11. Liver And Pancreas Pathology

Question 1

Why can necrosis occur in acute hepatitis?

Answer 1

Inflammation of the hepatocytes of the liver, sinusoids become blocked, blood cannot flow through, leading to necrosis.

Question 2

What is the normal life span of a red blood cell?

Answer 2

120 days

Question 3

Where does breakdown of red blood cells occur?

Answer 3

Extravascularly in macrophages in the spleen and liver.

Question 4

Why is the bilirubin released by heme breakdown in the spleen bound to albumin before being carried to the liver?

Answer 4

Bilirubin is hydrophobic.

Question 5

What happens to bilirubin in the liver?

Answer 5

Bilirubin is conjugated with glucocorticoid acid by UDP glucuronyl transferse. The conjugated bilirubin is water soluble and is secreted by hepatocytes into the bile canaliculi.

Question 6

What is stercobilin?

Answer 6

Conjugated bilirubin in bile, released into the intestines, converted into urobilinogen and then stercobilin. Is dark brown (hence faeces are brown).

Question 7

What is urobilin?

Answer 7

Urobilinogen from intestines, absorbed into blood, filtered out by kidneys and then converted into urobilin which is bright yellow and excreted in urine.

Question 8

Give 3 broad ways of measuring liver (days)function.

Answer 8

Failure of anabolism.
Failure to catabolise and excrete.
Markers of hepatocyte damage/dysfunction.

Question 9

What does hypoalbuminaemia indicate?

Answer 9

Severe liver dysfunction.

Question 10

What will happen to the prothrombin time in a patient with liver disease casing significant liver dysfunction?

Answer 10

Prolonged prothrombin time (INR).

Question 11

What causes pre-hepatic jaundice?

Answer 11

Too much bilirubin eg haemolytic anemia.

Question 12

What causes intra-hepatic jaundice?

Answer 12

Failure of hepatocytes to conjugate and/or secrete most of the bilirubin presented to them eg hepatitis, cirrhosis.

Question 13

What is cholestasis?

Answer 13

Stasis within the liver.

Question 14

What causes post-hepatic jaundice?

Answer 14

Failure of the biliary tree to convey the conjugated bilirubin to the duodenum eg biliary tree obstruction.

Question 15

What happens to the appearance of urine if serum levels of conjugated bilirubin rise and why?

Answer 15

Bilirubinuria - turns urine dark yellow.

Question 16

What happens to the appearance of urine if serum levels of urobilinogen rise?

Answer 16

Doesn’t noticeably colour the urine.

Question 17

How can conjugated bilirubin and urobilinogen levels be measured in urine?

Answer 17

With a dipstick.

Question 18

Why does post-hepatic jaundice lead to pruritis?

Answer 18

Inability to secrete bile salts.

Question 19

When is alanine aminotransferase (ALT) released?

Answer 19

By inflamed or damaged hepatocytes.

Question 20

Where is alkaline phosphatase found?

Answer 20

Liver canaliculi, bile ducts and bone.

Question 21

Give 3 causes of a raised alkaline phosphatase.

Answer 21

Bone disease - eg bone metastases, fracture, osteomalacia, hyperparathyroidism, Paget’s disease of bone.
Liver disease with cholestasis eg biliary obstruction, cirrhosis, liver metastases, drugs.
Growing bone - in children.

Question 22

What 4 causes of hepatitis can lead to a raised ALT?

Answer 22

Viral.
Acute alcohol intake.
Fatty liver disease.
Drugs/toxins.

Question 23

Where is gamma-glutamyl transferse found?

Answer 23

Bile ducts and to a lesser extent in hepatocytes.

Question 24

Give 4 causes of a raised gamma GT.

Answer 24

Biliary duct obstruction/cholestasis.
Cirrhosis.
Liver metastases.
Drugs.
Alcoholism.

Question 25

What is the underlying pathology in hepatitis?

Answer 25

Inflamed and/or necrotic hepatocytes that cannot function normally.

Question 26

What colour jaundice is seen in pre hepatic, intra hepatic and post hepatic jaundice?

Answer 26

Pre hepatic - pale yellow (mild).
Intra hepatic - orange yellow (moderate).
Post hepatic - yellow green (severe).

Question 27

Name 2 things a patient with liver failure will be more susceptible to.

Answer 27

Infections - bacterial and fungal.

Toxins and drugs.

Question 28

What causes hepatic encephalopathy?

Answer 28

Ammonia - in liver failure where there is increased blood ammonia due to failure to clear ammonia via the urea cycle.

Question 29

How is ammonia produced in the body?

Answer 29

By colonic bacteria and deamination of amino acids.

Question 30

Give 4 symptoms of hepatitis

Answer 30

Feeling generally unwell (particularly if viral).
Anorexia.
Fever.
Right upper quadrant pain.
Dark urine.
Jaundice.