MS RLE
SMCG
Function of Blood from Portal Vein
The portal vein brings nutrient-rich, oxygen-poor
blood from the GI tract to the liver.
This blood bathes hepatocytes through sinusoids and
is filtered by Kupffer cells, which remove bacteria
and debris.
About 80% of the liver’s blood supply is from the
portal vein, with the rest from the hepatic artery.
Hepatocyte Functions
Metabolize carbohydrates (glucose storage and
release), proteins (synthesize albumin, clotting
factors), and fats (lipid breakdown, cholesterol
synthesis).
Detoxify ammonia into urea.
Store vitamins A, B-complex, D, iron, and copper.
Produce and secrete bile for digestion.
Metabolize drugs via the cytochrome P450 system
(first-pass metabolism).
Role of the Liver in Glucose Metabolism
Converts excess glucose into glycogen
(glycogenesis) for storage.
Breaks down glycogen into glucose (glycogenolysis)
when needed.
Produces glucose from non-carbohydrate sources
like amino acids (gluconeogenesis) during fasting
or stress.
Bile and Its Pathways
Bile is continuously produced by hepatocytes, stored
in the gallbladder, and secreted into the intestine.
It flows from canaliculi → intrahepatic ducts →
hepatic duct → cystic duct (gallbladder) →
common bile duct → duodenum.
Aids in fat emulsification and excretion of waste
products like bilirubin and cholesterol.
Purpose of Conjugation of Bilirubin
Bilirubin is a breakdown product of hemoglobin.
The liver conjugates bilirubin, making it water-soluble
so it can be excreted into bile and then feces.
Unconjugated bilirubin is lipid-soluble and toxic;
conjugation prevents accumulation and toxicity.
Liver-Specific Tests and Functions
ALT (Alanine Aminotransferase): Increases with
hepatocellular injury.
AST (Aspartate Aminotransferase): Elevated in liver
and other tissue damage.
GGT (Gamma Glutamyl Transferase): Elevated in
alcohol-related and cholestatic liver diseases.
Bilirubin: Increased in jaundice and liver dysfunction.
Albumin: Low levels suggest impaired synthetic
function.
PT/INR: Prolonged in liver disease due to impaired
clotting factor production.
Hepatic Jaundice
Caused by hepatocellular dysfunction (e.g., hepatitis,
cirrhosis).
Both conjugated and unconjugated bilirubin may be
elevated.
Associated symptoms: fatigue, nausea, dark urine,
yellowing of the skin and eyes.
Portal Hypertension
Defined as elevated pressure in the portal venous
system, often due to cirrhosis.
Complications include: ascites, esophageal varices,
splenomegaly, and caput medusae.
Diagnosed by hepatic venous pressure gradient
(HVPG) > 10 mm Hg.
TIPS (Transjugular Intrahepatic Portosystemic Shunt)
A radiologic procedure that creates a shunt between
the portal and hepatic veins.
Reduces portal pressure, used for refractory variceal
bleeding or ascites.
Improves outcomes in patients not responding to
endoscopic or medical therapy.
Spironolactone
A potassium-sparing diuretic and aldosterone
antagonist.
Used as first-line treatment for ascites in cirrhosis.
Prevents hypokalemia and is often combined with
furosemide.
Lactulose Purpose in Hepatic Encephalopathy
A nonabsorbable disaccharide used to treat hepatic
encephalopathy.
Lowers ammonia levels by trapping it in the colon and
promoting its excretion via feces.
Produces 2–3 soft bowel movements daily to reduce
ammonia absorption.
Hepatitis A Prevention
Transmitted via the fecal–oral route.
Preventable through vaccination and good hygiene.
Immune globulin can be used for post-exposure
prophylaxis within 2 weeks.
All Hepatitis Variants
Hepatitis A: Fecal–oral; self-limiting.
Hepatitis B: Blood, body fluids; chronic infection
possible.
Hepatitis C: Bloodborne; high chronicity, now curable.
Hepatitis D: Requires HBV coinfection.
Hepatitis E: Fecal–oral; serious in pregnancy.
Hepatitis G/GBV-C: Bloodborne; unclear clinical
significance.
Diagnostic Test for Liver Abscess
Ultrasound, CT, or MRI for localization.
Percutaneous aspiration to confirm diagnosis and
identify organisms.
Blood cultures may be negative.
Active Hepatitis Infection Indicator (HBsAg)
Hepatitis B surface antigen (HBsAg) indicates active
infection.
Persistence beyond 6 months = chronic HBV.
Anti-HBs = recovery or successful vaccination.
Gallstones
Solid components (cholesterol or pigment) that form
in the gallbladder.
May be asymptomatic or cause biliary colic.
Can lead to cholecystitis or obstructive jaundice.
Biliary Colic
Intermittent RUQ pain caused by temporary blockage
of the cystic duct by a gallstone.
Pain often after fatty meals, can radiate to the right
shoulder.
Pancreatitis
Inflammation of the pancreas due to autodigestion by
pancreatic enzymes.
Acute: sudden, often due to gallstones or alcohol.
Chronic: irreversible fibrosis and enzyme
insufficiency.
Diagnosed by elevated amylase and lipase levels.
Whipple Procedure
