Liver general - Kumar

Question 1

What is cirrhosis?

Answer 1

• Represents the final common pathway for liver diseases
• Characterised by progressive fibrosis of the liver parenchyma –> portal hypertension and deterioration of liver function.

Question 2

What is the median survival of decompensated cirrhosis?

Answer 2

• 2 years

Question 3

What are the clinical signs of liver disease?

Answer 3

• General: encephalopathy / weight loss
• Eyes: jaundice / Kayser-Fleisher rings (Wilson’s disease) / Xanthelasma
• Parotid swelling
• Spider naevi
• Gynaecomastia
• Abdomen: scars / ascites / dilated superficial veins / hepatomegaly / splenomegaly / tumour / palpable gall bladder
• Hands: flapping tremor / palmar erythema / dupuytren’s contracture / clubbing / leuconychia
• Testicular atrophy
• Excoriations
• Oedema
• Bruises

Question 4

What are the functions of the liver?

Answer 4

• Protein synthesis
• Metabolism
• Immune
• Storage
• Excretion

Question 5

What proteins does the liver synthesise?

Answer 5

• Albumin
• Coagulation factors
• Transferrin
• Protein inhibitors (alpha1-antitrypsin)
• Complement
• Haptoglobin
• Caeruloplasmin

Question 6

What does the liver metabolise?

Answer 6

• Carbohydrates (glycogen)
• Protein
• Lipids

Question 7

How is the liver involved in the immune system?

Answer 7

• Kupffer cells

* Innate factors

Question 8

What is stored in the liver?

Answer 8

• Iron
• Copper
• Vitamins A, D, B12

Question 9

What is excreted by the liver?

Answer 9

• Bile salts
• Bilirubin
• Phospholipids
• Cholesterol
• Drugs

Question 10

Describe the liver biochemistry tests.

Answer 10

• Hepatocytes: ALT (alanine transferase) / AST (aspartate transferase) / gammaGT (gamma glutamyl transpeptidase)
• Bile canalicular membranes: ALK (alkaline phosphate)

Question 11

What are the liver function tests?

Answer 11

• Albumin

* Prothrombin time

Question 12

What should be felt for when palpating the liver?

Answer 12

• The liver edge:
• Is it smooth or irregular?
• Knobbly?
• Tender?

Question 13

How does the liver move on inspiration?

Answer 13

• Downwards

Question 14

How does the spleen move on inspiration?

Answer 14

•Downwards and to the right towards right iliac fossa

Question 15

List the common viral tests for acute liver disease

Answer 15

• HBsAG / IgM anti-HBc
• IgM HAV
• Anti-HEV
• Anti-HCV
• Cytomegalovirus
• Epstein-Barr
• Herpes simplex