Liver Anatomy and Function Quiz

Liver Anatomy

• The liver is a large, reddish-brown organ located in the upper-right side of the abdomen, below the diaphragm.
• It's the largest internal organ, divided into two lobes: the right lobe (larger) and the left lobe.
• The liver comprises approximately two-thirds of the liver's total mass.
• Blood is delivered to the liver from two sources: the hepatic artery (oxygen-rich blood from the heart) and the hepatic portal vein (nutrient-rich blood from the digestive system). These blood vessels enter the liver at the porta hepatis, on the liver's underside.
• Inside the liver, blood flows through a network of small tubes called sinusoids, lined with liver cells called hepatocytes.
• Hepatocytes perform many vital liver functions. They're arranged in small groups called lobules, roughly hexagonal in shape.
• Bile ducts within the liver eventually combine to form the common hepatic duct, carrying bile out of the liver and into the small intestine.

Liver Function

• The liver processes nutrients and medications absorbed by the digestive system.
• It regulates the body's metabolism, converting food to energy and storing it as glycogen.
• The liver is the body's main detoxifying organ, breaking down harmful substances, including drugs and alcohol, and removing them.
• It synthesizes essential compounds, such as bile for fat digestion, blood clotting factors, and albumin for fluid balance.
• It stores vitamins, minerals, and glycogen; releasing them when needed into the bloodstream.
• The liver plays a role in the body's immune system, producing immune factors and removing foreign bodies from the blood.

Liver Function Lab Tests

• Hepatocellular labs: Aminotransferases (ALT/AST) are markers of hepatocellular injury. Enzyme release into the bloodstream indicates potential injury
• Cholestasis labs: Include alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and 5' nucleotidase (5'NT), alongside serum bilirubin. Elevated markers suggest potential issues with bile secretion.
• Synthetic function tests: Assess liver protein synthesis via total protein and albumin levels. Prothrombin time (PT) and international normalized ratio (INR) measure coagulation factors.
• Serological tests include liver-related antibodies to diagnose autoimmune liver diseases.
• Other tests include cholesterol, ferritin, and alpha-fetoprotein (AFP), potential tumor markers.

Liver Blood Tests - Normal Ranges

• A table of normal ranges and abbreviations is provided for various liver blood tests. (Values may vary based on lab standards)

Liver Imaging

• Primary imaging modalities for diagnosing liver lesions include liver ultrasonography (US), Computed Tomography (CT), magnetic resonance imaging (MRI).
• Endoscopic-Retrograde-Cholangio-pancreatography (ERCP).
• Liver Biopsy.

Diseases of the Liver

• This section details several liver diseases (fatty liver, fibrosis, cirrhosis, different types of hepatitis, Wilson's disease, hemochromatosis, and hepatocellular carcinoma).
• Each disease is described with its cause, symptoms, and potential complications.

Hepatitis

• Hepatitis is categorized as acute or chronic based on the duration of inflammation and insult to the hepatic parenchyma
• Acute hepatitis, lasting less than six months, shows various symptoms (fever, nausea, vomiting, fatigue, jaundice, right-upper-quadrant abdominal tenderness, dark urine, pale stools). Extrahepatic manifestations can occur, especially in chronic hepatitis.
• Chronic hepatitis persists for longer than six months. Similar symptoms to acute hepatitis may occur, along additional complications such as amenorrhea, arthritis, skin rash, etc. End-stage liver disease, decompensated cirrhosis, and development of hepatocellular carcinoma are possible complications.

Infectious Causes of Acute Hepatitis

• Various viral and non-viral infectious agents, including specific types of hepatitis viruses, bacteria, fungi and parasites.

Toxin/Substance-Related Causes of Acute Hepatitis

• Alcohol-related conditions, drug-related issues and exposure to toxins, including specific chemical examples.

Other Causes of Acute Hepatitis

• Immunologic or inflammatory conditions (Autoimmune Hepatitis, etc.). This section details diseases related to the immune system's response to the liver.
• Metabolic conditions and hereditary causes, highlighting various metabolic and genetic disorders.
• Pregnancy-related causes, such as preeclampsia, acute fatty liver of pregnancy, and HELLP syndrome.
• Ischemic and Vascular conditions, such as cardiac causes, etc.
• Miscellaneous conditions which include drug reactions, viral infections, and others. Individual examples are included.

Liver Function Tests - Causes

• Diagram depicting the interconnectedness of various factors potentially causing liver dysfunction, including the role of inflammation, oxidative stress, and toxins.

Liver Disease - Nutritional Considerations

• This section emphasizes the importance of proper nutrition in managing and preventing liver disease.
• Patients with liver disease often experience altered metabolisms, leading to malnutrition, which leads to higher morbidity and mortality rates.
• This section recommends methods of improving nutritional intake, and avoidance of certain foods and practices, as well as the importance of early detection and timely treatment.

Liver Disease - Specific Issues/Conditions

This section covers detailed information on specific conditions, including liver imaging, liver function lab tests, and considerations in various specific conditions like NAFLD, Alcoholic Fatty Liver or Steatosis, Hepatic Cirrhosis, along with their specific factors and clinical presentation, as well as treatment management, guidelines and recommendations.

Wilson's Disease

• Rare, autosomal recessive disorder affecting multiple organs, primarily the brain, liver, and cornea.
• This is a detailed discussion about this genetic condition.
• Symptoms, diagnosis, and treatment are discussed in detail.
• This includes a recommended diet low in copper and further treatment options.

Hemochromatosis

• A detailed description of hemochromatosis, associated with excessive iron accumulation causing organ dysfunction.
• The causes, symptoms, diagnosis, and available therapeutic approaches (e.g., phlebotomy) are detailed.

Hepatosteatosis

• This describes fatty liver disease, a condition where fat accumulates in the liver, frequently associated with insulin resistance, obesity, metabolic syndrome, different types of diabetes, dyslipidaemia (high blood cholesterol) and details various causes with examples.
• This section delves into both primary (e.g., insulin resistance, obesity) and secondary (specifically drug-related, e.g., valproate, anti-retroviral medications; additional examples) causes.
• Disease progression and complications, including liver damage and fibrosis.
• Diagnosis and treatment considerations (including lifestyle changes and potential medical approaches.)
• Detailed explanation is provided on different types of fatty liver disease and their distinctions.

NAFLD

• A detailed study on non-alcoholic fatty liver disease. This includes
• Pathophysiology with descriptions of contributing factors including Genetics, Environment, Epigenetics, and Medication.
• Risk factors, progression of the disease, and available diagnostic and treatment approaches are explained in detail.
• Specific recommendations for lifestyle modification, dietary changes, and potential drugs for treatment are included in the sections on treatment management, and dietary recommendations.

Cirrhosis of the Liver

• This section explores the disease, including its cause, pathophysiology and complications.
• It covers an in-depth examination of associated etiologies.
• Nutritional considerations, prognostic implications and management strategies relevant to cirrhosis are discussed.

Hepatic Cirrhosis - Classification

• This section includes an detailed discussion of how cirrhosis is categorized (based on morphology and etiology.)
• This includes descriptions of the various types based on the underlying causes.

Hepatitis - Causes

• An overview of different disease processes and etiologies related to hepatitis and liver disease.

Hepatic Encephalopathy

• A detailed look at the neuropsychiatric disorder associated with liver failure, including various types (A, B, and C), pathophysiology, potential causes , and effective methods of treatment and management.
• Specific diagnostic criteria, risk factors, symptoms, and prognostic considerations are included.

Treatment of Jaundice

• Section on jaundice treatment and management, including the correction of underlying causes (hepatic or hematologic issues, etc)

Ascites

• Detailed information on ascites, its causes, and effective treatment strategies encompassing the correction of underlying causes and the avoidance of further damage.

Weight Adjustment

• There are tables showing how weight should be adjusted based on the severity of ascites and peripheral edema through detailed explanations of the scoring systems and related formulas.

AFLD - Management/treatment

• Detailed treatment and management information related to AFLD including both medical (abstinence, detoxification, and treatments associated with co-existing diseases) and surgical options (liver transplants.)

Nutritional Disorders and Liver Disease in Heavy Alcohol Drinkers

• Extensive information on nutritional disorders related to excessive alcohol consumption.
• Discussion on deficiency and surplus of vitamins, major minerals, along with dietary recommendations and implications for liver disease related to alcohol use.

Pathophysiology of Malnutrition in ArLD

• A thorough exploration of the underlying pathophysiology of malnutrition in advanced liver disease, including causes and effects of each contributor (e.g. hypercatabolism, intestinal dysfunction and impaired absorption, reduced appetite, and altered metabolism.)

Assessment and Management of Malnutrition in Liver Cirrhosis

• Comprehensive assessment and management approach for malnutrition in cirrhosis, emphasizing the need for detailed nutritional assessment, nutritional requirements, and supportive interventions, such as nutritional counselling and interventions as per specific needs.

Micronutrients in Patients with Cirrhosis

• Micronutrient considerations in cirrhosis management emphasizing the importance of vitamin and mineral supplementation to correct observed deficiencies.

Hepatic Cirrhosis - Treatment Management

• Specific treatment approaches in liver cirrhosis, such as strategies to limit disease progression and to enhance treatment of cause/underlying conditions.

Hepatic Cirrhosis - Prognosis

• Discussing how the progression of cirrhosis and the various tests that can be implemented to follow up on severity for specific patients.

Pathophysiology of Malnutrition

• A detailed overview of the pathophysiology of malnutrition related to liver disease, encompassing the various contributing factors.

Assessment of Nutritional Status in End Stage Liver Disease Patients

• Assessment protocols to comprehensively understand the nutritional status of individuals with end-stage liver disease. This section includes specific clinical and laboratory tools, as well as explanations.

Nutritional Interventions Before and After Liver Transplantation

• Detailed treatment procedures emphasizing the importance of caloric and protein intake specific to pre and post liver transplantation, and recommended supplements across the whole timeline.

Malnutrition in Patients Undergoing Liver Transplantation: Preoperative Nutrition

• Essential preoperative nutritional guidelines and recommendations for patients undergoing liver transplantation, focusing on maintaining adequate nutrition and body composition.

Different types of dietary recommendations to manage and prevent liver disease or specific conditions like cirrhotic sarcopenia, and hepatitis, are included in the study notes.

Explore the intricate structure and vital roles of the liver in this informative quiz. Learn about the liver’s anatomy, including its lobes, blood supply, and the functions of hepatocytes. Test your knowledge on how this essential organ processes nutrients and produces bile.