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, PhD
Metabolic
• Synthesis
• Breakdown
• Other functions (storage vit. A, B12, D, F)
Excretion
• Different products into bile
Vascular
• Storage of blood
Protein Metabolism
• aminoacids syntesis
Carbohydrate Metabolism
• gluconeogenesis
• glycogenolysis
• glycogenesis
Lipid Metabolism
• lipogenesis
• cholesterol synthesis
• production of factors I, II, V, VII, IX, and X
Breaks down insulin and other hormones
Breaks down hemoglobin
Breaks down and modifies toxic supstances
(methylation)
Convert ammonia to urea
Two different circulations
Nutritive
Portal vein
Functional
Hepatic artery
Alanin-aminotransferase (ALT)
Aspartat-aminotransferase (SGOT)
Albumin
Bilirubin
to screen for liver infections
to monitor the side effects of certain
medications
if you already have a liver disease, to monitor
the disease and how well particular treatment
is working
to measure the degree of scarring in the liver
if you’re experiencing the symptoms of a liver
disorder
if you’re planning on getting pregnant
ALT predominant AST predominant
• Chronic Hep B / C • Alcohol-related liver disease
• Acute A-E, EBV, CMV • Steatosis/ Steatohepatitis
• Steatosis / Steatohep • Cirrhosis
• Hemochromatosis
Non-hepatic source
• Medications / Toxins • Hemolysis
• Autoimmune • Myopathy
Hepatitis • Thyroid disease
• Alpha-1-antitrypsin
• Wilson’s Disease
• Celiac Disease
Acute Viral Hepatitis
does not predict outcome
Ischemic Hepatitis
hypotension
sepsis
hemorrhage-shock
MI
Elevated in liver ischemia
LDH types of isoenzymes
cirrhosis hepatitis B, C
bile duct obstruction hemolysis
pale stool
dark urine
Inherited
Toxic
Alcohol
Infective
Autoimmnune
Biliary tract
Fatty liver
Alpha 1-atitripsine deficiency
Hemochromatosis
Wilson disease
Drug induced
Autoimmune hepatitis
cirrhosis
Diagnosis: AST, ALT, bilirubin, 24 h urine copper
liver biopsy, copper in dry liver sample
Therapy: penicilamin, transplantation
Autoimmune disease
Cause unknown
Young pepople
Female>male
Fatigue
Flu-like symptoms
Abdominal pain
Loss of appetite
Type 2
Serum markers
ASTMA type 1
SLA/LP
Anti LKM type 2
Antinuclear antibody-ANA
AST, ALT, GGT, bilirubin, AP
Liver biopsy
Ultrasound
Corticosteroids
Azathyoprin
Transplantation
Autoimmune disease
Corticosteroids
Prognosis: cirrhosis
Autoimmune disease of biliary ducts
Intrahepatic, extrahepatic or both
Stenosis and dilation
Often overlaps with AIH and PBC
70% pts with PSC have ulcerose colitis
5% pts with ulcerose colitis have PSC
8%
AIC PSC
10% 6%
AUTOIMMUNE
HEPATITIS
GGT, AP, AST, ALT, bilirubin
Antinuclear antibody-ANA
Perinuclear anti-mitochondrial cytoplasmatic
antibody-pANCA)
MRCP
ERCP
Liver biopsy
Corticosteroids
Azathyoprin
Endoscopic dilatations
Liver transplantation
Hepatocellular carcinoma- HCC