How is bilirubin formed?
- Breakdown of RBCs releases haem from spleen- biliverdin (green) to bilirubin
What causes pre-hepatic jaundice?What type of bilirubin causes pre-hepatic jaundice?Why is there is increased RBC destruction?
- Increased RBC destruction- Unconjugated bilirubin- RBC membrane, cytoplasm problem (genetic, autoimmune/genetic, malaria)
What causes hepatic jaundice?What type of bilirubin causes hepatic jaundice?
- congenital (enzymes), acquired - Conjugated plus unconjugated bilirubin
What causes post-hepatic jaundice?What type of bilirubin causes post-hepatic jaundice?
- congenital, acquired - Conjugated bilirubin
Causes of acute liver failure? (4)
Alcoholic liver disease Viral hepatitis (A, B, E)Idiosyncratic reaction to medication e.g. paracetamol overdoseAcute fatty liver of pregnancy
What usually precipitates acute liver failure?
Dehydration, Alcohol binge, infection, infection, GI bleed or surgery
Treatment of acute liver disease?
TransplantationSurvive- liver may regenerate and return to normal or post-necrotic cirrhosis
How is chronic hepatitis classified? (4)
- Hepatitis B, C, D- Autoimmune - Drugs- Metabolic disease
Pathology of chronic hepatitis? (3)
- Liver cell necrosis - inflammation - Fibrosis
Pathological features of cirrhosis?Main causes of cirrhosis?Consequences
- Fibrosis, regenerated nodules hepatocytes, distorted liver architect- Alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis C- Portal Hypertension, varices, hepatic encephaopathy