum copper

• decreased ceruloplasmin levels